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01-12-2016

Utility of a brief computerized battery to assess HIV-associated neurocognitive impairment in a resource-limited setting

Authors: Nirupama Yechoor, Sheri L. Towe, Kevin R. Robertson, Daniel Westreich, Noeline Nakasujja, Christina S. Meade

Published in: Journal of NeuroVirology | Issue 6/2016

Abstract

Despite the persistently high prevalence of neurocognitive impairment in HIV-positive patients, routine HIV care in many resource-limited settings does not include neuropsychological assessment. The objective of this study was to examine the utility of a brief computerized battery for identifying neurocognitive impairment in a busy HIV clinic in Uganda. Specifically, we compared performance on a gold standard neuropsychological exam to that on the CogState Brief Battery. In this cross-sectional study, 181 HIV-positive patients completed both assessment batteries in a randomized order. The primary outcome measures were neurocognitive impairment on the standard exam defined by the global deficit score and cumulative performance on the CogState Brief Battery. Sixty-nine participants (38 %) were classified as impaired on the standard neuropsychological exam, and participants who were classified as impaired performed significantly worse on CogState compared to those who were unimpaired (p < 0.001). CogState had adequate specificity but low sensitivity, suggesting that it may not be a clinically useful screening tool to identify patients who likely have neurocognitive impairment in Uganda. This study supports the feasibility of using a computerized battery for assessing neurocognitive impairment in HIV-positive patients in resource-limited settings, but additional research is needed to identify screening tools with higher sensitivity for use in HIV clinics.

Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, Clifford DB, Cinque P, Epstein LG, Goodkin K, Gisslen M, Grant I, Heaton RK, Joseph J, Marder K, Marra CM, McArthur JC, Nunn M, Price RW, Pulliam L, Robertson KR, Sacktor N, Valcour V, Wojna VE (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69:1789–99CrossRefPubMedPubMedCentral

Bartels C, Wegrzyn M, Wiedl A, Ackermann V, Ehrenreich H (2010) Practice effects in healthy adults: a longitudinal study on frequent repetitive cognitive testing. BMC Neurosci 11:118CrossRefPubMedPubMedCentral

Beglinger LJ, Gaydos B, Tangphao-Daniels O, Duff K, Kareken DA, Crawford J, Fastenau PS, Siemers ER (2005) Practice effects and the use of alternate forms in serial neuropsychological testing. Arch Clin Neuropsychol 20:517–29CrossRefPubMed

Benedict RHB, Mezhir JJ, Walsh K, Hewitt RG (2000) Impact of human immunodeficiency virus type-1-associated cognitive dysfunction on activities of daily living and quality of life. Arch Clin Neuropsychol 15:535–44CrossRefPubMed

Blackstone K, Moore DJ, Franklin DR Jr, Clifford DB, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, Ellis RJ, Atkinson JH, Grant I, Heaton RK, For The Charter G (2012) Defining neurocognitive impairment in HIV: deficit scores versus clinical ratings. Clin Neuropsychol 26:894–908CrossRefPubMed

Cairney S, Maruff P (2007) Information technology and indigenous people. Information Science Publishing, Melbourne, Australia

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

Castelnuovo B, Babigumira J, Lamorde M, Muwanga A, Kambugu A, Colebunders R (2009) Improvement of the patient flow in a large urban clinic with high HIV seroprevalence in Kampala, Uganda. Int J STD AIDS 20:123–4CrossRefPubMed

Cysique LA, Maruff P, Darby D, Brew BJ (2006) The assessment of cognitive function in advanced HIV-1 infection and AIDS dementia complex using a new computerised cognitive test battery. Arch Clin Neuropsychol 21:185–94CrossRefPubMed

Cysique LA, Bain MP, Lane TA, Brew BJ (2012) Management issues in HIV-associated neurocognitive disorders. Neurobehav HIV Med 4:63–73CrossRef

Cysique LA, Heaton RK, Kamminga J, Lane T, Gates TM, Moore DM, Hubner E, Carr A, Brew BJ (2014) HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research. J Neurovirol 20:258–68CrossRefPubMedPubMedCentral

D’Elia LF, Satz P, Uchiyama CL, White T (1996) Color Trails test: professional manual. Psychological Assessment Resources, Odessa, FL

Habib AG, Yakasai AM, Owolabi LF, Ibrahim A, Habib ZG, Gudaji M, Karaye KM, Ibrahim DA, Nashabaru I (2013) Neurocognitive impairment in HIV-1-infected adults in Sub-Saharan Africa: a systematic review and meta-analysis. Int J Infect Dis 17:e820–e831CrossRefPubMed

Hammers D, Spurgeon E, Ryan K, Persad C, Heidebrink J, Barbas N, Albin R, Frey K, Darby D, Giordani B (2011) Reliability of repeated cognitive assessment of dementia using a brief computerized battery. Am J Alzheimers Dis Other Demen 26:326–33CrossRefPubMed

Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, McCutchan JA, Reicks C, Grant I (2004) The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 10:317–31CrossRefPubMed

Heaton RK, Clifford DB, Franklin DR Jr, Woods SP, Ake C, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Rivera-Mindt M, Vigil OR, Taylor MJ, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I (2010) HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology 75:2087–96CrossRefPubMedPubMedCentral

Heaton RK, Franklin D, Ellis R, McCutchan J, Letendre S, LeBlanc S, Corkran S, Duarte N, Clifford D, Woods S, Collier A, Marra C, Morgello S, Mindt M, Taylor M, Marcotte T, Atkinson J, Wolfson T, Gelman B, McArthur J, Simpson D, Abramson I, Gamst A, Fennema-Notestine C, Jernigan T, Wong J, Grant I (2011) HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 17:3–16CrossRefPubMed

