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Michael HU, Brouillette MJ, Tamblyn R, Fellows LK, Mayo NE. The association between anticholinergic/sedative burden and physical frailty in people aging with HIV. AIDS 2024; 38:509-519. [PMID: 38051790 DOI: 10.1097/qad.0000000000003806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study aimed to estimate the strength of the association between anticholinergic/sedative burden and concurrent physical frailty in people aging with HIV. DESIGN This cross-sectional analysis examined baseline data from 824 adults with a mean age of 53 enrolled in the Positive Brain Health Now study. METHODS Anticholinergic medications were identified using four methods: Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Risk Scale (ARS), Anticholinergic Drug Scale (ADS), and the anticholinergic list of the Anticholinergic and Sedative Burden Catalog (ACSBC). Sedatives were identified using the Sedative Load Model (SLM) and the sedative list of the ACSBC. Physical frailty was assessed using a modified Fried Frailty Phenotype (FFP) based on self-report items. Multivariable logistic regression models, adjusted for sociodemographic factors, lifestyle considerations, HIV-related variables, comorbidities, and co-medication use, were used to estimate odds ratios (ORs). RESULTS Anticholinergic burden demonstrated associations with frailty across various methods: total anticholinergic burden (OR range: 1.22-1.32; 95% confidence interval (CI) range: 1.03-1.66), sedative burden (OR range: 1.18-1.24; 95% CI range: 1.02-1.45), high anticholinergic burden (OR range: 2.12-2.74; 95% CI range: 1.03-6.19), and high sedative burden (OR range: 1.94-2.18; 95% CI: 1.01-4.34). CONCLUSION The anticholinergic and sedative burdens may represent modifiable risk factors for frailty in people aging with HIV. Future studies should evaluate the effects of reducing anticholinergic and sedative burdens on frailty outcomes and explore the prognostic value of diverse scoring methods.
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Affiliation(s)
- Henry Ukachukwu Michael
- Division of Experimental Medicine, McGill University
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center
| | - Marie-Josée Brouillette
- Department of Psychiatry, Faculty of Medicine, McGill University
- Chronic Viral Illness Service, McGill University Health Centre (MUHC)
- Infectious Diseases and Immunity in Global Health Program, MUHC-RI
| | - Robyn Tamblyn
- Division of Experimental Medicine, McGill University
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lesley K Fellows
- Department of Neurology & Neurosurgery, Montreal Neurological Institute
| | - Nancy E Mayo
- Division of Experimental Medicine, McGill University
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University
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Humayun MM, Brouillette MJ, Fellows LK, Mayo NE. The Patient Generated Index (PGI) as an early-warning system for predicting brain health challenges: a prospective cohort study for people living with Human Immunodeficiency Virus (HIV). Qual Life Res 2023; 32:3439-3452. [PMID: 37428407 DOI: 10.1007/s11136-023-03475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE In research people are often asked to fill out questionnaires about their health and functioning and some of the questions refer to serious health concerns. Typically, these concerns are not identified until the statistician analyses the data. An alternative is to use an individualized measure, the Patient Generated Index (PGI) where people are asked to self-nominate areas of concern which can then be dealt with in real-time. This study estimates the extent to which self-nominated areas of concern related to mood, anxiety and cognition predict the presence or occurrence of brain health outcomes such as depression, anxiety, psychological distress, or cognitive impairment among people aging with HIV at study entry and for successive assessments over 27 months. METHODS The data comes from participants enrolled in the Positive Brain Health Now (+ BHN) cohort (n = 856). We analyzed the self-nominated areas that participants wrote on the PGI and classified them into seven sentiment groups according to the type of sentiment expressed: emotional, interpersonal, anxiety, depressogenic, somatic, cognitive and positive sentiments. Tokenization was used to convert qualitative data into quantifiable tokens. A longitudinal design was used to link these sentiment groups to the presence or emergence of brain health outcomes as assessed using standardized measures of these constructs: the Hospital Anxiety and Depression Scale (HADS), the Mental Health Index (MHI) of the RAND-36, the Communicating Cognitive Concerns Questionnaire (C3Q) and the Brief Cognitive Ability Measure (B-CAM). Logistic regressions were used to estimate the goodness of fit of each model using the c-statistic. RESULTS Emotional sentiments predicted all of the brain health outcomes at all visits with adjusted odds ratios (OR) ranging from 1.61 to 2.00 and c-statistics > 0.73 (good to excellent prediction). Nominating an anxiety sentiment was specific to predicting anxiety and psychological distress (OR 1.65 & 1.52); nominating a cognitive concern was specific to predicting self-reported cognitive ability (OR 4.78). Positive sentiments were predictive of good cognitive function (OR 0.36) and protective of depressive symptoms (OR 0.55). CONCLUSIONS This study indicates the value of using this semi-qualitative approach as an early-warning system in predicting brain health outcomes.
