Department of Psychological Medicine, Tan Tock Seng Hospital, Annex 1 Building Level 3, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
National Centre for Infectious Diseases, Tan Tock Seng Hospital, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.
AIDS Res Ther. 2019 Apr 15;16(1):9. doi: 10.1186/s12981-019-0224-4.
Practical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and clinically feasible battery to screen for HIV-associated neurocognitive disorders (HAND) in resource-limited settings even where English is not the native language.
A total of 53 outpatients were recruited from a multi-ethnic Southeast Asian HIV-positive cohort. Performance on a neuropsychological protocol was used to define cognitive impairment, of which 28 patients (52.8%) were identified with HAND. Receiver operating characteristic analysis was used to determine the best combinations of cognitive tests for the screening battery.
3 different combinations of cognitive tests that required minimal literacy, time to administer, and administrator training were found to classify HAND with fair accuracy. Montreal Cognitive Assessment (MoCA), in combination with tests of psychomotor coordination, verbal learning and speed processing, yielded area under curve scores of above 0.75, the primary outcome of receiver operating characteristic analysis.
The 3-test combinations presented in this study appear to be promising screening options for HAND in HIV-infected patients. The addition of 2 tests to MoCA improves the overall accuracy while retaining its convenience, giving more potential for the inclusion of cognitive screening in routine clinical care. Further validation of the batteries in specific settings is warranted to determine specific screening cut-offs to a global cognitive score.
尽管高效抗逆转录病毒疗法（highly active antiretroviral therapy，HAART）得到广泛应用，但 HIV 感染者仍普遍存在神经认知障碍（HIV-associated neurocognitive disorders，HAND），需要进行全面的神经心理学测试进行诊断，因此有必要制定实用的筛查策略来检测各种严重程度的 HAND。本研究旨在开发一种简短且在临床可行的检测方法，用于在资源有限的环境中筛查 HAND，即使当地语言不是英语。
本研究共纳入了来自多民族东南亚 HIV 阳性队列的 53 名门诊患者。使用神经心理学测试来定义认知障碍，其中 28 名患者（52.8%）被诊断为 HAND。通过受试者工作特征分析（receiver operating characteristic analysis，ROC）确定最佳的认知测试组合作为筛查工具。
发现了 3 种不同的认知测试组合，它们需要最少的文化程度、测试时间和管理员培训，可以准确地区分 HAND。蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）与心理运动协调、语言学习和速度处理测试相结合，ROC 分析的主要结果显示曲线下面积（area under the curve，AUC）评分超过 0.75。
本研究中提出的这 3 种测试组合似乎是 HAND 筛查的有前途的选择。在 MoCA 中增加 2 项测试可以提高整体准确性，同时保持其便利性，为将认知筛查纳入常规临床护理提供更多可能。有必要在特定环境中进一步验证这些测试组合，以确定特定的筛查切点与全球认知评分的关系。
