Concurrent classification accuracy of the HIV dementia scale for HIV-associated neurocognitive disorders in the CHARTER Cohort.
Title | Concurrent classification accuracy of the HIV dementia scale for HIV-associated neurocognitive disorders in the CHARTER Cohort. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Sakamoto, M, Marcotte, TD, Umlauf, A, Franklin, D, Heaton, RK, Ellis, RJ, Letendre, S, Alexander, T, McCutchan, JA, Morgan, EE, Woods, SPaul, Collier, AC, Marra, CM, Clifford, DB, Gelman, B, McArthur, JC, Morgello, S, Simpson, DM, Grant, I |
Corporate Authors | CHARTER Group |
Journal | J Acquir Immune Defic Syndr |
Volume | 62 |
Issue | 1 |
Pagination | 36-42 |
Date Published | 2013 Jan 01 |
ISSN | 1944-7884 |
Keywords | Adult, AIDS Dementia Complex, CHARTER, Clinical Medicine, Female, Humans, Internal, Male, Middle Aged, Sensitivity and Specificity, Severity of Illness Index, United States |
Abstract | BACKGROUND: The HIV Dementia Scale (HDS) was developed to screen for HIV-associated neurocognitive disorders (HAND), but concerns have persisted regarding its substandard sensitivity. This study aimed to examine the classification accuracy of the HDS using raw and norm-based cut points and to evaluate the contribution of the HDS subtests to predicting HAND.METHODS: A total of 1580 HIV-infected participants from 6 US sites completed the HDS, and a gold standard neuropsychological battery, on which 51% of participants were impaired.RESULTS: Sensitivity and specificity to HAND using the standard raw HDS cut point were 24% and 92%, respectively. The raw HDS subtests of attention, recall, and psychomotor speed significantly contributed to classification of HAND, whereas visuomotor construction contributed the least. A modified raw cut point of 14 yielded sensitivity of 66% and specificity of 61%, with cross-validation. Using norms also significantly improved sensitivity to 69% with a concomitant reduction of specificity to 56%, whereas the positive predictive value declined from 75% to 62% and negative predictive value improved from 54% to 64%. The HDS showed similarly modest rates of sensitivity and specificity among subpopulations of individuals with minimal comorbidity and successful viral suppression.CONCLUSIONS: Findings indicate that while the HDS is a statistically significant predictor of HAND, particularly when adjusted for demographic factors, its relatively low diagnostic classification accuracy continues to hinder its clinical utility. A raw cut point of 14 greatly improved the sensitivity of the previously established raw cut score, but may be subject to ceiling effects, particularly on repeat assessments. |
DOI | 10.1097/QAI.0b013e318278ffa4 |
Alternate Journal | J. Acquir. Immune Defic. Syndr. |
PubMed ID | 23111573 |
PubMed Central ID | PMC3529802 |
Grant List | HHSN271201000030C / MH / NIMH NIH HHS / United States HHSN271201000036C / MH / NIMH NIH HHS / United States N01MH22005 / MH / NIMH NIH HHS / United States UL1 RR029887 / RR / NCRR NIH HHS / United States N01 MH022005 / MH / NIMH NIH HHS / United States |