title: A comparison of the sensitivity, stability, and reliability of three diagnostic schemes for HIV-associated neurocognitive disorders.
abstract: HIV-associated neurocognitive disorders (HAND) occur in approximately 50% of HIV-infected individuals, yet available diagnostic criteria yield varying prevalence rates. This study examined the frequency, reliability, and sensitivity to everyday functioning problems of three HAND diagnostic criteria (DSM-5, Frascati, Gisslén). Participants included 361 adults with HIV disease and 199 seronegative adults. Neurocognitive status as defined by each of the three diagnostic systems was determined via a comprehensive neuropsychological battery. Everyday functioning was evaluated through self-report and clinician ratings. Results of logistic regressions revealed an association of HIV serostatus with Frascati-defined neurocognitive impairment (p = .027, OR = 1.7[1.1, 2.7]), but not DSM-5 or Gisslén-defined criteria (ps > .05). Frascati and DSM-5 criteria demonstrated agreement on 71% of observations, Frascati and Gisslén showed agreement on 80%, and DSM-5 and Gisslén criteria showed agreement on 46%, though reliability across the three criteria was poor. Only Frascati-defined neurocognitive impairment significantly predicted everyday functioning problems (p = .002, OR = 2.3[1.4, 3.8]). However, when both neurocognitive and complaint criteria were considered, the DSM-5 guidelines demonstrated significant relationships to everyday functioning, serostatus, and also increased reliability overtime compared to neurocognitive criteria alone (all ps < .05). A subset (n = 118) of the HIV+ group was assessed again after 14.0 (2.2) months. DSM-5 criteria evidenced significantly higher rates of incident neurocognitive disorder compared to both Frascati (p = .003) and Gisslén (p = .021) guidelines, while there were fewer remitting neurocognitive disorder diagnoses when Gisslén criteria were applied to the study sample compared to Frascati (p = .04). Future studies should aim to identify gold standard biological markers (e.g., neuropathology) and clinical outcomes associated with specific diagnostic criteria.
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA.
authors.forename: Savanna M
authors.initials: SM
authors.lastname: Tierney
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Sheppard
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA.
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Kordovski
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA.
authors.forename: Marika P
authors.initials: MP
authors.lastname: Faytell
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA.
authors.forename: Gunes
authors.initials: G
authors.lastname: Avci
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA. spwoods@uh.edu.
authors.forename: Steven Paul
authors.initials: SP
authors.lastname: Woods
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000821:virology; D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D016022:Case-Control Studies; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity
keywords: Diagnosis; HIV; Neurocognitive disorders; Neuropsychology