title: Screening for neurocognitive impairment in HIV-positive adults aged 50 years and older: Montreal Cognitive Assessment relates to self-reported and clinician-rated everyday functioning.
abstract: As the HIV+ population ages, the risk for and need to screen for HIV-associated neurocognitive disorders (HAND) increases. The aim of this study is to determine the utility and ecological validity of the Montreal Cognitive Assessment (MoCA) among older HIV+ adults. A total of 100 HIV+ older adults aged 50 years or over completed a comprehensive neuromedical and neurocognitive battery, including the MoCA and several everyday functioning measures. The receiver operating characteristic curve indicates ≤26 as the optimal cut-off balancing sensitivity (84.2%) and specificity (55.8%) compared to "gold standard" impairment as measured on a comprehensive neuropsychological battery. Higher MoCA total scores are significantly (p < .01) associated with better performance in all individual cognitive domains except motor abilities, with the strongest association with executive functions (r = -0.49, p < .01). Higher MoCA total scores are also significantly (p <.01) associated with fewer instrumental activities of daily living declines (r = -0.28), fewer everyday cognitive symptoms (r = -0.25), and better clinician-rated functional status (i.e., Karnofsky scores; r = 0.28); these associations remain when controlling for depressive symptoms. HIV+ individuals who are neurocognitively normal demonstrate medium-to-large effect size differences in their MoCA performance compared to those with asymptomatic neurocognitive impairment (d = 0.85) or syndromic HAND (mild neurocognitive disorder or HIV-associated dementia; d = 0.78), while the latter two categories do not differ. Although limited by less than optimal specificity, the MoCA demonstrates good sensitivity and ecological validity, which lends support to its psychometric integrity as a brief cognitive screening tool among older HIV+ adults.
authors.affiliation: a Department of Psychiatry , University of California , San Diego , CA , USA.
authors.forename: P L
authors.initials: PL
authors.lastname: Fazeli
authors.affiliation: b San Diego State University/University of California , San Diego Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA.
authors.forename: K B
authors.initials: KB
authors.lastname: Casaletto
authors.affiliation: b San Diego State University/University of California , San Diego Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA.
authors.forename: E
authors.initials: E
authors.lastname: Paolillo
authors.affiliation: a Department of Psychiatry , University of California , San Diego , CA , USA.|c Stein Institute for Research on Aging , University of California , San Diego , CA , USA.|d Veterans Administration San Diego Health Care System , San Diego , CA , USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Moore
authors.affiliation: a Department of Psychiatry , University of California , San Diego , CA , USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Moore
authors.lastname: The Hnrp Group
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000209:etiology; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics; D057566:Self Report; D012680:Sensitivity and Specificity
keywords: Cognitive assessment; External validity.; HIV/AIDS; IADLs; MoCA