Bottiggi Kara Anne, Chang Jason J, Schmitt Frederick A, Avison Malcolm J, Mootoor Yunanan, Nath Avindra, Berger Joseph R
Graduate Center for Gerontology, College of Public Health, University of Kentucky, KY, USA.
J Neurol Sci. 2007 Sep 15;260(1-2):11-5. doi: 10.1016/j.jns.2006.03.023. Epub 2007 May 4.
HIV-associated dementia (HIV-D) is a subcortical dementia consisting of cognitive and motor symptoms that ultimately affects as many as 20% of patients with AIDS and is associated with significant morbidity and mortality. With the advent of highly active antiretroviral therapy (HAART), the use of sensitive and efficient screening tests for HIV-D continue to be needed for identifying individuals who develop this disorder.
The objective of this study was to compare the HIV Dementia Scale (HDS) with comprehensive neuropsychological procedures in detecting both minor cognitive and motor disorder (MCMD) and HIV-D in a population of patients with varying durations of HAART.
Forty-six HIV-seropositive patients completed both the HDS and a battery of neuropsychological tests as they enrolled in a MRI study. Each person was also assigned a MSK score based on clinical neurological examination. HDS score of <or=10 were considered cognitively impaired and scores >10 were considered cognitively unimpaired. Two separate sensitivity analyses were performed. Global Z scores (NPZ8) averaged from eight individual neuropsychological subtests were compared to the HDS score for each subject. An NPZ8 score -2.0 standard deviations (S.D.) below the mean was used to define HIV-D. Additionally, HIV-D, defined as -2.0 S.D. below the mean on one test or -1.0 S.D. below the mean on two or more tests from the NPZ8, were also compared to the HDS. Finally, performance on these cognitive measures was used to predict duration of HAART in this sample.
Using the average NPZ8 score based on American Academy of Neurology consensus criteria yielded a test sensitivity of 30%, a specificity of 0%, a positive predictive value of 0%, and a negative predictive value of 58% when compared to clinical MSK ratings. Comparison of the number of impaired tests with MSK severity yielded a test sensitivity of 43%, a specificity of 91%, a positive predictive value of 83%, and a negative predictive value of 61%. HDS scores were less efficient in predicting the presence of subtle and mild HIV-D in this sample.
While the HDS is a useful bedside test that a physician may quickly administer to HIV seropositive patients to assist in diagnosing suspected cases of frank HIV-D, the HDS, as a screen, is not as accurate in detecting HIV-D as a more thorough neuropsychological examination. With an increasing prevalence of HIV-D and minor cognitive/motor disorder (MCMD) following the introduction of HAART, the development of more sensitive bedside measures is essential in order to identify individuals with these disorders and monitor treatment regimens.
人类免疫缺陷病毒相关性痴呆（HIV-D）是一种皮质下痴呆，由认知和运动症状组成，最终影响多达20%的艾滋病患者，并与显著的发病率和死亡率相关。随着高效抗逆转录病毒疗法（HAART）的出现，仍需要使用敏感且有效的HIV-D筛查测试来识别发生这种疾病的个体。
本研究的目的是在接受不同疗程HAART的患者群体中，比较HIV痴呆量表（HDS）与综合神经心理学检查方法在检测轻微认知和运动障碍（MCMD）及HIV-D方面的效果。
46名HIV血清阳性患者在参加一项MRI研究时完成了HDS和一系列神经心理学测试。每个人还根据临床神经学检查被赋予一个MSK评分。HDS评分≤10被认为认知受损，评分>10被认为认知未受损。进行了两项独立的敏感性分析。将八个个体神经心理学子测试的平均总体Z评分（NPZ8）与每个受试者的HDS评分进行比较。NPZ8评分低于平均值2.0个标准差（S.D.）被用于定义HIV-D。此外，将NPZ8中一项测试低于平均值2.0个标准差或两项或更多测试低于平均值1.0个标准差定义的HIV-D也与HDS进行比较。最后，使用这些认知测量的表现来预测该样本中HAART的疗程。
与临床MSK评级相比，根据美国神经病学学会共识标准得出的平均NPZ8评分，测试敏感性为30%，特异性为0%，阳性预测值为0%，阴性预测值为58%。将受损测试数量与MSK严重程度进行比较，测试敏感性为43%，特异性为91%，阳性预测值为83%，阴性预测值为61%。在该样本中，HDS评分在预测细微和轻度HIV-D的存在方面效率较低。
虽然HDS是一种有用的床边测试，医生可以快速对HIV血清阳性患者进行测试，以协助诊断疑似的明显HIV-D病例，但作为一种筛查方法，HDS在检测HIV-D方面不如更全面的神经心理学检查准确。随着HAART引入后HIV-D和轻微认知/运动障碍（MCMD）患病率的增加，开发更敏感的床边测量方法对于识别患有这些疾病的个体并监测治疗方案至关重要。
