aDepartment of Statistics bDepartment of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania cPopulation Health Sciences, Harvard University, Cambridge, Massachusetts dDepartment of Epidemiology eDepartment of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania fDepartment of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California gDepartment of Psychiatry, Rush University School of Medicine, Chicago, Illinois hDepartment of Psychiatry iDepartment of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland jDepartment of Radiology, Northwestern University, Evanston, Illinois kDepartment of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland lDepartment of Psychiatry mDepartment of Neurology nDepartment of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
AIDS. 2019 Nov 15;33(14):2115-2124. doi: 10.1097/QAD.0000000000002312.
Prevalence estimates of cognitive impairment in HIV disease vary widely. Here we used multivariate normative comparison (MNC) with identify individuals with impaired cognition, and to compare the results with those using the Frascati and Gisslén criteria.
The current project used data collected before October 2014 from bisexual/gay men from the Multicenter AIDS Cohort Study. A total of 2904 men (mean age 39.7 years, 52.7% seropositive) had complete data in six cognitive domains at their first neuropsychological evaluation. T-scores were computed for each domain and the MNC was applied to detect impairment among seronegative and seropositive groups.
The MNC classified 6.26% of seronegative men as being impaired using a predetermined 5% false discovery rate. By contrast, the Frascati and the Gisslén criteria identified 24.54 and 11.36% of seronegative men as impaired. For seropositive men, the percentage impairment was 7.45, 25.73, and 11.69%, respectively, by the MNC, Frascati and Gisslén criteria. When we used seronegative men without medical comorbidities as the control group, the MNC, the Frascati and the Gisslén criteria identified 5.05, 27.07, and 4.21% of the seronegative men, and 4.34, 30.95, and 4.48% of the seropositive men as having cognitive impairment. For each method, serostatus was not associated with cognitive impairment.
The MNC controls the false discovery rate and therefore avoids the low specificity that characterizes the Frascati and Gisslén criteria. More research is needed to evaluate the sensitivity of the MNC method in a seropositive population that may be sicker and older than the current study sample and that includes women.
艾滋病毒疾病认知障碍的流行率估计差异很大。在这里，我们使用多元规范比较（MNC）来识别认知障碍患者，并将结果与使用 Frascati 和 Gisslén 标准的结果进行比较。
本研究使用 2014 年 10 月前从参加多中心艾滋病队列研究的男同性恋/双性恋者收集的数据。共有 2904 名男性（平均年龄 39.7 岁，52.7% 血清阳性）在首次神经心理评估时完成了六个认知领域的完整数据。为每个领域计算 T 分数，并应用 MNC 来检测血清阴性和血清阳性组的障碍。
MNC 将 6.26%的血清阴性男性归类为使用预定的 5%假发现率受损。相比之下，Frascati 和 Gisslén 标准分别将 24.54%和 11.36%的血清阴性男性归类为受损。对于血清阳性男性，MNC、Frascati 和 Gisslén 标准分别将 7.45%、25.73%和 11.69%的男性归类为受损。当我们使用没有合并症的血清阴性男性作为对照组时，MNC、Frascati 和 Gisslén 标准分别将 5.05%、27.07%和 4.21%的血清阴性男性和 4.34%、30.95%和 4.48%的血清阳性男性归类为认知障碍。对于每种方法，血清状态与认知障碍无关。
MNC 控制了假发现率，因此避免了 Frascati 和 Gisslén 标准的低特异性。需要进一步研究来评估 MNC 方法在可能比当前研究样本更病弱和年龄更大的血清阳性人群中的敏感性，并且包括女性。
