A brief and feasible paper-based method to screen for neurocognitive impairment in HIV-infected patients: the NEU screen

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 63; no. 5; p. 585
• Main Authors: Muñoz-Moreno, Jose A, Prats, Anna, Pérez-Álvarez, Núria, Fumaz, Carmina R, Garolera, Maite, Doval, Eduardo, Negredo, Eugènia, Ferrer, Maria J, Clotet, Bonaventura
• Format: Journal Article
• Language: English
• Published: United States 15.08.2013
• Subjects: Adult; AIDS Dementia Complex - diagnosis; Anti-Retroviral Agents - therapeutic use; Female; HIV Infections - complications; HIV Infections - drug therapy; Humans; Male; Mass Screening - methods; Middle Aged; Neuropsychological Tests; Sensitivity and Specificity; Time Factors
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0b013e31829e1408

Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder. A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ∼2 hours). Multiple score combinations were compared to find a paper-based method that took ≤10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated. Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individuals (48%) and was associated with lower nadir CD4 count (P < 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P < 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of attention/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper-based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ∼35 minutes). The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV-infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.