Journal of NeuroVirology

, Volume 19, Issue 2, pp 137–143

Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND

Authors

  • Thep Chalermchai
    • SEARCH, The Thai Red Cross AIDS Research Center
    • Memory and Aging Center, Department of NeurologyUniversity of California San Francisco
    • Division of Geriatric Medicine, Department of MedicineUniversity of California San Francisco
  • Pasiri Sithinamsuwan
    • Phramongkutklao Hospital
  • Suteeraporn Pinyakorn
    • HIV-NAT, The Thai Red Cross AIDS Research Center
  • David Clifford
    • Department of NeurologyWashington University in St Louis
  • Robert H. Paul
    • Department of PsychologyUniversity of Missouri
  • Somporn Tipsuk
    • SEARCH, The Thai Red Cross AIDS Research Center
  • James L. K. Fletcher
    • SEARCH, The Thai Red Cross AIDS Research Center
  • Victor DeGruttola
    • Department of BiostatisticsHarvard School of Public Health
  • Silvia Ratto-Kim
    • Military HIV Research ProgramWalter Reed Army Institute of Research
  • Nicholas Hutchings
    • Memory and Aging Center, Department of NeurologyUniversity of California San Francisco
  • Cecilia Shikuma
    • Hawaii Center for AIDSUniversity of Hawaii at Mānoa
  • Jintanat Ananworanich
    • SEARCH, The Thai Red Cross AIDS Research Center
    • HIV-NAT, The Thai Red Cross AIDS Research Center
    • Faculty of MedicineChulalongkorn University
  • The SEARCH 007 and 011 study groups
Article

DOI: 10.1007/s13365-013-0151-4

Cite this article as:
Chalermchai, T., Valcour, V., Sithinamsuwan, P. et al. J. Neurovirol. (2013) 19: 137. doi:10.1007/s13365-013-0151-4

Abstract

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.

Keywords

HIV dementiaNeuropsychologyAsiaNeuropsychological testsTrail Making Test

Copyright information

© Journal of NeuroVirology, Inc. 2013