Skip to main content

Performances on the CogState and Standard Neuropsychological Batteries Among HIV Patients Without Dementia

AIDS and Behavior volume 15, pages 1902–1909 (2011)Cite this article

Abstract

HIV-associated neurocognitive disorders remain prevalent but challenging to diagnose particularly among non-demented individuals. To determine whether a brief computerized battery correlates with formal neurocognitive testing, we identified 46 HIV-infected persons who had undergone both formal neurocognitive testing and a brief computerized battery. Simple detection tests correlated best with formal neuropsychological testing. By multivariable regression model, 53% of the variance in the composite Global Deficit Score was accounted for by elements from the brief computerized tool (P < 0.01). These data confirm previous correlation data with the computerized battery. Using the five significant parameters from the regression model in a Receiver Operating Characteristic curve, 90% of persons were accurately classified as being cognitively impaired or not. The test battery requires additional evaluation, specifically for identifying persons with mild impairment, a state upon which interventions may be effective.

Resumen

Los trastornos neurocognitivos asociados con el virus de inmunodeficiencia humana (VIH) son altamente prevalentes pero difíciles de diagnosticar, particularmente entre individuos que no presentan signos de demencia en el momento del examen clínico. Para determinar si una breve batería de pruebas computarizada correlaciona con resultados de pruebas neurocognitivas, identificamos a 46 individuos infectados con VIH que se habían sometido a pruebas neurocognitivas así como a esta prueba computarizada. Los resultados preliminares indicaron que las pruebas de detección simples mostraron la mejor correlación con los exámenes neurocognitivos. Mediante el uso de un modelo de regresión multivariable fuimos capaces de explicar el 53% de la varianza del Global Deficit Score (GDS, puntuación compuesta del déficit global) con componentes de la breve batería computarizada (P < 0.01). Estos datos confirman estudios anteriores que analizaron la correlación entre el GDS y la batería computarizada. Utilizando los cinco parámetros significativos del modelo de regresión en una curva del Receiver Operating Characteristic (ROC), el 90% de las personas fueron clasificadas correctamente como individios que presentaban deterioro cognitivo o no. Se necesitan estudios adicionales de esta batería de pruebas, en particular para identificar a personas con un deterioro leve, el cual podría ser especialmente interesante debido a que intervenciones clínicas, psicológicas o farmacéuticas podrían ser eficaces.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99.

    PubMed  Article  CAS  Google Scholar 

  2. Woods SP, Moran LM, Carey CL, Dawson, Iudicello JE, Gibson S, HIV Neurobehavioral Research Center Group., et al. Prospective memory in HIV infection: is “remembering to remember” a unique predictor of self-reported medication management? Arch Clin Neuropsychol. 2008;23:257–70.

    PubMed  Article  Google Scholar 

  3. Marcotte TD, Lazzaretto D, Scott JC, Roberts E, Woods SP, Letendre S, et al. Visual attention deficits are associated with driving accidents in cognitively-impaired HIV-infected individuals. J Clin Exp Neuropsychol. 2006;28:13–28.

    PubMed  Article  Google Scholar 

  4. Heaton RK, Velin RA, McCutchan JA, Gulevich SJ, Atkinson JH, Wallace MR, et al. Neuropsychological impairment in human immunodeficiency virus-infection: implications for employment. HNRC Group. HIV Neurobehavioral Research Center. Psychosom Med. 1994;56:8–17.

    PubMed  CAS  Google Scholar 

  5. Sevigny JJ, Albert SM, McDermott MP, Schifitto G, McArthur JC, Sacktor N, et al. An evaluation of neurocognitive status and markers of immune activation as predictors of time to death in advanced HIV infection. Arch Neurol. 2007;64:97–102.

    PubMed  Article  Google Scholar 

  6. Effros RB, Fletcher CV, Gebo K, Halter JB, Hazzard WR, Horne FM, et al. Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clin Infect Dis. 2008;15:542–53.

    Article  Google Scholar 

  7. Robertson KR, Smurzynski M, Parsons TD, Wu K, Bosch RJ, Wu J, et al. The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS. 2007;12:1915–21.

    Article  Google Scholar 

  8. Simioni S, Cavassini M, Annoni J, Rimbault Abraham A, Bourquin I, Schiffer V, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS. 2010;24:1243–50.

    PubMed  Google Scholar 

  9. Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, Musisi S, et al. The international HIV dementia scale: a new rapid screening test for HIV dementia. AIDS. 2005;19:1367–74.

    PubMed  Google Scholar 

  10. Bottiggi KA, Chang JJ, Schmitt FA, Avison MJ, Mootoor Y, Nath A, et al. The HIV dementia scale: predictive power in mild dementia and HAART. J Neurol Sci. 2007;260:11–5.

    PubMed  Article  Google Scholar 

  11. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.

    PubMed  Article  CAS  Google Scholar 

  12. U.S. Department of Health and Human Services Agency for Health Care Policy and Research. Clinical Practice Guidelines, Number 19. (1996). Recognition and initial assessment of Alzheimer’s disease and related dementias. AHCPR Publication No. 97-0702, Rockville http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.30948.

