Clinical validation of the NeuroScreen
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The NeuroScreen comprises two easily administered components: the Brief NeuroCognitive Screen (BNCS), designed to estimate the frequency of human immunodeficiency virus (HIV)-associated cognitive disorders; and the Brief Peripheral Neuropathy Screen (BPNS), for distal sensory polyneuropathy (DSPN) in HIV. In this study, both the NeuroScreen and a more extensive standardized validation neurodiagnostic evaluation were administered to HIV-positive subjects (N = 301) enrolled in two large cohort studies at multiple sites. BNCS performance was summarized in the form of a demographically adjusted mean z-score, the NPZ3. The area under the receiver-operating characteristic (ROC) curve for the BNCS as compared to the reference standard neuropsychological (NP) evaluation was 0.74 (95% confidence interval [CI] 0.69, 0.79). Using a cut-point of −0.33 on the NPZ3 provided a correct classification rate of 68%, with roughly balanced sensitivity (65%) and specificity (72%). Under the assumption of a 30% prevalence of cognitive impairment, the calculated positive predictive value (PPV) of the BNCS was 86%. Relative to its reference standard, a modified Total Neuropathy Score (TNS) administered by a neurologist, the BPNS gave a similar correct diagnostic classification rate of 78%; sensitivity 49% [95% CI 37%, 60%]; specificity 88% [95% CI 82%, 91%]. Under the assumption of a 40% prevalence of DSPN, the PPV of the BPNS was 72%. These predictive values suggest that the NeuroScreen will be useful for tracking trends in the prevalence of HIV-associated neurologic disease in large cohorts in the era of combination antiretroviral therapy. However, because it yields substantial numbers of false positives and negatives, the NeuroScreen may be less useful in evaluating individual patients.
- ANN (1991). Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force. Neurology 41: 778–785.
- Carey CL, Woods SP, Rippeth JD, Gonzalez R, Moore DJ, Marcotte TD, Grant I, Heaton RK (2004). Initial validation of a screening battery for the detection of HIV-associated cognitive impairment. Clin Neuropsychol 18: 234–248. CrossRef
- Cornblath DR, Chaudhry V, Carter K, Lee D, Seysedadr M, Miernicki M, Joh T (1999). Total neuropathy score: validation and reliability study. Neurology 53: 1660–1664.
- Cysique LA, Maruff P, Brew BJ (2004). Antiretroviral therapy in HIV infection: are neurologically active drugs important? Arch Neurol 61: 1699–1704. CrossRef
- De Long ER, De Long DM, Clarke-Pearson DL (1998). Comparing the areas under two or more correlated receiver operating curves: a nonparametric approach. Biometrics 44: 837–845. CrossRef
- Dore GJ, Correll PK, Li, Y, Kaldor JM, Cooper DA, Brew BJ (1999). Changes to AIDS dementia complex in the era of highly active antiretroviral therapy. AIDS 13: 1249–1253. CrossRef
- Dore GJ, McDonald A, Li, Y, Kaldor JM, Brew BJ (2003). Marked improvement in survival following AIDS dementia complex in the era of highly active antiretroviral therapy. AIDS 17: 1539–1545. CrossRef
- Hanley JA, McNeil BJ (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143: 29–36.
- Heaton RK (1992). Comprehensive norms for an expanded Halstead-Reitan battery: a supplement for the WAIS-R. In: Psychological assessment resources. Odessa, FL.
- Heaton RK (1994). The utility of clinical ratings for detecting early cognitive change in HIV infection. In: Neuropsychology of HIV infection. Grant I, Martin A (eds). New York: Oxford University Press: pp 188–206.
- Heaton RK, Grant I, Matthews CG (1991). Comprehensive norms for an expanded Halstead-Reitan battery: demographic corrections, research findings, and clinical applications. In: Psychological assessment resources. Odessa, FL.
- Heaton RK, Miller SW, Taylor MJ, Grant I (2004). Revised comprehensive norms for an expanded Halstead-Reitan battery: demographically adjusted neuropsychological Norms for African American and Caucasian adults. In: Psychological assessment resources. Lutz, FL.
- Marra CM, Boutin P, Collier AC (1998). Screening for distal sensory peripheral neuropathy in HIV-infected persons in research and clinical settings. Neurology 51: 1678–1681.
- Maschke M, Kastrup O, Esser S, Ross B, Hengge U, Hufnagel A (2000). Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry 69: 376–380. CrossRef
- McArthur, JC (2004). HIV dementia: an evolving disease. J Neuroimmunol 157: 3–10. CrossRef
- Morgello S, Estanislao L, Simpson D, Geraci A, DiRocco A, Gerits P, Ryan E, Yakoushina T, Khan S, Mahboob R, Naseer M, Dorfman D, Sharp V (2004). HIV-associated distal sensory polyneuropathy in the era of highly active antiretroviral therapy: the Manhattan HIV Brain Bank. Arch Neurol 61: 546–551. CrossRef
- Newcombe RG (1998). Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17: 857–872. CrossRef
- Sacktor N, McDermott MP, Marder K, Schifitto G, Selnes OA, McArthur JC, Stern Y, Albert S, Palumbo D, Kieburtz K, De Marcaida JA, Cohen B, Epstein L (2002). HIV-associated cognitive impairment before and after the advent of combination therapy. J NeuroVirol 8: 136–142. CrossRef
- Simel DL, Samsa GP, Matchar DB (1991). Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol 44: 763–770. CrossRef
- Clinical validation of the NeuroScreen
Journal of NeuroVirology
Volume 11, Issue 6 , pp 503-511
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- cognitive impairment
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- Author Affiliations
- 1. Department of Neurosciences, UCSD AntiViral Research Center and HIV Neurobehavioral Research Center, University of California, San Diego, 150 W. Washington Street, 92103, San Diego, CA, USA
- 2. Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
- 3. Department of Neurology, Washington University, St. Louis, Missouri, USA
- 4. Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- 5. Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- 6. Department of Medicine, UCSD AntiViral Research Center (AVRC) and HIV Neurobehavioral Research Center, University of California, San Diego, California, USA
- 7. Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts, USA
- 8. Department of Neurology, Mount Sinai Medical Center, New York, New York, USA
- 9. Division of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- 10. Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA