Gouse H, Thomas K G F, Masson C J, Henry M, Joska J A, Cysique L A, Ling S, Ye X, Liu J, Robbins R N
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
J Neurovirol. 2025 Feb;31(1):41-55. doi: 10.1007/s13365-024-01235-6. Epub 2024 Dec 30.
Effective neuropsychological assessment of people with HIV (PWH) in low- and middle-income countries (LMICs) is hampered by the unavailability of adequate test norms. We aimed to: (1) develop demographically-corrected (regression-based) South African (SA) normative data for an HIV appropriate neuropsychological test battery for Xhosa home-language speakers; (2) compare the utility of those norms to that of (i) internal standardization norms and (ii) US test publisher norms; and (3) determine the criterion validity of the newly-developed norms. 114 controls and 102 demographically comparable Xhosa home-language people living with HIV completed a well-establised, standard HIV neuropsychological test battery assessing seven cognitive domains. Using a common performance metric (z-score), we compared control and PWH test performance and examined the extent to which the three different normative datasets embedded demographic effects e.g., education. Using internal standardization norms, analyses detected medium-sized correlations of overall test performance with age and education. Correlations were fully corrected for by the newly-developed demographically-corrected norms. Using demographically-corrected norms, PWH performed significantly more poorly than controls in five cognitive domains, whereas using internal standardization norms and test-publisher norms, PWH performed significantly more poorly than controls in one and two domains, respectively. Demographically-corrected norms estimated 43.1% of PWH were cognitively impaired; these estimates were 22.5% using test-publisher norms and 19.6% using internal standardization norms. Demographically-corrected SA norms were more sensitive to cognitive impairment in PWH than the other sets of norms. Expansion of this regression-based method to create population-appropriate norms will benefit research and clinical practice in LMICs.
在低收入和中等收入国家（LMICs），由于缺乏足够的测试常模，对感染艾滋病毒的人（PWH）进行有效的神经心理学评估受到阻碍。我们的目标是：（1）为科萨语母语使用者开发一套适用于艾滋病毒的神经心理学测试组合的经人口统计学校正（基于回归）的南非（SA）常模数据；（2）将这些常模与（i）内部标准化常模和（ii）美国测试出版商常模的效用进行比较；（3）确定新开发常模的效标效度。114名对照者和102名在人口统计学上可比的科萨语母语艾滋病毒感染者完成了一套成熟的、标准的艾滋病毒神经心理学测试组合，该组合评估七个认知领域。使用共同的表现指标（z分数），我们比较了对照者和艾滋病毒感染者的测试表现，并研究了三种不同的常模数据集在多大程度上嵌入了人口统计学效应，如教育程度。使用内部标准化常模，分析发现总体测试表现与年龄和教育程度存在中等程度的相关性。新开发的经人口统计学校正的常模完全校正了这些相关性。使用经人口统计学校正的常模，艾滋病毒感染者在五个认知领域的表现明显比对照者差，而使用内部标准化常模和测试出版商常模时，艾滋病毒感染者分别在一个和两个领域的表现明显比对照者差。经人口统计学校正的常模估计43.1%的艾滋病毒感染者存在认知障碍；使用测试出版商常模时这一估计为22.5%，使用内部标准化常模时为19.6%。经人口统计学校正的南非常模比其他常模组对艾滋病毒感染者的认知障碍更敏感。将这种基于回归的方法扩展以创建适合人群的常模将有益于低收入和中等收入国家的研究和临床实践。
