TY - JOUR
T1 - Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND
AU - Chalermchai, Thep
AU - Valcour, Victor
AU - Sithinamsuwan, Pasiri
AU - Pinyakorn, Suteeraporn
AU - Clifford, David
AU - Paul, Robert H.
AU - Tipsuk, Somporn
AU - Fletcher, James L.K.
AU - Degruttola, Victor
AU - Ratto-Kim, Silvia
AU - Hutchings, Nicholas
AU - Shikuma, Cecilia
AU - Ananworanich, Jintanat
N1 - Funding Information:
This work was supported by NIH grants R01-NS053359 (SR) and R01-NS061696 (VV). We thank the study subjects for their participation and Nicholas Hutchings for assistance with the manuscript.
PY - 2013/4
Y1 - 2013/4
N2 - Although HIV-associated dementia (HAD) occurs in less than 5 % of individuals with access to combination antiretroviral therapy, rates of milder forms of HIV-associated neurocognitive disorder (HAND) are much higher. We sought to define an optimal cut point for the International HIV Dementia Scale (IHDS) in Thailand for the identification of symptomatic HAND, defined as both HAD and mild neurocognitive disorder. We then sought to determine if adding a simple test from a larger neuropsychological battery could improve the performance characteristics for identifying symptomatic HAND. In this study, subjects comprising 75 seropositive adults in Bangkok, Thailand, completed neuropsychological tests and underwent a full neurological assessment. HAND diagnoses were determined by consensus conference using the 2007 Frascati criteria, blinded to the IHDS results. The optimal IHDS cut point was determined by receiver operating characteristic analysis with cross-validation. Individual neuropsychological tests were then evaluated and combined with the IHDS to test performance characteristics. The IHDS was poor at detecting symptomatic HAND at the optimized cut point of ≤10 (sensitivity, 53.3 %; specificity, 89.8 %). Trail Making Test A was most effective in improving performance characteristics when combined with the IHDS, with net sensitivity of 86 % and specificity of 79 %. In this setting, the IHDS performed poorly in identifying symptomatic HAND, but was substantially improved by the addition of Trail Making Test A, which typically requires less than 2 min to complete. This combination should be validated in a larger setting since it may address the critical need for HAND screening instruments in international settings.
AB - Although HIV-associated dementia (HAD) occurs in less than 5 % of individuals with access to combination antiretroviral therapy, rates of milder forms of HIV-associated neurocognitive disorder (HAND) are much higher. We sought to define an optimal cut point for the International HIV Dementia Scale (IHDS) in Thailand for the identification of symptomatic HAND, defined as both HAD and mild neurocognitive disorder. We then sought to determine if adding a simple test from a larger neuropsychological battery could improve the performance characteristics for identifying symptomatic HAND. In this study, subjects comprising 75 seropositive adults in Bangkok, Thailand, completed neuropsychological tests and underwent a full neurological assessment. HAND diagnoses were determined by consensus conference using the 2007 Frascati criteria, blinded to the IHDS results. The optimal IHDS cut point was determined by receiver operating characteristic analysis with cross-validation. Individual neuropsychological tests were then evaluated and combined with the IHDS to test performance characteristics. The IHDS was poor at detecting symptomatic HAND at the optimized cut point of ≤10 (sensitivity, 53.3 %; specificity, 89.8 %). Trail Making Test A was most effective in improving performance characteristics when combined with the IHDS, with net sensitivity of 86 % and specificity of 79 %. In this setting, the IHDS performed poorly in identifying symptomatic HAND, but was substantially improved by the addition of Trail Making Test A, which typically requires less than 2 min to complete. This combination should be validated in a larger setting since it may address the critical need for HAND screening instruments in international settings.
KW - Asia
KW - HIV dementia
KW - Neuropsychological tests
KW - Neuropsychology
KW - Trail Making Test
UR - http://www.scopus.com/inward/record.url?scp=84882572500&partnerID=8YFLogxK
U2 - 10.1007/s13365-013-0151-4
DO - 10.1007/s13365-013-0151-4
M3 - Article
C2 - 23483520
AN - SCOPUS:84882572500
SN - 1355-0284
VL - 19
SP - 137
EP - 143
JO - Journal of NeuroVirology
JF - Journal of NeuroVirology
IS - 2
ER -