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Affiliation(s)
- Muhammad Mustafa Humayun
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada.
- Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, QC, Canada.
| | - Marie-Josée Brouillette
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Nancy E Mayo
- Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Qi Y, Wang W, Rao B, Yang X, Yu W, Li JY, Sun ZC, Zhou F, Li YZ, Guo YF, Wang Y, Li HJ. Value of Radiomic Analysis Combined With Diffusion Tensor Imaging in Early Diagnosis of HIV-Associated Neurocognitive Disorders. J Magn Reson Imaging 2023; 58:1882-1891. [PMID: 37118972 DOI: 10.1002/jmri.28741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The combination of radiomics and diffusion tensor imaging (DTI) may have potential clinical value in the early stage of HIV-associated neurocognitive disorders (HAND). PURPOSE To investigate the value of DTI-based radiomics in the early stage of HAND in people living with HIV (PLWH). STUDY TYPE Retrospective. POPULATION A total of 138 male PLWH were included, including 68 with intact cognition (IC) and 70 with asymptomatic neurocognitive impairment (ANI). Seventy healthy controls (HCs) were recruited for tract-based spatial statistics (TBSS) analysis. All PLWHs were randomly divided into training and validation cohorts at a 7:3 ratio. FIELD STRENGTH/SEQUENCE A 3 T, single-shot spin-echo echo planar imaging (EPI). ASSESSMENT The differences between the PLWH groups were compared using TBSS and region of interest (ROI) analysis. Radiomic features were extracted from the corpus callosum (CC) on DTI postprocessed images, including fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD). The performance of the radiomic signatures was evaluated by ROC curve analysis. The radiomic signature with the highest area under the curve (AUC) was combined with clinical characteristics to construct a nomogram. Decision curve analysis (DCA) was performed to evaluate the ability of different methods in discriminating ANI. STATISTICAL TESTS Chi-square test, independent-samples t test, Kruskal-Wallis test, Mann-Whitney U test, threshold-free cluster enhancement (TFCE), ROC curve analysis, DCA, multivariate logistic regression analysis, Hosmer-Lemeshow test. P < 0.05 with TFCE corrected and P < 0.0001 without TFCE corrected were considered statistically significant. RESULTS The ANI group showed lower FA and higher AD than the IC group. In the validation cohort, the AUCs of the FA-, AD-, MD- and RD-based radiomic signatures and the clinicoradiomic nomogram were 0.829, 0.779, 0.790, 0.864, and 0.874, respectively. DCA revealed that the nomogram was of greater clinical value than TBSS analysis, the clinical models, and the RD-based radiomic signature. DATA CONCLUSION The combination of DTI and radiomics is correlated with early stage of HAND in PLWH. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Yu Qi
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Bo Rao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xue Yang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Yu
- Center for Rehabilitation Medicine, Department of Psychiatry, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jia-Ying Li
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhi-Chao Sun
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Feini Zhou
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuan-Zhe Li
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi-Fan Guo
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Wang
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hong-Jun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Isnard S, Royston L, Scott SC, Mabanga T, Lin J, Fombuena B, Bu S, Berini CA, Goldberg MS, Finkelman M, Brouillette MJ, Fellows LK, Mayo NE, Routy JP. Translocation of bacterial LPS is associated with self-reported cognitive abilities in men living with HIV receiving antiretroviral therapy. AIDS Res Ther 2023; 20:30. [PMID: 37202809 DOI: 10.1186/s12981-023-00525-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Gut damage allows translocation of bacterial lipopolysaccharide (LPS) and fungal β-D-glucan (BDG) into the blood. This microbial translocation contributes to systemic inflammation and risk of non-AIDS comorbidities in people living with HIV, including those receiving antiretroviral therapy (ART). We assessed whether markers of gut damage and microbial translocation were associated with cognition in ART-treated PLWH. METHODS Eighty ART-treated men living with HIV from the Positive Brain Health Now Canadian cohort were included. Brief cognitive ability measure (B-CAM) and 20-item patient deficit questionnaire (PDQ) were administered to all participants. Three groups were selected based on their B-CAM levels. We excluded participants who received proton pump inhibitors or antiacids in the past 3 months. Cannabis users were also excluded. Plasma levels of intestinal fatty acid binding protein (I-FABP), regenerating islet-derived protein 3 α (REG3α), and lipopolysaccharides (LPS = were quantified by ELISA, while 1-3-β-D-glucan BDG) levels were assessed using the Fungitell assay. Univariable, multivariable, and splines analyses were performed. RESULTS Plasma levels of I-FABP, REG3α, LPS and BDG were not different between groups of low, intermediate and high B-CAM levels. However, LPS and REG3α levels were higher in participants with PDQ higher than the median. Multivariable analyses showed that LPS association with PDQ, but not B-CAM, was independent of age and level of education. I-FABP, REG3α, and BDG levels were not associated with B-CAM nor PDQ levels in multivariable analyses. CONCLUSION In this well characterized cohort of ART-treated men living with HIV, bacterial but not fungal translocation was associated with presence of cognitive difficulties. These results need replication in larger samples.
