| Publication Abstract Display | | Type: Poster | | Title: Norms
and
alternative
cutpoints
improve
sensitivity/specificity
tradeoff
for
the
HIV
Dementia
Scale:
The
CHARTER
study. | | Authors: Sakamoto M, Marcotte TD, Umlauf A, Franklin D, Heaton RK, Ellis RJ, Alexander T, Morgan EE, Woods S, Collier A,
Clifford D, Gelman B, McCutchan A, McArthur J, Morgello S, Grant I, and the CHARTER
Group | | Date: 02-15-2012 | | Abstract:Objective: The HIV Dementia
Scale (HDS) is a brief
screen designed to detect
HIV-related
neuropsychological (NP)
impairment. Utilizing
a large,
diverse cohort,
the
aims
of
this
study
were
to
1)
examine
the
classification
accuracy
of
the
HDS
for
NP
impairment
using
raw
and
norm-‐based
cutpoints
and
2)
evaluate
the
contribution
of
the
HDS
subtests
to
predicting
NP
impairment.
Participants
&
Methods:
1,580
HIV-‐infected
participants
from
6
U.S.
clinics
completed
the
HDS
and
a
comprehensive
NP
battery.
Based
on
a
gold
standard
of
clinical
ratings,
51%
(n=810)
of
the
sample
was
NP
impaired.
Results:
Sensitivity
and
specificity
of
the
standard
raw
cutpoint
(≤
10)
was
27%
and
92%.
Using
published
age-‐
and
education-‐adjusted
normative
standards
(T<40),
sensitivity
significantly
improved
to
69%
(p
<
.001),
but
specificity
declined
to
57%.
Within
a
training
subgroup,
a
cutpoint
of
14
yielded
optimal
sensitivity
(66%)
and
specificity
(61%),
which
was
confirmed
in
the
validation
subgroup.
Individuals
incorrectly
classified
as
impaired
by
the
raw
score
tended
to
be
older,
less
educated,
and
African
American.
Among
the
subtests,
attention,
4-‐word
recall,
and
speed
significantly
(p
<
.001)
contributed
to
detection
of
NP
impairment,
while
construction
(p=
.55)
did
not.
Conclusions:
HDS
sensitivity
to
NP
impairment
is
significantly
improved
by
using
norms.
Raising
the
raw
cutpoint
for
impairment
to
14
also
improves
sensitivity,
which
may
be
more
appropriate
for
the
milder
impairments
in
the
era
of
effective
treatments,
but
the
use
of
norms,
when
available,
is
recommended
to
avoid
demographic
biases
in
impairment
classification. |
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