Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 May 15;29(8):895-902.
doi: 10.1097/QAD.0000000000000152.

A better screening tool for HIV-associated neurocognitive disorders: is it what clinicians need?

Marie-J Brouillette  1 , Nancy Mayo, Lesley K Fellows, Elena Lebedeva, Johanne Higgins, Edgar T Overton, Beau M Ances, Lisa Koski
Affiliations

A better screening tool for HIV-associated neurocognitive disorders: is it what clinicians need?

Marie-J Brouillette et al. AIDS. .

Abstract

Objective: Existing screening tools for HIV-Associated Neurocognitive Disorders (HAND) may lack the accuracy required for clinical use. We hypothesized that the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) as a screening tool for HAND might be improved with a stronger scoring methodology.

Design: Two hundred HIV-positive participants aged 18-65 years completed the MoCA and a battery of neuropsychological tests.

Methods: HAND diagnosis was established according to the Frascati criteria, and an NPZ-8 score was also calculated. Rasch analysis was applied to the MoCA items to create a quantitative score.

Results: The optimal cut-off on the quantitative MoCA for detecting impairment as per Frascati criteria yielded a sensitivity of 0.74 and a specificity of 0.68. Overall accuracy was 0.79 (95% CI: 0.73-0.85), an improvement over standard scoring methods. However, whether cognition was quantified with the quantitative MoCA or with NPZ-8, there was substantial overlap between diagnostic categories; several individuals categorized as impaired had better overall cognitive function as assessed by NPZ-8 or quantitative MoCA than those classified as normal using standard criteria.

Conclusion: Quantifying performance on MoCA items through Rasch analysis improves its accuracy as a screening tool for HAND, and demonstrates that cognition can be measured as a unidimensional construct in HIV, at least at the level of precision of bedside testing. However, the current categorical diagnostic approach to HAND is poorly aligned with summary measures of cognitive ability. Measuring cognition as a quasi-continuous construct may be more relevant than conventional HAND diagnostic categories for many clinical purposes.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Distribution of patients and item thresholds along the spectrum of cognitive ability.
Fig. 2
Fig. 2
Distribution of quantitative MoCA scores and NPZ-8 according to NP severity rating.
Fig. 3
Fig. 3
Receiver operating characteristic (ROC) curve of the quantitative MoCA scores.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Leblanc S, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 2011; 17:3–16. - PMC - PubMed
    1. Ciccarelli N, Fabbiani M, Colafigli M, Trecarichi EM, Silveri MC, Cauda R, et al. Revised central nervous system neuropenetration-effectiveness score is associated with cognitive disorders in HIV-infected patients with controlled plasma viraemia. Antivir Ther 2013; 18:153–160. - PubMed
    1. Simioni S, Cavassini M, Annoni JM, Rimbault Abraham A, Bourquin I, Schiffer V, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS 2010; 24:1243–1250. - PubMed
    1. Heaton RK, Clifford DB, Franklin DR, Jr, Woods SP, Ake C, Vaida F, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology 2010; 75:2087–2096. - PMC - PubMed
    1. Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 2004; 10:317–331. - PubMed

Publication types