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Affiliation(s)
- Stéphane Isnard
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Léna Royston
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Susan C Scott
- Division of Clinical Epidemiology, Center for Outcomes Research and Evaluation, McGill University Health Centre (MUHC), Montreal, Canada
| | - Tsoarello Mabanga
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - John Lin
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Brandon Fombuena
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Simeng Bu
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Carolina A Berini
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Marie-Josée Brouillette
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Lesley K Fellows
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Nancy E Mayo
- Division of Clinical Epidemiology, Center for Outcomes Research and Evaluation, McGill University Health Centre (MUHC), Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Department of Medicine, Division of Geriatrics, McGill University, Montreal, Canada
| | - Jean-Pierre Routy
- Infectious Disease and Immunity in Global Health Program, Research Institute of McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada.
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
- Division of Hematology, McGill University Health Centre, Montreal, QC, Canada.
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Kaur N, Askari S, Fellows LK, Brouillette MJ, Mayo NE. Development of a self-report measure of cognitive change: assessment of interpretability in two samples, people with HIV and people without HIV. Qual Life Res 2023; 32:853-865. [PMID: 36477436 DOI: 10.1007/s11136-022-03288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
AIM The overall aim of this study was to develop a method of measuring change in cognitive ability from the person's perspective. METHODS Cognitive change items came from an item pool that was used to develop the Communicating Cognitive Concerns Questionnaire (C3Q). The change items were administered to a test sample of 211 people with HIV + and a sample of 484 people drawn from the general population (HIV- sample). Rasch analysis was used to identify items that formed a linear continuum and correlations with measures of related constructs were used to support the interpretability of the new measure. RESULTS Eleven of the original 12 change items fit the unidimensional Rasch model in both samples with a near similar ordering of the items. The average value for cognitive change of the HIV + sample was greater than that of the HIV- sample. Values on C3Q-Change correlated most highly (> 0.7) with current self-reported cognitive status and measures of depression and anxiety (> 0.6). The lowest correlation was with performance-based cognitive ability (r = 0.2). CONCLUSION The items of C3Q-Change fit a strong measurement model and related to converging constructs in an expected way. Further work needs to be done to assess the meaning of self-reported cognitive change in relationship to measured change and to examine sources of differential item functioning.
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Affiliation(s)
- Navaldeep Kaur
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
| | - Sorayya Askari
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | | | - Nancy E Mayo
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada. .,Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada.
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Rojas-Líbano D, Zúñiga J, Corrales V, Pino P, Infante M, Turnbull OH, Bowman C, Salas C. The Bangor Gambling Task: Computerized replication and reappraisal of an emotion-based decision task. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-13. [PMID: 36639359 DOI: 10.1080/23279095.2022.2162403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Emotion-based decision making (EBDM) is the capacity to make decisions based on prior emotional consequences of actions. Several neuropsychological tasks, using different gambling paradigms and with different levels of complexity, have been designed to assess EBDM. The Bangor Gambling Task (BGT) was created as a brief and simple card gambling-task to assess EBDM. BGT contains a single-card deck and requires participants to decide whether to gamble or not, which can result in wins or losses. Unknown to the participant, the winning probabilities decrease throughout the task (from 0.75 in the first block to 0.25 in the fifth block), requiring participants to reduce their gambling probability to avoid long-term losses. A few studies have offered evidence regarding the BGT convergent validity. However, there are no computerized versions of BGT available, thus slowing the process of gathering information to explore the EBDM mechanisms behind the task, its validity, and clinical usefulness. In this article, we present a computerized version of the BGT using the Matlab environment and make all our code available. We explore BGT's replicability and analyze its probabilistic structure, providing trial-level and block-level analyses. Eighty-one participants performed the computerized version, which followed the same structure as the original version. It took participants 8.5 ± 3.3 minutes to complete the task, which is faster than the paper version. Replicating previous studies, participants diminished their gambling probability throughout the task, learning to inhibit the initially rewarded gambling behavior. This change in gambling probability could be considered a proxy for EBDM. Our analyses suggest that the last blocks are especially sensitive to capturing deficits in EBDM, and we propose some modifications to BGT's original version to enhance the initial exploratory and learning phase. Our results show that the BGT constitutes a quick and simple task to evaluate EBDM capacities.