  13. Cysique LA, Maruff P, Darby D, Brew BJ. The assessment of cognitive function in advanced HIV-1 infection and AIDS dementia complex using a new computerised cognitive test battery. Arch Clin Neuropsychol. 2006;21:85–94.

    Article  Google Scholar 

  14. Winston A, Garvey L, Scotney E, Yerrakalva D, Allsop JM, Thomson EC, et al. Does acute hepatitis C infection affect the central nervous system in HIV-1 infected individuals? J Viral Hepat. 2010;17:419–26.

    PubMed  Article  CAS  Google Scholar 

  15. Vellozzi C, Brooks JT, Bush TJ, Conley LJ, Henry K, Carpenter CC, et al. The study to understand the natural history of HIV and AIDS in the era of effective therapy (SUN Study). Am J Epidemiol. 2009;169:642–52.

    PubMed  Article  Google Scholar 

  16. Heaton RK, Clifford DB, Franklin DR, Woods SP, Ake C, Vaida F, et al. HIV-associated neurocogntive disorders persisint in the era od poetent antiretroviral therapy. Neurology. 2010;75:2087–96.

    PubMed  Article  Google Scholar 

  17. Letendre SL, Marquie-Beck J, Ellis RJ, Woods SP, Best B, Clifford DB, et al. The role of cohort studies in drug development: clinical evidence of antiviral activity of serotonin reuptake inhibitors and HMG-CoA reductase inhibitors in the central nervous system. J Neuroimmune Pharmacol. 2007;2:120–7.

    PubMed  Article  Google Scholar 

  18. Army Individual Test Battery. Manual of directions and scoring. Washington: War Department, Adjutant General’s Office; 1994.

    Google Scholar 

  19. Gladsjo JA, Schuman CC, Evans JD, Peavy GM, Miller SW, Heaton RK. Norms for letter and category fluency: demographic corrections for age, education, and ethnicity. Assessment. 1999;6:147–78.

    PubMed  Article  CAS  Google Scholar 

  20. Heaton RK, Grant I, Matthews CG. Comprehensive norms for an expanded Halstead-Reitan battery: demographic corrections, research findings, and clinical applications. Odessa: Psychological Assessment Resources, Inc; 1991.

    Google Scholar 

  21. Heaton RK, Taylor MJ, Manly JJ. Demographic effects and use of demographically corrected norms with theWAIS-III and WMS-III. In: Tulsky DS, Heaton RK, Chelune G, Ivnik R, Bornstein RA, Prifitera A, Ledbetter M, editors. Clinical interpretation of the WAIS-III and WMSIII. San Diego: Academic Press; 2002.

    Google Scholar 

  22. Wechsler D. The Psychological Corporation. (1997). Wechsler adult intelligence scale. 3rd edn. (WAIS-III). San Antonio.

  23. Diehr MC, Heaton RK, Miller W, Grant I. The paced auditory serial addition task (PASAT): norms for age, education, and ethnicity. Assessment. 1998;5:375–87.

    PubMed  Article  CAS  Google Scholar 

  24. Gronwall DM. Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills. 1977;44:367–73.

    PubMed  Article  CAS  Google Scholar 

  25. Kløve H. Clinical neuropsychology. In: Forster FM, editor. The medical clinics of north America. New York: Saunders; 1963.

    Google Scholar 

  26. Benedict RH. Brief visuospatial memory test—revised. Odessa: Psychological Assessment Resources, Inc; 1997.

    Google Scholar 

  27. Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test–revised: normative data and analysis of inter-formand test-retest reliability. Clin Neuropsychol. 1998;12:43–55.

    Google Scholar 

  28. Kongs SK, Thompson LL, Iverson GL, Heaton RK. Wisconsin card sorting test—64 card computerized version. Odessa: Psychological Assessment Resources; 2000.

    Google Scholar 

  29. Benton AL, Hamsher K, Sivan AB. Multilingual aphasia examination. Iowa City: AJA Associates; 1994.

    Google Scholar 

  30. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: theory and clinical interpretation. Tucson: Neuropsychology Press; 1993.

    Google Scholar 

  31. Howell DC. Statistical methods for psychology. 5th edn. Pacific Grove: Duxbury Thomas Learning; 2002.

  32. Carey CL, Woods SP, Gonzalez R, Conover E, Marcotte TD, Grant I, Group HNRC. Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004;26:307–19.

    PubMed  Article  Google Scholar 

  33. Kortte KB, Horner MD, Windham WK. The trail making test, part B: cognitive flexibility or ability to maintain set? Appl Neuropsychol. 2002;9:106–9.

    PubMed  Article  Google Scholar 

  34. Hardy DJ, Hinkin CH. Reaction time performance in adults with HIV/AIDS. J Clin Exp Neuropsychol. 2002;24:912–29.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors would like to express our appreciation to all the SUN study and CHARTER participants. The CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) is supported by award N01 MH22005 from the National Institutes of Health.

