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Publication Abstract Display
Type: Poster
Title: Is diagnosis of asymptomatic neurocognitive impairment (ANI) a predictor of death?
Authors: Rooney A, Gouaux B, Ellis R, Grant I, Moore DJ, and the CNTN Group
Date: 10-16-2013
Abstract:Objective: Recent questions have arisen regarding the clinical importance of the mildest form of HIV-associated Neurocognitive Disorders (HAND), Asymptomatic Neurocognitive Impairment (ANI). The objective of the present study was to determine whether persons diagnosed with ANI are at greater risk for death as compared to neurocognitively normal individuals. Method: Participants included 543 HIV-infected individuals at increased risk of death due to advanced HIV characteristics enrolled in the National NeuroAIDS Tissue Consortium. Participants completed a comprehensive neuropsychological assessment covering seven domains and self-report questionnaires of mood and daily functioning allowing for a HAND diagnosis (Antinori et al., 2007). Using HAND criteria, participants were classified as neurocognitively normal (NC Normal), ANI, mild neurocognitive disorder (MND) or HIV-associated dementia (HAD) at the last in-life study visit prior to death for those participants who died or the last available visit if still living. Results: There was a stair-step effect, with 42.1% of normal individuals classified as deceased, 65.2% of ANI, 70.2% MND and 80.4% of HAD individuals (p<.0001). Participants with ANI did not differ their current CD4 count from the other three groups; however, the normal group differed from both MND (p=0.003) and HAD (p=0.02) group in that they had higher CD4 counts. Conclusions: Neurocognitive diagnosis significantly predicts mortality in a cohort of HIV-infected individuals. Even mild neurocognitive impairment without evidence of daily functioning impairment (i.e., ANI) results in a significant increase in mortality risk compared to NC Normal individuals. The present study argues for the importance of ANI as a meaningful diagnostic category.

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