Journal of NeuroVirology

, Volume 11, Issue 6, pp 503–511

Clinical validation of the NeuroScreen

  • Ronald J. Ellis
  • Scott R. Evans
  • David B. Clifford
  • Lauren R. Moo
  • Justin C. McArthur
  • Ann C. Collier
  • Constance Benson
  • Ron Bosch
  • David Simpson
  • Constantin T. Yiannoutsos
  • Yijun Yang
  • Kevin Robertson
  • Neurological AIDS Research Consortium
  • AIDS Clinical Trials Group Study Teams A5001 and A362
Article

DOI: 10.1080/13550280500384966

Cite this article as:
Ellis, R.J., Evans, S.R., Clifford, D.B. et al. Journal of NeuroVirology (2005) 11: 503. doi:10.1080/13550280500384966

Abstract

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.

Keywords

antiretroviral cognitive impairment HIV neuropathy 

Copyright information

© Journal of NeuroVirology, Inc. 2005

Authors and Affiliations

  • Ronald J. Ellis
    • 1
  • Scott R. Evans
    • 2
  • David B. Clifford
    • 3
  • Lauren R. Moo
    • 4
  • Justin C. McArthur
    • 4
  • Ann C. Collier
    • 5
  • Constance Benson
    • 6
  • Ron Bosch
    • 7
  • David Simpson
    • 8
  • Constantin T. Yiannoutsos
    • 9
  • Yijun Yang
    • 2
  • Kevin Robertson
    • 10
  • Neurological AIDS Research Consortium
  • AIDS Clinical Trials Group Study Teams A5001 and A362
  1. 1.Department of Neurosciences, UCSD AntiViral Research Center and HIV Neurobehavioral Research CenterUniversity of California, San DiegoSan DiegoUSA
  2. 2.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  3. 3.Department of NeurologyWashington UniversitySt. LouisUSA
  4. 4.Departments of Neurology and EpidemiologyJohns Hopkins UniversityBaltimoreUSA
  5. 5.Department of MedicineUniversity of Washington School of MedicineSeattleUSA
  6. 6.Department of Medicine, UCSD AntiViral Research Center (AVRC) and HIV Neurobehavioral Research CenterUniversity of CaliforniaSan DiegoUSA
  7. 7.Statistical and Data Analysis CenterHarvard School of Public HealthBostonUSA
  8. 8.Department of NeurologyMount Sinai Medical CenterNew YorkUSA
  9. 9.Division of BiostatisticsIndiana University School of MedicineIndianapolisUSA
  10. 10.Department of Neurology, School of MedicineUniversity of North CarolinaChapel HillUSA

Personalised recommendations