Conflicts of interest

No authors have conflicts of interest regarding this research.

Author information

Authors and Affiliations

  1. Washington University School of Medicine, St Louis, MO, USA

    Edgar Turner Overton & David B. Clifford

  2. Department of Biology, Brigham Young University, Provo, UT, USA

    John S. K. Kauwe & David Patty

  3. Department of Psychology, University of Missouri, St. Louis, MO, USA

    Robert Paul

  4. Brown University School of Medicine, Providence, RI, USA

    Karen Tashima, David F. Tate & Charles C. J. Carpenter

  5. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Pragna Patel & John T. Brooks

Authors
  1. Edgar Turner Overton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John S. K. Kauwe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karen Tashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David F. Tate
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pragna Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Charles C. J. Carpenter
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David Patty
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. John T. Brooks
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. David B. Clifford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edgar Turner Overton.

Appendix

Appendix

The SUN Study Investigators are: John T. Brooks, Pragna Patel, Lois Conley, and Tim Bush, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia; Kathleen Wood, Rose Baker, and Cheryl Akridge, Cerner Corporation, Vienna, Virginia; John Hammer, Tara Kennedy, Barbara Widick and Billie Thomas, Denver Infectious Disease Consultants, Inc., Denver, Colorado; Ken Lichtenstein and Cheryl Stewart, National Jewish Medical and Research Center, Denver, Colorado; Keith Henry, Jason Baker, Rachel Prosser, Edie Gunderson, Miki Olson, and John Hall, Hennepin County Medical Center, Minneapolis, Minnesota; Frank Rhame, Mark Olson, and Eve Austad, Abbott-Northwestern Hospital, Minneapolis, Minnesota; Hal Martin, Meaghan Morton, and Cheri Murch, Park-Nicollet Institute, Minneapolis, Minnesota; Charles Carpenter, Susan Cu-Uvin, Kenneth Mayer, Erna Milunka Kojic, Jennifer Florczyk, Sara Metzler, and Patricia D’Aiello, The Miriam Hospital, Providence, Rhode Island; and E. Turner Overton, Don Connor, Lisa Kessels, Mariea Snell, Sara Hubert, Dorothea Dedeaux-Turner, and Dave Coughlan, Washington University School of Medicine, St. Louis, Missouri.

The CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) group is affiliated with the Johns Hopkins University, Mount Sinai School of Medicine, University of California, San Diego, University of Texas, Galveston, University of Washington, Seattle, Washington University, St. Louis and is headquartered at the University of California, San Diego and includes: Director: Igor Grant, M.D.; Co-Directors: J. Allen McCutchan, M.D., Ronald J. Ellis, M.D., Ph.D., Thomas D. Marcotte, Ph.D.; Center Manager: Donald Franklin, Jr.; Neuromedical Component: Ronald J. Ellis, M.D., Ph.D. (P.I.), J. Allen McCutchan, M.D., Terry Alexander, R.N.; Laboratory, Pharmacology and Immunology Component: Scott Letendre, M.D. (P.I.), Edmund Capparelli, Pharm.D.; Neurobehavioral Component: Robert K. Heaton, Ph.D. (P.I.), J. Hampton Atkinson, M.D., Steven Paul Woods, Psy.D., Matthew Dawson; Virology Component: Joseph K. Wong, M.D. (P.I.); Imaging Component: Christine Fennema-Notestine, Ph.D. (Co-P.I.), Michael J. Taylor, Ph.D. (Co-P.I.), Rebecca Theilmann, Ph.D.; Data Management Unit: Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman,; Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D.; Protocol Coordinating Component: Thomas D. Marcotte, Ph.D. (P.I.), Rodney von Jaeger, M.P.H.; Johns Hopkins University Site: Justin McArthur (P.I.), Mary Smith; Mount Sinai School of Medicine Site: Susan Morgello, M.D. (Co-P.I.) and David Simpson, M.D. (Co-P.I.), Letty Mintz, N.P.; University of California, San Diego Site: J. Allen McCutchan, M.D. (P.I.), Will Toperoff, N.P.; University of Washington, Seattle Site: Ann Collier, M.D. (Co-P.I.) and Christina Marra, M.D. (Co-P.I.), Trudy Jones, M.N., A.R.N.P.; University of Texas, Galveston Site: Benjamin Gelman, M.D., Ph.D. (P.I.), Eleanor Head, R.N., B.S.N.; and Washington University, St. Louis Site: David Clifford, M.D. (P.I.), Muhammad Al-Lozi, M.D., Mengesha Teshome, M.D.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Overton, E.T., Kauwe, J.S.K., Paul, R. et al. Performances on the CogState and Standard Neuropsychological Batteries Among HIV Patients Without Dementia. AIDS Behav 15, 1902–1909 (2011). https://doi.org/10.1007/s10461-011-0033-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-011-0033-9

Keyword

  • HIV infection
  • neurocognitive function
  • HIV-associated dementia
  • CogState
  • SUN study