Concurrent classification accuracy of the HIV dementia scale for HIV-associated neurocognitive disorders in the CHARTER cohort

Maiko Sakamoto, Thomas D. Marcotte, Anya Umlauf, Donald Franklin, Robert K. Heaton, Ronald J. Ellis, Scott Letendre, Terry Alexander, J. A. McCutchan, Erin E. Morgan, Steven P. Woods, Ann C. Collier, Christina M. Marra, David B. Clifford, Benjamin Gelman, Justin C. McArthur, Susan Morgello, David Simpson, Igor Grant

Research output: Contribution to journalArticle

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Abstract

Background: The HIV Dementia Scale (HDS) was developed to screen for HIV-associated neurocognitive disorders (HAND), but concerns have persisted regarding its substandard sensitivity. This study aimed to examine the classification accuracy of the HDS using raw and norm-based cut points and to evaluate the contribution of the HDS subtests to predicting HAND. Methods: A total of 1580 HIV-infected participants from 6 US sites completed the HDS, and a gold standard neuropsychological battery, on which 51% of participants were impaired. Results: Sensitivity and specificity to HAND using the standard raw HDS cut point were 24% and 92%, respectively. The raw HDS subtests of attention, recall, and psychomotor speed significantly contributed to classification of HAND, whereas visuomotor construction contributed the least. A modified raw cut point of 14 yielded sensitivity of 66% and specificity of 61%, with cross-validation. Using norms also significantly improved sensitivity to 69% with a concomitant reduction of specificity to 56%, whereas the positive predictive value declined from 75% to 62% and negative predictive value improved from 54% to 64%. The HDS showed similarly modest rates of sensitivity and specificity among subpopulations of individuals with minimal comorbidity and successful viral suppression. Conclusions: Findings indicate that while the HDS is a statistically significant predictor of HAND, particularly when adjusted for demographic factors, its relatively low diagnostic classification accuracy continues to hinder its clinical utility. A raw cut point of 14 greatly improved the sensitivity of the previously established raw cut score, but may be subject to ceiling effects, particularly on repeat assessments.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume62
Issue number1
DOIs
StatePublished - Jan 1 2013

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AIDS Dementia Complex
HIV
Sensitivity and Specificity
Neurocognitive Disorders
Comorbidity
Demography

Keywords

  • cognition
  • HIV
  • HIV dementia scale
  • HIV-associated neurocognitive disorders
  • screening measures

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Concurrent classification accuracy of the HIV dementia scale for HIV-associated neurocognitive disorders in the CHARTER cohort. / Sakamoto, Maiko; Marcotte, Thomas D.; Umlauf, Anya; Franklin, Donald; Heaton, Robert K.; Ellis, Ronald J.; Letendre, Scott; Alexander, Terry; McCutchan, J. A.; Morgan, Erin E.; Woods, Steven P.; Collier, Ann C.; Marra, Christina M.; Clifford, David B.; Gelman, Benjamin; McArthur, Justin C.; Morgello, Susan; Simpson, David; Grant, Igor.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 62, No. 1, 01.01.2013, p. 36-42.

