title: Validation of the International HIV Dementia Scale as a Screening Tool for HIV-Associated Neurocognitive Disorders in a German-Speaking HIV Outpatient Clinic.
abstract: BACKGROUND
  HIV-associated neurocognitive disorders (HAND) are widely present among people living with HIV. Especially its milder forms, asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), remain highly prevalent worldwide. Diagnosing these conditions is subject to a time and resource consuming neuropsychological assessment. Selecting patients at a higher risk of cognitive impairment by using a simple but effective screening tool helps to organise access to further neuropsychological diagnosis. The International HIV Dementia Scale (IHDS) has until now been a well-established screening tool in African and American countries, however these populations' demographics defer significantly from ours, so using the same parameters could be ineffective.
  
  
  OBJECTIVE
  To calculate the prevalence of this condition among people attending an HIV outpatient clinic in Berlin and to validate the use of the IHDS as a screening tool for HAND in a German-speaking population.
  
  
  METHODS
  We screened 480 HIV-infected patients using the IHDS, 89% of them were on a stable antiretroviral treatment. Ninety of them completed a standardised neuropsychological battery of tests and a specific cognitive complaints questionnaire. The same procedure was applied to a control group of 30 HIV-negative participants. HAND diagnosis was established according to the Frascati criteria.
  
  
  RESULTS
  The overall prevalence of HAND in our cohort was 43% (20% ANI, 17% MND and 6% HIV-associated dementia). The optimal cut-off on the IHDS for detecting HAND cases was set at 11 and achieved both a sensitivity and a specificity of 80%. When specifically screening for the more severe form of HAND, HIV-associated dementia, a cut-off value of 10 offered an increase in both sensitivity (94%) and specificity (86%). The Youden Index for diagnostic accuracy was 0.6 and 0.8, respectively.
  
  
  CONCLUSIONS
  The prevalence of HAND was comparable to the reported by recent studies performed in countries with a similar economic development. The study confirms the IHDS to be a useful HAND screening tool in primary care settings and establishes new recommendations for its use in German-speaking countries.
authors.affiliation: Praxis Jessen2 + Kollegen, Berlin, Germany.|Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Victor
authors.identifier: http://orcid.org/0000-0003-4871-1808
authors.initials: V
authors.lastname: Marin-Webb
authors.affiliation: Praxis Jessen2 + Kollegen, Berlin, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Jessen
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Kopp
authors.affiliation: Praxis Jessen2 + Kollegen, Berlin, Germany.
authors.forename: Arne B
authors.initials: AB
authors.lastname: Jessen
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Hahn
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D000328:Adult; D005260:Female; D005858:Germany / Q000453:epidemiology / Q000208:ethnology; D015658:HIV Infections / Q000208:ethnology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D055815:Young Adult