Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND
- 302 Downloads
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.
KeywordsHIV dementia Neuropsychology Asia Neuropsychological tests Trail Making Test
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.
SEARCH 007 and 011 protocol teams: Nittaya Phanuphak MD, Nitiya Chomchey, Somprartthana Rattanamanee, and Pairoa Praihirunkit from SEARCH/TRCARC; Nijasri Charnnarong MD and Sukalaya Lerdlum MD from Chulalongkorn University; Yotin Chinvarun MD from Phramongkutklao Medical Center; Mark de Souza PhD MPH, Alexandra Schuetz PhD, and Rapee Trichavaroj from the Armed Forces Research Institute of Medical Sciences; Supunee Jirajariyavej MD from Taksin Hospital; Bruce Shiramizu MD from the University of Hawai’i; and Carol Liu, Elijah Mun, Stephanie Chiao, and Lauren Wendelken from UCSF.
Conflict of interest
The authors declare no conflicts of interest.
- Breuer E, Stoloff K, Myer L, Seedat S, Stein DJ, Joska J (2011) Reliability of the lay adherence counsellor administered substance abuse and mental illness symptoms screener (SAMISS) and the International HIV Dementia Scale (IHDS) in a primary care HIV clinic in Cape Town, South Africa. AIDS Behav 16:1464–1471CrossRefGoogle Scholar
- Heaps JM, Valcour V, Chalermchai T, Paul R, Rattanamanee S, Siangphoe U, Sithinamsuwan P, Chairangsaris P, Nidhindandana S, Tipsuk S, Suttichom D, Fletcher J, Shikuma C, Anaworanich J (2013) Development of normative neuropsychological performance in Thailand for the assessment of HIV-associated neurocognitive disorders. J Clin Exp Neuropsychol (In press)Google Scholar
- Joint United Nations Programme on HIV/AIDS (2010) Global report: UNAIDS report on the global AIDS epidemic. In Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 2010: v.Google Scholar
- Njamnshi AK, Djientcheu Vde P, Fonsah JY, Yepnjio FN, Njamnshi DM, The MWE, International HIV (2008) Dementia Scale is a useful screening tool for HIV-associated dementia/cognitive impairment in HIV-infected adults in Yaounde-Cameroon. J Acquir Immune Defic Syndr 49:393–397PubMedCrossRefGoogle Scholar
- Singh D, Sunpath H, John S, Eastham L, Gouden R (2008) The utility of a rapid screening tool for depression and HIV dementia amongst patients with low CD4 counts—a preliminary report. Afr J Psychiatry (Johannesbg) 11:282–286Google Scholar
- Sungkanuparph S, Techasathit W, Utaipiboon C et al (2010) Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2010. Asian Biomed 4:515–528Google Scholar
- Valcour VG, Chiao S, Rosen HJ, et al. (2011) Functional deficits identified in patients with Asymptomatic Neurocognitive Impairment (ANI) track to changes in brain integrity and size. In: 19th Conference on Retroviruses and Opportunistic Infections (CROI 2012). Seattle, WA,Google Scholar