Research output: Contribution to journalArticle

Sakamoto, M, Marcotte, TD, Umlauf, A, Franklin, D, Heaton, RK, Ellis, RJ, Letendre, S, Alexander, T, McCutchan, JA, Morgan, EE, Woods, SP, Collier, AC, Marra, CM, Clifford, DB, Gelman, B, McArthur, JC, Morgello, S, Simpson, D & Grant, I 2013, 'Concurrent classification accuracy of the HIV dementia scale for HIV-associated neurocognitive disorders in the CHARTER cohort', Journal of Acquired Immune Deficiency Syndromes, vol. 62, no. 1, pp. 36-42. https://doi.org/10.1097/QAI.0b013e318278ffa4
Sakamoto, Maiko ; Marcotte, Thomas D. ; Umlauf, Anya ; Franklin, Donald ; Heaton, Robert K. ; Ellis, Ronald J. ; Letendre, Scott ; Alexander, Terry ; McCutchan, J. A. ; Morgan, Erin E. ; Woods, Steven P. ; Collier, Ann C. ; Marra, Christina M. ; Clifford, David B. ; Gelman, Benjamin ; McArthur, Justin C. ; Morgello, Susan ; Simpson, David ; Grant, Igor. / Concurrent classification accuracy of the HIV dementia scale for HIV-associated neurocognitive disorders in the CHARTER cohort. In: Journal of Acquired Immune Deficiency Syndromes. 2013 ; Vol. 62, No. 1. pp. 36-42.
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abstract = "Background: The HIV Dementia Scale (HDS) was developed to screen for HIV-associated neurocognitive disorders (HAND), but concerns have persisted regarding its substandard sensitivity. This study aimed to examine the classification accuracy of the HDS using raw and norm-based cut points and to evaluate the contribution of the HDS subtests to predicting HAND. Methods: A total of 1580 HIV-infected participants from 6 US sites completed the HDS, and a gold standard neuropsychological battery, on which 51{\%} of participants were impaired. Results: Sensitivity and specificity to HAND using the standard raw HDS cut point were 24{\%} and 92{\%}, respectively. The raw HDS subtests of attention, recall, and psychomotor speed significantly contributed to classification of HAND, whereas visuomotor construction contributed the least. A modified raw cut point of 14 yielded sensitivity of 66{\%} and specificity of 61{\%}, with cross-validation. Using norms also significantly improved sensitivity to 69{\%} with a concomitant reduction of specificity to 56{\%}, whereas the positive predictive value declined from 75{\%} to 62{\%} and negative predictive value improved from 54{\%} to 64{\%}. The HDS showed similarly modest rates of sensitivity and specificity among subpopulations of individuals with minimal comorbidity and successful viral suppression. Conclusions: Findings indicate that while the HDS is a statistically significant predictor of HAND, particularly when adjusted for demographic factors, its relatively low diagnostic classification accuracy continues to hinder its clinical utility. A raw cut point of 14 greatly improved the sensitivity of the previously established raw cut score, but may be subject to ceiling effects, particularly on repeat assessments.",
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AU - Sakamoto, Maiko

AU - Marcotte, Thomas D.

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AU - Franklin, Donald

AU - Heaton, Robert K.

AU - Ellis, Ronald J.

AU - Letendre, Scott

AU - Alexander, Terry

AU - McCutchan, J. A.

AU - Morgan, Erin E.

AU - Woods, Steven P.

AU - Collier, Ann C.

AU - Marra, Christina M.

AU - Clifford, David B.

AU - Gelman, Benjamin

AU - McArthur, Justin C.

AU - Morgello, Susan

AU - Simpson, David

AU - Grant, Igor

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N2 - Background: The HIV Dementia Scale (HDS) was developed to screen for HIV-associated neurocognitive disorders (HAND), but concerns have persisted regarding its substandard sensitivity. This study aimed to examine the classification accuracy of the HDS using raw and norm-based cut points and to evaluate the contribution of the HDS subtests to predicting HAND. Methods: A total of 1580 HIV-infected participants from 6 US sites completed the HDS, and a gold standard neuropsychological battery, on which 51% of participants were impaired. Results: Sensitivity and specificity to HAND using the standard raw HDS cut point were 24% and 92%, respectively. The raw HDS subtests of attention, recall, and psychomotor speed significantly contributed to classification of HAND, whereas visuomotor construction contributed the least. A modified raw cut point of 14 yielded sensitivity of 66% and specificity of 61%, with cross-validation. Using norms also significantly improved sensitivity to 69% with a concomitant reduction of specificity to 56%, whereas the positive predictive value declined from 75% to 62% and negative predictive value improved from 54% to 64%. The HDS showed similarly modest rates of sensitivity and specificity among subpopulations of individuals with minimal comorbidity and successful viral suppression. Conclusions: Findings indicate that while the HDS is a statistically significant predictor of HAND, particularly when adjusted for demographic factors, its relatively low diagnostic classification accuracy continues to hinder its clinical utility. A raw cut point of 14 greatly improved the sensitivity of the previously established raw cut score, but may be subject to ceiling effects, particularly on repeat assessments.

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