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Affiliation(s)
- Daniel Rojas-Líbano
- Centro de Estudios en Neurociencia Humana y Neuropsicología, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Javiera Zúñiga
- Centro de Estudios en Neurociencia Humana y Neuropsicología, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Programa de Magister en Neurociencia Social, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Vanessa Corrales
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Paulina Pino
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Macarena Infante
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Oliver H Turnbull
- Unidad de Neuropsicología Clínica, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Caroline Bowman
- Unidad de Neuropsicología Clínica, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Christian Salas
- Centro de Estudios en Neurociencia Humana y Neuropsicología, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- School of Psychology, Bangor University, Wales, UK
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A. P. P. TAM battery: Development and pilot testing of a Tamil computer-assisted cognitive test battery for older adults. Clin Neuropsychol 2022:1-20. [DOI: 10.1080/13854046.2022.2156396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mayo NE, Levine B, Brouillette MJ, Bélanger D, Fellows LK. Efficacy potential of Goal Management Training to improve cognitive function in older people living with HIV. Contemp Clin Trials Commun 2022; 30:101023. [PMID: 36345346 PMCID: PMC9636436 DOI: 10.1016/j.conctc.2022.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Goal Management Training® (GMT) teaches strategies to reduce cognitive load and improve focus in everyday tasks. The aim of this study was to ascertain feasibility, acceptability, and efficacy potential of GMT for people (≥50 years) with stable HIV infection scoring low on tests of cognitive ability. A two-sample, parallel, controlled trial was carried out. Feasibility was demonstrated, as 21/30 participants in the GMT group attended ≥8 of the 9 sessions and completed at least half of the homework. There was no change on the primary performance-based cognitive outcomes in the GMT group or in the control group (n = 23). There was a meaningful improvement in self-reported cognition in those adherent to the intervention. GMT is a promising intervention for people aging with HIV who are dealing with cognitive difficulties affecting their everyday life and should be further investigated.
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Affiliation(s)
- Nancy E Mayo
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Division of Clinical Epidemiology and Division of Geriatrics, McGill University Health Centre (MUHC), Center for Outcomes Research and Evaluation, MUHC-RI. Royal Victoria Hospital Site, Ross Pavilion R4.29, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada
| | - Brian Levine
- Rotman Research Institute at Baycrest and Professor of Psychology and Medicine (Neurology), University of Toronto, Canada
| | - Marie-Josée Brouillette
- Department of Psychiatry, McGill University, Chronic Viral Illness Service, McGill University Health Centre (MUHC), Infectious Diseases and Immunity in Global Health Program, MUHC-RI, Canadian Institutes of Health Research Canadian HIV Trials Network, Canada
| | | | - Lesley K Fellows
- Dept of Neurology & Neurosurgery, McGill University, Montreal Neurological Institute, 3801 University St, Montreal, QC, H3A 2B4, Canada.,Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia, Canada
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Gül Ö, Gündüz A, Sevgi DY, Demirbaş ND, Uzun N, Dökmetaş İ. Cognitive Assessment of Young Adults Before and After Initiation of Combination Antiretroviral Therapy. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:163-171. [PMID: 38633390 PMCID: PMC10986713 DOI: 10.36519/idcm.2022.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/16/2022] [Indexed: 04/19/2024]
Abstract
Objective In the determination and monitoring of neurocognitive disorders in human immunodeficiency virus (HIV)-positive individuals, there is a need for significantly more practical methods which provide results in a shorter time than the tests that require challenging and specialized expertise. This study aimed to evaluate cognitive functions and the factors affecting them in naïve HIV-positive patients using by Montreal Cognitive Assessment (MoCA) test before and after the initiation of combination antiretroviral therapy. Materials and Methods HIV-positive, treatment-naïve patients monitored between January-June 2017 were included in the study. The MoCA test was performed at the beginning and the sixth month of the treatment. Results Forty male patients were included in the study. The mean age was calculated as 29.1±4.0. When the factors affecting the MoCA score were examined, there was a significant relationship between the education level and the MoCA score. Smoking, using alcohol, and substance did not have a significant impact on baseline MoCA values. A significant correlation was found between cluster differentiation 4 (CD4) count and HIV RNA level and attention function. There was a significant increase in the total MoCA score and the MoCA subgroup scores at the end of the sixth month of the treatment. Conclusion MoCA test is one of the most practical tests that can be applied in a short time period, and it was found useful in evaluating the changes in the cognitive functions of HIV-positive patients during antiretroviral treatment.
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Affiliation(s)
- Özlem Gül
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Alper Gündüz
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Dilek Yıldız Sevgi
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Nazife Duygu Demirbaş
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Nuray Uzun
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - İlyas Dökmetaş
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
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Abstract
OBJECTIVES In the neuroHIV literature, cognitive reserve has most often been operationalized using education, occupation, and IQ. The effects of other cognitively stimulating activities that might be more amenable to interventions have been little studied. The purpose of this study was to develop an index of cognitive reserve in people with HIV, combining multiple indicators of cognitively stimulating lifetime experiences into a single value. METHODS The data set was obtained from a Canadian longitudinal study (N = 856). Potential indicators of cognitive reserve captured at the study entry included education, occupation, engagement in six cognitively stimulating activities, number of languages spoken, and social resources. Cognitive performance was measured using a computerized test battery. A cognitive reserve index was formulated using logistic regression weights. For the evidence on concurrent and predictive validity of the index, the measures of cognition and self-reported everyday functioning were each regressed on the index scores at study entry and at the last follow-up [mean duration: 25.9 months (SD 7.2)], respectively. Corresponding regression coefficients and 95% confidence intervals (CIs) were computed. RESULTS Professional sports [odds ratio (OR): 2.9; 95% CI 0.59-14.7], visual and performance arts (any level of engagement), professional/amateur music, complex video gaming and competitive games, and travel outside North America were associated with higher cognitive functioning. The effects of cognitive reserve on the outcomes at the last follow-up visit were closely similar to those at study entry. CONCLUSION This work contributes evidence toward the relative benefit of engaging in specific cognitively stimulating life experiences in HIV.
