Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings
Abstract Background Practical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-04-01
|
| Series: | AIDS Research and Therapy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12981-019-0224-4 |
| _version_ | 1819081316264574976 |
|---|---|
| author | Lai Gwen Chan Mei Jing Ho Yijun Carol Lin Yining Ong Chen Seong Wong |
| author_facet | Lai Gwen Chan Mei Jing Ho Yijun Carol Lin Yining Ong Chen Seong Wong |
| author_sort | Lai Gwen Chan |
| collection | DOAJ |
| description | Abstract Background Practical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and clinically feasible battery to screen for HIV-associated neurocognitive disorders (HAND) in resource-limited settings even where English is not the native language. Methods A total of 53 outpatients were recruited from a multi-ethnic Southeast Asian HIV-positive cohort. Performance on a neuropsychological protocol was used to define cognitive impairment, of which 28 patients (52.8%) were identified with HAND. Receiver operating characteristic analysis was used to determine the best combinations of cognitive tests for the screening battery. Results 3 different combinations of cognitive tests that required minimal literacy, time to administer, and administrator training were found to classify HAND with fair accuracy. Montreal Cognitive Assessment (MoCA), in combination with tests of psychomotor coordination, verbal learning and speed processing, yielded area under curve scores of above 0.75, the primary outcome of receiver operating characteristic analysis. Conclusion The 3-test combinations presented in this study appear to be promising screening options for HAND in HIV-infected patients. The addition of 2 tests to MoCA improves the overall accuracy while retaining its convenience, giving more potential for the inclusion of cognitive screening in routine clinical care. Further validation of the batteries in specific settings is warranted to determine specific screening cut-offs to a global cognitive score. |
| first_indexed | 2024-12-21T19:58:50Z |
| format | Article |
| id | doaj.art-2144f618d46a4a9ab6d59948594b9df8 |
| institution | Directory Open Access Journal |
| issn | 1742-6405 |
| language | English |
| last_indexed | 2024-12-21T19:58:50Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | AIDS Research and Therapy |
| spelling | doaj.art-2144f618d46a4a9ab6d59948594b9df82022-12-21T18:52:01ZengBMCAIDS Research and Therapy1742-64052019-04-011611810.1186/s12981-019-0224-4Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settingsLai Gwen Chan0Mei Jing Ho1Yijun Carol Lin2Yining Ong3Chen Seong Wong4Department of Psychological Medicine, Tan Tock Seng HospitalDepartment of Psychological Medicine, Tan Tock Seng HospitalDepartment of Psychological Medicine, Tan Tock Seng HospitalDepartment of Psychological Medicine, Tan Tock Seng HospitalNational Centre for Infectious Diseases, Tan Tock Seng HospitalAbstract Background Practical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and clinically feasible battery to screen for HIV-associated neurocognitive disorders (HAND) in resource-limited settings even where English is not the native language. Methods A total of 53 outpatients were recruited from a multi-ethnic Southeast Asian HIV-positive cohort. Performance on a neuropsychological protocol was used to define cognitive impairment, of which 28 patients (52.8%) were identified with HAND. Receiver operating characteristic analysis was used to determine the best combinations of cognitive tests for the screening battery. Results 3 different combinations of cognitive tests that required minimal literacy, time to administer, and administrator training were found to classify HAND with fair accuracy. Montreal Cognitive Assessment (MoCA), in combination with tests of psychomotor coordination, verbal learning and speed processing, yielded area under curve scores of above 0.75, the primary outcome of receiver operating characteristic analysis. Conclusion The 3-test combinations presented in this study appear to be promising screening options for HAND in HIV-infected patients. The addition of 2 tests to MoCA improves the overall accuracy while retaining its convenience, giving more potential for the inclusion of cognitive screening in routine clinical care. Further validation of the batteries in specific settings is warranted to determine specific screening cut-offs to a global cognitive score.http://link.springer.com/article/10.1186/s12981-019-0224-4HIV-associated neurocognitive disordersCognitive impairmentScreeningNeuropsychology |
| spellingShingle | Lai Gwen Chan Mei Jing Ho Yijun Carol Lin Yining Ong Chen Seong Wong Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings AIDS Research and Therapy HIV-associated neurocognitive disorders Cognitive impairment Screening Neuropsychology |
| title | Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings |
| title_full | Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings |
| title_fullStr | Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings |
| title_full_unstemmed | Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings |
| title_short | Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings |
| title_sort | development of a neurocognitive test battery for hiv associated neurocognitive disorder hand screening suggested solutions for resource limited clinical settings |
| topic | HIV-associated neurocognitive disorders Cognitive impairment Screening Neuropsychology |
| url | http://link.springer.com/article/10.1186/s12981-019-0224-4 |
| work_keys_str_mv | AT laigwenchan developmentofaneurocognitivetestbatteryforhivassociatedneurocognitivedisorderhandscreeningsuggestedsolutionsforresourcelimitedclinicalsettings AT meijingho developmentofaneurocognitivetestbatteryforhivassociatedneurocognitivedisorderhandscreeningsuggestedsolutionsforresourcelimitedclinicalsettings AT yijuncarollin developmentofaneurocognitivetestbatteryforhivassociatedneurocognitivedisorderhandscreeningsuggestedsolutionsforresourcelimitedclinicalsettings AT yiningong developmentofaneurocognitivetestbatteryforhivassociatedneurocognitivedisorderhandscreeningsuggestedsolutionsforresourcelimitedclinicalsettings AT chenseongwong developmentofaneurocognitivetestbatteryforhivassociatedneurocognitivedisorderhandscreeningsuggestedsolutionsforresourcelimitedclinicalsettings |