Publication Abstract Display
Type: Poster
Title: Identification of an abbreviated test battery for detection of HIV-associated neurocognitive impairment in an early-treated HIV-infected cohort.
Authors: Moore D, Poehlman Roediger M, Eberly L, Blackstone K, Hale B, Weintrob A, Ganesan A, Agan B, Letendre S, Crum-Cianflone N
Date: 03-05-2012
Abstract:Background: HIV-associated neurocognitive (NC) disorders remain prevalent despite improved antiretroviral treatment (ART). Given this, it is essential to identify an abbreviated neuropsychological battery (<=20 minutes to administer) that is both sensitive and specific to neurocognitive impairment (NCI). Methods: Participants were 200 HIV-infected US military beneficiaries, who were early diagnosed with HIV, had few comorbidities, and had open access to antiretroviral medications. All participants completed a comprehensive, seven-domain (18-test), neuropsychological battery (120 min); NCI was determined using a standardized score derived from demographically adjusted T-scores (global deficit score >0.5). Restricting the estimated administration time of the screening battery to <=20 minutes, we examined the sensitivity and specificity of detecting NCI for all possible combinations of 2-, 3-, and 4- neuropsychological tests from the comprehensive battery. We used a bootstrapping technique to assure that sensitivity/specificity estimates were not sensitive to sample anomalies. Results: Our HIV-infected cohort was relatively healthy (median CD4 count: 546 cells/mm3) with 64% receiving ART. Prevalence of NCI was low (19%). The screening combinations with the best sensitivity and specificity for NCI were a 2-test combination of the Stroop Color Test and the Hopkins Verbal Learning Test-Revised (11 min; sensitivity=73%; specificity=83%) and a 3-test combination that included the above measures plus the Paced Auditory Serial Addition Test (PASAT; 16 min; sensitivity=86%; specificity=75%). The addition of Action Fluency to the above three tests improved specificity (18 min; sensitivity=86%; specificity=87%). A 3-test combination requiring less than 10 minutes in administration time (9 minutes) included Trail Making Test–Part A, Grooved Pegboard Test non-dominant hand, and PASAT and also showed good sensitivity (76%) and specificity (80%). Conclusions: Combinations of widely accepted neuropsychological tests demonstrated adequate sensitivity and specificity compared to a more time intensive NC test battery. Tests of executive functioning, verbal learning, and working memory appeared to be particularly useful in detecting NCI. While several screening instruments have been developed for the detection of HIV-associated NCI, utilizing a combination of validated, relatively easy to administer, neuropsychological tests with established normative data may represent an excellent approach to detecting NCI.

return to publications listing