A comparison of screening batteries in the detection of neurocognitive impairment in HIV-infected Spanish speakers
Andrew J Levine1, Manuel Palomo1, Charles H Hinkin2,3, Miguel Valdes-Sueiras1,5, Enrique Lopez3,4, Glenn Mathisen1,5, Suzanne Donovan1,5, Elyse J Singer1
1National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA, 2Veterans Affairs Greater Los Angeles Healthcare System, 3Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, 4Department of Psychiatry and Behavioral Neuroscience, Cedars-Sinai Medical Center, Los Angeles; 5Olive View-UCLA Medical Center, Sylmar, CA, USA
Background: A substantial number of Spanish-speaking individuals from Mexico and Central America are now living in the United States. These individuals are at heightened risk for HIV infection and, due to late diagnosis and limited resources, for HIV-associated neurocognitive disorders (HAND). Early detection is key, yet adequate methods for detecting HAND in Spanish speakers, especially in resource-poor areas, remains problematic. Therefore, it is necessary to identify accurate yet efficient neurocognitive screening tools that are appropriate for use in resource-limited AIDS clinics serving Spanish-speaking patients.
Methods: Twenty-one Spanish-speaking, HIV-positive adults who migrated from Mexico or Central America underwent neuromedical and neurocognitive evaluation in Spanish. The concordance of three neurocognitive screening measures (the HIV Dementia Scale [HDS], the Mini-Mental State Examination [MMSE], and the NEUROPSI) with a comprehensive neuropsychological battery was examined. In addition, accuracy in detecting neurocognitive impairment using standard and alternative cutoff scores was examined.
Results: The HDS and the NEUROPSI showed high correlation with the comprehensive neuropsychological battery. The HDS and the NEUROPSI also had the highest sensitivity (67% and 75%, respectively) and specificity (50% and 38%, respectively). Both measures also showed greater sensitivity than the MMSE to very mild forms of HAND.
Conclusion: In this small sample of HIV-positive Spanish speakers from Mexico and Central America living in the United States, the HDS and the NEUROPSI demonstrated reasonable accuracy in detecting neurocognitive impairment, while the MMSE demonstrated very poor accuracy. The HDS and the NEUROPSI were equally sensitive in detecting mild HAND. Continued test development is required to capture this disorder, especially in resource-limited settings.
Keywords: HIV-associated neurocognitive disorders, Spanish speaking, NEUROPSI, HIV Dementia Scale, Mini-Mental State Examination
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