Heilbronner RL, Sweet JJ, Attix DK, Krull KR, Henry GK, Hart RP (2010) Official position of the American Academy of Clinical Neuropsychology on serial neuropsychological assessments: The utility and challenges of repeat test administrations in clinical and forensic contexts. Clin Neuropsychol 24:1267–78CrossRefPubMed

Jawaid A, Pradeep V, Shamsi A, Schulz PE (2011) Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. Neurology 77:406–7, author reply 467CrossRefPubMed

Lewis MS, Dingwall KM, Berkhout N, Sayers S, Maruff P, Cairney S (2010) Assessment of cognition in an adolescent indigenous population. Australian Psychologist 45:123–131CrossRef

Lovejoy TI, Suhr JA (2009) The relationship between neuropsychological functioning and HAART adherence in HIV-positive adults: a systematic review. J Behav Med 32:389–405CrossRefPubMed

Maj M, D’Elia L, Satz P, Janssen R, Zaudig M, Uchiyama C, Starace F, Galderisi S, Chervinsky A (1993) Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study. Arch Clin Neuropsychol 8:123–35CrossRefPubMed

Maj M, Satz P, Janssen R, Zaudig M, Starace F, D’Elia L, Sughondhabirom B, Mussa M, Naber D, Ndetei D et al (1994) WHO Neuropsychiatric AIDS study, cross-sectional phase II. Neuropsychological and neurological findings. Arch Gen Psychiatry 51:51–61CrossRefPubMed

Maruff P, Thomas E, Cysique L, Brew B, Collie A, Snyder P, Pietrzak RH (2009) Validity of the CogState Brief Battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex. Arch Clin Neuropsychol 24:165–78CrossRefPubMed

Matthews CG, Klove H (1964) Instruction manual for the adult neuropsychology test battery. University of Wisconsin Medical School, Madison, WI

McCutchan JA, Marquie-Beck JA, Fitzsimons CA, Letendre SL, Ellis RJ, Heaton RK, Wolfson T, Rosario D, Alexander TJ, Marra C, Ances BM, Grant I (2012) Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder. Neurology 78:485–92CrossRefPubMedPubMedCentral

Miller EN, Selnes OA, McArthur JC, Satz P, Becker JT, Cohen BA, Sheridan K, Machado AM, Van Gorp WG, Visscher B (1990) Neuropsychological performance in HIV-1-infected homosexual men: the Multicenter AIDS Cohort Study (MACS). Neurology 40:197–203CrossRefPubMed

Overton ET, Kauwe JS, Paul R, Tashima K, Tate DF, Patel P, Carpenter CC, Patty D, Brooks JT, Clifford DB (2011) Performances on the CogState and standard neuropsychological batteries among HIV patients without dementia. AIDS Behav 15:1902–9CrossRefPubMedPubMedCentral

Rabkin JG, McElhiney M, Ferrando SJ, Van Gorp W, Lin SH (2004) Predictors of employment of men with HIV/AIDS: a longitudinal study. Psychosom Med 66:72–8CrossRefPubMed

Robertson KR, Nakasujja N, Wong M, Musisi S, Katabira E, Parsons TD, Ronald A, Sacktor N (2007) Pattern of neuropsychological performance among HIV positive patients in Uganda. BMC Neurol 7:8CrossRefPubMedPubMedCentral

Robertson KR, Liner J, Heaton R (2009) Neuropsychological assessment of HIV-infected populations in international settings. Neuropsychol Rev 19:232–49CrossRefPubMedPubMedCentral

Robertson KR, Bayon C, Molina JM, McNamara P, Resch C, Munoz-Moreno JA, Kulasegaram R, Schewe K, Burgos-Ramirez A, De Alvaro C, Cabrero E, Guion M, Norton M, van Wyk J (2014) Screening for neurocognitive impairment, depression, and anxiety in HIV-infected patients in Western Europe and Canada. AIDS care 26:1555–61CrossRefPubMedPubMedCentral

Robertson K, Jiang H, Evans S, Marra C, Berzins B, Hakim J, Sacktor N, Campbell T, Walawander A, Schouten J, and the 5199/5271 study teams (2015). Neurocognitive impairment in diverse resource limited settings: The International Neurological Study ACTG A5199 and The International Neurocognitive Normative Study ACTG A5271. In: Conference on Retroviruses and Opportunistic Infections: Seattle, WA

Schweizer TA, Ware J, Fischer CE, Craik FI, Bialystok E (2011) Bilingualism as a contributor to cognitive reserve: evidence from brain atrophy in Alzheimer’s disease. Cortex 48:991–6CrossRefPubMed

Volberding PA, Deeks SG (2010) Antiretroviral therapy and management of HIV infection. Lancet 376:49–62CrossRefPubMed

Wechsler D (1945) A standardized memory scale for clinical use. J Psychol 19:87–95CrossRef

Zipursky AR, Gogolishvili D, Rueda S, Brunetta J, Carvalhal A, McCombe JA, Gill MJ, Rachlis A, Rosenes R, Arbess G, Marcotte T, Rourke SB (2013) Evaluation of brief screening tools for neurocognitive impairment in HIV/AIDS: a systematic review of the literature. AIDS 27:2385–401CrossRefPubMedPubMedCentral

Title: Utility of a brief computerized battery to assess HIV-associated neurocognitive impairment in a resource-limited setting
Authors: Nirupama Yechoor
Sheri L. Towe
Kevin R. Robertson
Daniel Westreich
Noeline Nakasujja
Christina S. Meade
Publication date: 01-12-2016
Publisher: Springer International Publishing
Published in: Journal of NeuroVirology / Issue 6/2016
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-016-0456-1

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Utility of a brief computerized battery to assess HIV-associated neurocognitive impairment in a resource-limited setting

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