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Wilson S, Milanini B, Javandel S, Nyamayaro P, Valcour V. Validity of Digital Assessments in Screening for HIV-Related Cognitive Impairment: a Review. Curr HIV/AIDS Rep 2021; 18:581-592. [PMID: 34820750 PMCID: PMC8612826 DOI: 10.1007/s11904-021-00585-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE OF REVIEW While traditional neuropsychological tests are the gold standard in screening for HIV-related cognitive impairment, computerized neuropsychological assessment devices (CNADs) offer an alternative to these time- and resource-intensive batteries and may prove to be particularly useful for remote assessments or longitudinal monitoring. This review seeks to describe the benefits, limitations, and validity of CNADs in the evaluation of HIV-associated neurocognitive disorder (HAND). RECENT FINDINGS We identified eight CNADs that have undergone validity testing for cognitive impairment in the setting of HIV. Included among these are batteries that have been modeled after the traditional neuropsychological exam, as well as others that implement new technologies, such as simulated reality and daily ecological assessments in their testing. Currently, these digital batteries do not yet have the ability to supplant gold standard neuropsychological tests in screening for HAND. However, many have the potential to become effective clinical screening tools.
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Affiliation(s)
- Samuel Wilson
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Benedetta Milanini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Shireen Javandel
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Primrose Nyamayaro
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.
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12
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Quigley A, Brouillette MJ, Fellows LK, Mayo N. Action for better brain health among people living with HIV: protocol for a randomized controlled trial. BMC Infect Dis 2021; 21:843. [PMID: 34416849 PMCID: PMC8377450 DOI: 10.1186/s12879-021-06540-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle changes can protect or improve brain health in older adults. However, sustained lifestyle change is difficult for everyone and may be more difficult for those with executive dysfunction, including some people living with HIV. Thus, the key question is how we can improve adherence to the most promising interventions among people living with HIV experiencing cognitive difficulties. Goal management training is a cognitive rehabilitation program that targets executive dysfunction by teaching goal-directed behaviour and self-management. It is a promising means to improve adherence to lifestyle interventions. OBJECTIVE To estimate the extent to which goal management training before a healthy lifestyle program is associated with greater adherence to health recommendations, achievement of health-related goals, and better brain health and health outcomes compared to the healthy lifestyle program alone among people living with HIV. METHODS Brain Health Now cohort participants with cognitive difficulties or are not aging successfully are eligible. All participants will be given health resources, a health coach, a goal-setting digital application, and access to an online goal-setting workshop. The intervention group will participate in nine 2-h goal management training sessions and then will enter the healthy lifestyle program. Control participants will enter the healthy lifestyle program directly. A total sample of 100 participants will participate for 12 months. The main outcome is adherence to the healthy lifestyle program, defined as the number of weeks where physical activity adherence targets were met (150 min per week, measured with an activity monitor). Weekly social activities will be captured via self-report with confidential photo validation. We will send weekly health state reports to the participants. Downstream outcomes include cognitive ability, health-related quality of life, mobility, vascular risk profile, and social network size. We will analyze the data using a linear regression model. DISCUSSION This project is the first to test whether goal management training can augment adherence to health recommendations among individuals with cognitive difficulties. If successful, behavioural interventions such as goal management training could be implemented as an adjunct to lifestyle interventions in other clinical populations. TRIAL REGISTRATION This trial was registered on clinicaltrials.gov (NCT04345484) on April 14, 2020, https://clinicaltrials.gov/ct2/show/NCT04345484?term=NCT04345484&draw=2&rank=1 .
