Grethlein David, Pirrone Vanessa, Devlin Kathryn N, Dampier Will, Szep Zsofia, Winston Flaura K, Ontañón Santiago, Walshe Elizabeth A, Malone Kim, Tillman Shinika, Ances Beau M, Kandadai Venk, Kolson Dennis L, Wigdahl Brian
Diagnostic Driving, Inc., Philadelphia, PA, United States.
Department of Computer Science, The Games Artificial Intelligence and Media Systems (GAIMS) Center, College of Computing and Informatics, Drexel University, Philadelphia, PA, United States.
Front Neurosci. 2022 Aug 24;16:912766. doi: 10.3389/fnins.2022.912766. eCollection 2022.
Existing screening tools for HIV-associated neurocognitive disorders (HAND) are often clinically impractical for detecting milder forms of impairment. The formal diagnosis of HAND requires an assessment of both cognition and impairment in activities of daily living (ADL). To address the critical need for identifying patients who may have disability associated with HAND, we implemented a low-cost screening tool, the Virtual Driving Test (VDT) platform, in a vulnerable cohort of people with HIV (PWH). The VDT presents an opportunity to cost-effectively screen for milder forms of impairment while providing practical guidance for a cognitively demanding ADL.
We aimed to: (1) evaluate whether VDT performance variables were associated with a HAND diagnosis and if so; (2) systematically identify a manageable subset of variables for use in a future screening model for HAND. As a secondary objective, we examined the relative associations of identified variables with impairment within the individual domains used to diagnose HAND.
In a cross-sectional design, 62 PWH were recruited from an established HIV cohort and completed a comprehensive neuropsychological assessment (CNPA), followed by a self-directed VDT. Dichotomized diagnoses of HAND-specific impairment and impairment within each of the seven CNPA domains were ascertained. A systematic variable selection process was used to reduce the large amount of VDT data generated, to a smaller subset of VDT variables, estimated to be associated with HAND. In addition, we examined associations between the identified variables and impairment within each of the CNPA domains.
More than half of the participants ( = 35) had a confirmed presence of HAND. A subset of twenty VDT performance variables was isolated and then ranked by the strength of its estimated associations with HAND. In addition, several variables within the final subset had statistically significant associations with impairment in motor function, executive function, and attention and working memory, consistent with previous research.
We identified a subset of VDT performance variables that are associated with HAND and assess relevant functional abilities among individuals with HAND. Additional research is required to develop and validate a predictive HAND screening model incorporating this subset.
现有的用于筛查与HIV相关的神经认知障碍（HAND）的工具在临床上往往难以检测出较轻形式的损伤。HAND的正式诊断需要对认知和日常生活活动（ADL）中的损伤进行评估。为了满足识别可能因HAND而导致残疾的患者的迫切需求，我们在一组易受影响的HIV感染者（PWH）中实施了一种低成本的筛查工具——虚拟驾驶测试（VDT）平台。VDT为经济高效地筛查较轻形式的损伤提供了机会，同时为一项对认知要求较高的ADL提供实用指导。
我们旨在：（1）评估VDT性能变量是否与HAND诊断相关，如果是；（2）系统地确定一组可管理的变量子集，用于未来HAND筛查模型。作为次要目标，我们研究了所确定变量与用于诊断HAND的各个领域内的损伤之间的相对关联。
采用横断面设计，从一个已建立的HIV队列中招募了62名PWH，他们完成了一项全面的神经心理学评估（CNPA），随后进行了一次自主的VDT。确定了HAND特异性损伤以及七个CNPA领域中每个领域内的损伤的二分诊断。使用系统的变量选择过程将生成的大量VDT数据减少到估计与HAND相关的较小的VDT变量子集。此外，我们研究了所确定变量与CNPA各个领域内的损伤之间的关联。
超过一半的参与者（n = 35）被确认存在HAND。分离出了20个VDT性能变量的子集，然后根据其与HAND估计关联的强度进行排序。此外，最终子集中的几个变量与运动功能、执行功能以及注意力和工作记忆方面的损伤具有统计学上的显著关联，这与先前的研究一致。
我们确定了一组与HAND相关的VDT性能变量，并评估了HAND患者的相关功能能力。需要进一步的研究来开发和验证一个纳入该子集的预测性HAND筛查模型。
