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

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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.

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Acknowledgments

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.

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Authors and Affiliations

  1. SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand

    Thep Chalermchai, Somporn Tipsuk, James L. K. Fletcher & Jintanat Ananworanich

  2. Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, MC: 1207, San Francisco, CA, 94158, USA

    Victor Valcour & Nicholas Hutchings

  3. Division of Geriatric Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Victor Valcour

  4. Phramongkutklao Hospital, Bangkok, Thailand

    Pasiri Sithinamsuwan

  5. HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand

    Suteeraporn Pinyakorn & Jintanat Ananworanich

  6. Department of Neurology, Washington University in St Louis, St Louis, MO, USA

    David Clifford

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

    Robert H. Paul

  8. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    Victor DeGruttola

  9. Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Jintanat Ananworanich

  10. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA

    Silvia Ratto-Kim

  11. Hawaii Center for AIDS, University of Hawaii at Mānoa, Honolulu, HI, USA

    Cecilia Shikuma

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  1. Thep Chalermchai
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The SEARCH 007 and 011 study groups

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Correspondence to Victor Valcour.

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Chalermchai, T., Valcour, V., Sithinamsuwan, P. et al. Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND. J. Neurovirol. 19, 137–143 (2013). https://doi.org/10.1007/s13365-013-0151-4

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  • DOI: https://doi.org/10.1007/s13365-013-0151-4

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