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Affiliation(s)
- Adria Quigley
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada.
| | - Marie-Josée Brouillette
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, McGill University, 3801 University St, Montreal, QC, H3A 2B4, Canada
| | - Nancy Mayo
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada
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13
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Fernandez Cruz AL, Chen CM, Sanford R, Collins DL, Brouillette MJ, Mayo NE, Fellows LK. Multimodal neuroimaging markers of variation in cognitive ability in older HIV+ men. PLoS One 2021; 16:e0243670. [PMID: 34314416 PMCID: PMC8315526 DOI: 10.1371/journal.pone.0243670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/12/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This study used converging methods to examine the neural substrates of cognitive ability in middle-aged and older men with well-controlled HIV infection. METHODS Seventy-six HIV+ men on antiretroviral treatment completed an auditory oddball task and an inhibitory control (Simon) task while time-locked high-density EEG was acquired; 66 had usable EEG data from one or both tasks; structural MRI was available for 43. We investigated relationships between task-evoked EEG responses, cognitive ability and immunocompromise. We also explored the structural correlates of these EEG markers in the sub-sample with complete EEG and MRI data (N = 27). RESULTS EEG activity was associated with cognitive ability at later (P300) but not earlier stages of both tasks. Only the oddball task P300 was reliably associated with HIV severity (nadir CD4). Source localization confirmed that the tasks engaged partially distinct circuits. Thalamus volume correlated with oddball task P300 amplitude, while globus pallidus volume was related to the P300 in both tasks. INTERPRETATION This is the first study to use task-evoked EEG to identify neural correlates of individual differences in cognition in men living with well-controlled HIV infection, and to explore the structural basis of the EEG markers. We found that EEG responses evoked by the oddball task are more reliably related to cognitive performance than those evoked by the Simon task. We also provide preliminary evidence for a subcortical contribution to the effects of HIV infection severity on P300 amplitudes. These results suggest brain mechanisms and candidate biomarkers for individual differences in cognition in HIV.
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Affiliation(s)
- Ana Lucia Fernandez Cruz
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Chien-Ming Chen
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ryan Sanford
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - D. Louis Collins
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Nancy E. Mayo
- School of Physical and Occupational Therapy, Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lesley K. Fellows
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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14
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Demeyere N, Haupt M, Webb SS, Strobel L, Milosevich ET, Moore MJ, Wright H, Finke K, Duta MD. Introducing the tablet-based Oxford Cognitive Screen-Plus (OCS-Plus) as an assessment tool for subtle cognitive impairments. Sci Rep 2021; 11:8000. [PMID: 33846501 PMCID: PMC8041764 DOI: 10.1038/s41598-021-87287-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
Here, we present the Oxford Cognitive Screen-Plus, a computerised tablet-based screen designed to briefly assess domain-general cognition and provide more fine-grained measures of memory and executive function. The OCS-Plus was designed to sensitively screen for cognitive impairments and provide a differentiation between memory and executive deficits. The OCS-Plus contains 10 subtasks and requires on average 24 min to complete. In this study, 320 neurologically healthy ageing participants (age M = 62.66, SD = 13.75) from three sites completed the OCS-Plus. The convergent validity of this assessment was established in comparison to the ACE-R, CERAD and Rey–Osterrieth. Divergent validity was established through comparison with the BDI and tests measuring divergent cognitive domains. Internal consistency of each subtask was evaluated, and test–retest reliability was determined. We established the normative impairment cut-offs for each of the subtasks. Predicted convergent and divergent validity was found, high internal consistency for most measures was also found with the exception of restricted range tasks, as well as strong test–retest reliability, which provided evidence of test stability. Further research demonstrating the use and validity of the OCS-Plus in various clinical populations is required. The OCS-Plus is presented as a standardised cognitive assessment tool, normed and validated in a sample of neurologically healthy participants. The OCS-Plus will be available as an Android App and provides an automated report of domain-general cognitive impairments in executive attention and memory.
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Affiliation(s)
- Nele Demeyere
- Department of Experimental Psychology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6AE, UK.
| | - Marleen Haupt
- Department of General and Experimental Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.,Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sam S Webb
- Department of Experimental Psychology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6AE, UK
| | - Lea Strobel
- Department of General and Experimental Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Elise T Milosevich
- Department of Experimental Psychology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6AE, UK
| | - Margaret J Moore
- Department of Experimental Psychology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6AE, UK
| | | | - Kathrin Finke
- Department of General and Experimental Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.,Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Mihaela D Duta
- Department of Experimental Psychology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6AE, UK.,Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford, OX1 3QD, UK
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15
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Niemczak C, Fellows A, Lichtenstein J, White-Schwoch T, Magohe A, Gui J, Wilbur J, Clavier O, Massawe E, Moshi N, Boivin M, Kraus N, Buckey J. Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study. JMIR Form Res 2021; 5:e26406. [PMID: 33470933 PMCID: PMC7902183 DOI: 10.2196/26406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 12/20/2022] Open
Abstract
Background The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group). Conclusions The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.
