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Comparative Study
. 2014 Jul 31;9(7):e103498.
doi: 10.1371/journal.pone.0103498. eCollection 2014.

Neurocognitive function in HIV-infected patients: comparison of two methods to define impairment

Alejandro Arenas-Pinto  1 , Alan Winston  2 , Wolfgang Stöhr  3 , John Day  4 , Rebecca Wiggins  5 , Say Pheng Quah  6 , Jonathan Ainsworth  7 , Sue Fleck  3 , David Dunn  3 , Alex Accoroni  8 , Nicholas I Paton  9 ; PIVOT Trial Team
Collaborators, Affiliations
Comparative Study

Neurocognitive function in HIV-infected patients: comparison of two methods to define impairment

Alejandro Arenas-Pinto et al. PLoS One. .

Abstract

Objective: To compare two definitions of neurocognitive impairment (NCI) in a large clinical trial of effectively-treated HIV-infected adults at baseline.

Methods: Hopkins Verbal Learning test-Revised (HVLT-R), Colour Trail (CTT) and Grooved Pegboard (GPT) tests were applied exploring five cognitive domains. Raw scores were transformed into Z-scores and NCI defined as summary NPZ-5 score one standard deviation below the mean of the normative dataset (i.e. <-1SD) or Z-scores <-1SD in at least two individual domains (categorical scale). Principal component analysis (PCA) was performed to explore the contribution of individual tests to the total variance.

Results: Mean NPZ-5 score was -0.72 (SD 0.98) and 178/548 (32%) participants had NPZ-5 scores <-1SD. When impairment was defined as <-1SD in at least two individual tests, 283 (52%) patients were impaired. Strong correlations between the two components of the HVLT-R test (learning/recall) (r = 0.73), and the CTT and (attention/executive functioning) (r = 0.66) were observed. PCA showed a clustering with three components accounting for 88% of the total variance. When patients who scored <-1SD only in two correlated tests were considered as not impaired, prevalence of NCI was 43%. When correlated test scores were averaged, 36% of participants had NPZ-3 scores <-1SD and 32% underperformed in at least two individual tests.

Conclusion: Controlling for differential contribution of individual test-scores on the overall performance and the level of correlation between components of the test battery used appear to be important when testing cognitive function. These two factors are likely to affect both summary scores and categorical scales in defining cognitive impairment.

Trial registration: EUDRACT: 2007-006448-23 and ISRCTN04857074.

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Conflict of interest statement

Competing Interests: The authors have read the journal’s policy and have the following conflicts: Dr Alejandro Arenas-Pinto has received honoraria or research grants, or been investigator, in clinical trials sponsored by Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Pfizer, ViiV Healthcare and Janssen Cilag. Dr Alan Winston holds grants from the British Medical Research Council and the European Union (Framework 7). Has received honoraria or research grants, or been a consultant or investigator, in clinical trials sponsored by Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Janssen Cilag, Roche, Pfizer and ViiV Healthcare. Prof N Paton has received honoraria from Roche / Genentec for work on a DSMB; from AbbVie and Merck and Jansssen for speaking at meetings / attending advisory boards; and has received grant funding or donations of drugs for research studies from GSK, Gilead, Merck, Abbvie, Janssen and Pfizer. This does not alter their adherence to PLOS ONE policies on sharing data and materials. The rest of the authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Proportion of patients with functional domains impaired (<−1SD), overall and by number of tests impaired.
See this image and copyright information in PMC

References

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