Ellis Ronald J, Evans Scott R, Clifford David B, Moo Lauren R, McArthur Justin C, Collier Ann C, Benson Constance, Bosch Ron, Simpson David, Yiannoutsos Constantin T, Yang Yijun, Robertson Kevin
Department of Neurosciences, UCSD AntiViral Research Center and HIV Neurobehavioral Research Center, University of California, San Diego, California 92103, USA.
J Neurovirol. 2005 Dec;11(6):503-11. doi: 10.1080/13550280500384966.
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%, 60%]; specificity 88% [95% Cl82%, 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.
简易神经认知筛查（BNCS），旨在评估人类免疫缺陷病毒（HIV）相关认知障碍的发生率；以及简易周围神经病变筛查（BPNS），用于检测HIV患者的远端感觉性多发性神经病变（DSPN）。在本研究中，神经筛查和更广泛的标准化验证性神经诊断评估均应用于参与两项多中心大型队列研究的301名HIV阳性受试者。BNCS的表现以经人口统计学调整的平均z评分（NPZ3）的形式进行总结。与参考标准神经心理学（NP）评估相比，BNCS的受试者工作特征（ROC）曲线下面积为0.74（95%置信区间[CI] 0.69，0.79）。使用NPZ3上-0.33的切点，正确分类率为68%，敏感性（65%）和特异性（72%）大致平衡。在认知障碍患病率为30%的假设下，BNCS计算出的阳性预测值（PPV）为86%。相对于其参考标准，即由神经科医生进行的改良总神经病变评分（TNS），BPNS的正确诊断分类率相似，为78%；敏感性49% [95%，60%]；特异性88% [95% CI 82%，91%]。在DSPN患病率为40%的假设下，BPNS的PPV为72%。这些预测值表明，在联合抗逆转录病毒治疗时代，神经筛查对于追踪大型队列中HIV相关神经疾病的患病率趋势将是有用的。然而，由于它会产生大量假阳性和假阴性结果，神经筛查在评估个体患者时可能不太有用。
