Original articleDetecting HIV Associated Neurocognitive Disorders in Adolescents: What Is the Best Screening Tool?
Section snippets
Methods
Psychological and medical charts of 71 patients, who completed psychological assessments between April 1999 and July 2006, were reviewed independently. Neurology consultation was based on psychological testing results (not HDS scores) or clinical symptoms upon exam in a hospital-based Adolescent Clinic. The neurologist, blinded to the results of the HIV dementia scale, MMSE and IQ results, determined the presence of encephalopathy using AAN criteria [6].
Data were de-identified and coded in
Results
All patients were African-American. Patients with CDC classifications B and C were prescribed antiretroviral medications. Adherence data were not available. Six patients (Table 1), 8% of sample (all male, all six perinatally infected) had a diagnosis of encephalopathy (three patients, encephalopathy, NOS; one patient, herpes encephalitis; one patient, encephalitis history and toxoplasmosis of brain; and one patient, HIV encephalopathy). One patient had lymphoma of the brain and was excluded. No
Discussion
The HDS correctly classified five of six adolescents with encephalopathy, in comparison to the MMSE identifying three of the six; nonetheless the HDS was not found to be statistically significantly superior to the MMSE. Small sample size, lack of a base rate for encephalopathy in ALWHA, as well as earlier studies suggesting that the HDS is lacking in sensitivity but is highly specific [14] may account for this finding. Consistent with findings by Morgan et al [14], in our sample, which was
Acknowledgments
The authors thank Lucy Civitello, M.D. who provided guidance with the initial study design and who was the neurologist to whom we referred our patients for assessment. We also express our appreciation to Jennifer Marsh, J.D., Ph.D. who conducted the initial data analysis and was responsible for the integrity of the data. We thank Constance L. Trexler, B.S.N., R.N., C.P.N., and Stephanie Crane, B.A., Ph.D., who were responsible for the chart review and administrative support.
References (14)
- et al.
Mini-Mental State: A practical method for grading the cognitive states of patients for the clinician
J Psychiatr Res
(1975) - et al.
Updated research nosology for HIV-associated neurocognitive disorders
Neurology
(2007) - et al.
Neurocognitive functioning in pediatric human immunodeficiency virus infection: Effects of combined therapy
Arch Pediatr Adolesc Med
(2005) - et al.
Biomarkers of HIV-1 CNS infection and injury
Neurology
(2007) - et al.
Neurobiology of HIV, psychiatric and substance abuse comorbidity research; Workshop report
Brain, Behavior, and Immunity
(2007) - et al.
Incidence rates of progressive childhood encephalopahty in Oslo, Norway: A population based study
BMC Pediatr
(2007) - et al.
Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force
Neurology
(1991)