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Affiliation(s)
- Christopher Niemczak
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Abigail Fellows
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Jonathan Lichtenstein
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Travis White-Schwoch
- Department of Communication Sciences and Disorders, Northwestern University, Chicago, IL, United States
| | - Albert Magohe
- Dar Dar Programs, Dar es Salaam, United Republic of Tanzania
| | - Jiang Gui
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | | | | | - Enica Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Ndeserua Moshi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Michael Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Nina Kraus
- Department of Communication Sciences and Disorders, Northwestern University, Chicago, IL, United States
| | - Jay Buckey
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
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16
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Webb SS, Jespersen A, Chiu EG, Payne F, Basting R, Duta MD, Demeyere N. The Oxford digital multiple errands test (OxMET): Validation of a simplified computer tablet based multiple errands test. Neuropsychol Rehabil 2021; 32:1007-1032. [PMID: 33406992 DOI: 10.1080/09602011.2020.1862679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Impairments in executive functioning are common following Acquired Brain Injury, though there are few screening tools which present a time efficient and ecologically valid approach to assessing the consequences of executive impairments. We present the Oxford Digital Multiple Errands Test (OxMET), a novel and simplified computer-tablet version of a Multiple Errands Test. We recruited 124 neurologically healthy controls and 105 stroke survivors to complete the OxMET task. Normative data and internal consistency were established from the healthy control data. Convergent and divergent validation was assessed in a mixed subset of 158 participants who completed the OxMET and OCS-Plus. Test-retest reliability was examined across a mixed subset of 39 participants. Finally, we investigated the known-group discriminability of the OxMET. The OxMET demonstrated very high internal consistency, and stable group level test-retest performance as well as good convergent and divergent validity. The OxMET demonstrated high sensitivity and good specificity in overall differentiation of stroke survivors from controls. The Oxford Digital Multiple Errands Test is a brief, easy to administer tool, designed to quickly screen for potential consequences of executive impairments in a virtual environment shopping task on a computer tablet. Initial normative data and validation within a chronic stroke cohort is presented.
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Affiliation(s)
- Sam S Webb
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Anders Jespersen
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Francesca Payne
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Romina Basting
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Mihaela D Duta
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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17
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Development and validation of a voice-of-the-patient measure of cognitive concerns experienced by people living with HIV. Qual Life Res 2020; 30:921-930. [PMID: 33104940 DOI: 10.1007/s11136-020-02679-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE People living with HIV may experience some degree of mild cognitive impairment. They are best placed to report on their cognitive symptoms, but no HIV-specific questionnaire exists to elicit these concerns. This study aimed to validate a set of items to form a measure METHODS: 48 items were tested on an initial sample of 204 people with HIV. Rasch analysis was used to identify those that fit a hierarchical continuum. The hierarchy was validated on a new sample of 703 people with HIV and a sample of 484 people without HIV. RESULTS 18 items fit the model and formed the Communicating Cognitive Concerns Questionnaire (C3Q). The items spanned the full range of cognitive ability, distinguished between people working and not working, and correlated with other self-report outcomes such as mental health (0.56) and work productivity (0.60), although showed a low correlation with cognitive test performance. CONCLUSION The C3Q is the first questionnaire specifically developed for use among people with HIV. While not strongly associated with cognitive test performance, it reflects real-life concerns of people and is associated with mood, work, and work productivity. It is a needed step in assessing cognition in this population.
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18
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Quigley A, Brouillette MJ, Gahagan J, O’Brien KK, MacKay-Lyons M. Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes among People Living with HIV: A Randomized Controlled Pilot Trial. J Int Assoc Provid AIDS Care 2020; 19:2325958220935698. [PMID: 32583707 PMCID: PMC7318828 DOI: 10.1177/2325958220935698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022] Open
Abstract
The purpose of this pilot randomized controlled trial is to assess the feasibility and impact of a triweekly 12-week yoga intervention among people living with HIV (PLWH). Additional objectives included evaluating cognition, physical function, medication adherence, health-related quality of life (HRQoL), and mental health among yoga participants versus controls using blinded assessors. We recruited 22 medically stable PLWH aged ≥35 years. A priori feasibility criteria were ≥70% yoga session attendance and ≥70% of participants satisfied with the intervention using a postparticipation questionnaire. Two participants withdrew from the yoga group. Mean yoga class attendance was 82%, with 100% satisfaction. Intention-to-treat analyses (yoga n = 11, control n = 11) showed no within- or between-group differences in cognitive and physical function. The yoga group improved over time in HRQoL cognition (P = .047) with trends toward improvements in HRQoL health transition (P =.063) and depression (P = .055). This pilot study provides preliminary evidence of feasibility and benefits of yoga for PLWH.
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Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jacqueline Gahagan
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kelly Kathleen O’Brien
- Department of Physiotherapy, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Canada
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19
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Quigley A, O'Brien KK, Brouillette MJ, MacKay-Lyons M. Evaluating the Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes in People Living With HIV: Protocol for a Randomized Pilot Trial. JMIR Res Protoc 2019; 8:e13818. [PMID: 31115343 PMCID: PMC6547772 DOI: 10.2196/13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite lower mortality rates due to combination antiretroviral therapy, people living with HIV (PLWH) are grappling with increasingly complex health issues, including cognitive impairments in areas such as memory, attention, processing speed, and motor function. Yoga has been shown to be an effective form of exercise and mindfulness-based stress reduction for many clinical populations. However, no randomized trials have evaluated the impact of yoga on cognitive and physical function among PLWH. Objective The aim of this pilot randomized trial was to determine the feasibility of a yoga intervention to lay the groundwork for a full-scale, multisite, community-based trial for PLWH. Specific objectives are to (1) assess the feasibility of study protocol and procedures, (2) compare cognition in the yoga group with the usual care control group after 12 weeks of the intervention in PLWH, and (3) compare the effects of the 12-week yoga intervention versus control on balance, walking speed, physical activity, mental health, medication adherence, and quality of life among PLWH. Methods We propose a pilot randomized trial with 2 parallel groups (yoga versus control). We will recruit 25 PLWH (>35 years) from community and health organizations in Halifax, Canada. After baseline assessment with blinded assessors, participants will be randomly assigned to the yoga or control group, using a random computer generator. Participants in the yoga group will engage in supervised 60-min group-based yoga sessions 3 times a week for 12 weeks at a yoga studio. Participants in the control group will maintain their current physical activity levels throughout the study. Results As per the Consolidated Standards of Reporting Trials extension for pilot studies, means of all outcomes, mean change, and 95% CIs will be calculated for each group separately. Two-tailed independent t tests and Fisher exact tests will be used to compare groups at baseline. We will analyze quantitative postintervention questionnaire responses using Chi-square tests, and open-ended responses will be analyzed thematically. Intention-to-treat and per-protocol analyses will be used to analyze secondary variables. Changes in outcome variables will be examined between groups and within groups. Effect sizes will be reported for each outcome. A priori adherence and satisfaction criteria will be met if participants attend >70% of the yoga sessions and if >70% of the participants are satisfied with the intervention as determined by a postparticipation questionnaire. Study enrollment began in January 2018, with results expected for October 2019. Conclusions This pilot randomized trial will be the first to investigate the feasibility and effect of a yoga intervention on cognitive and physical outcomes among PLWH. This work will inform the feasibility of further investigations in terms of capacity building, participant recruitment and retention, and assessment and intervention protocols. Trial Registration ClinicalTrials.gov NCT03071562; https://clinicaltrials.gov/ct2/show/NCT03071562 (Archived by WebCite at http://www.webcitation.org/785sfhWkw) International Registered Report Identifier (IRRID) DERR1-10.2196/13818
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Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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20
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Brouillette MJ, Fellows LK, Finch L, Thomas R, Mayo NE. Properties of a brief assessment tool for longitudinal measurement of cognition in people living with HIV. PLoS One 2019; 14:e0213908. [PMID: 30908501 PMCID: PMC6433222 DOI: 10.1371/journal.pone.0213908] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background Mild cognitive impairment is common in chronic HIV infection and there is concern that it may worsen with age. Distinguishing static impairment from on-going decline is clinically important, but the field lacks well-validated cognitive measures sensitive to decline and feasible for routine clinical use. Measures capable of detecting improvement are also needed to assess interventions. The objective of this study is to estimate the extent of change on repeat administration of three different forms of a brief computerized cognitive assessment battery (B-CAM) developed for assessing cognitive ability in the mildly-impaired to normal range in people living with HIV. We hypothesized no change over a six-month period in people on effective antiretroviral therapy. Methods 102 HIV+ individuals completed a set of computerized cognitive tasks on three occasions over a six-month period. Rasch analysis was used to determine if change over time (i.e. improvement due to practice) was uniform across tasks and to refine scoring in order to produce three forms of the B-CAM of equivalent level of difficulty. Group-based trajectory analysis (GBTA) was then applied to determine if performance at baseline influenced the magnitude of practice-related improvement on the battery as a whole over the course of follow-up. Results Two cognitive tasks (fluency and word recall) had different levels of difficulty across test sessions, related to the different forms of the tasks. These two items were split by testing session. For all other items, the level of difficulty remained constant across all three time points. GBTA showed that the sample was composed of three distinct groups of people with unique trajectories, defined mainly by level of cognitive ability at baseline. Only the highest group showed an apparent improvement over time, but this change fell within measurement error. Conclusions Rasch analysis provides mathematical confirmation that these three forms of the B-CAM are of equivalent difficulty. GBTA demonstrates that no adjustment of the total score is required to correct for practice effects. Application of these modern statistical methods paves the way towards rapid and robust quantification of change in cognition.
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Affiliation(s)
- Marie-Josée Brouillette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Center, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- * E-mail:
| | - Lesley K. Fellows
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Lois Finch
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Réjean Thomas
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
| | - Nancy E. Mayo
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University Montreal, Quebec, Canada
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Bortolotti S, Zarantonello L, Uliana A, Vitturi N, Schiff S, Bisiacchi P, Avogaro A, Amodio P, Maran A. Impaired cognitive processing speed in type 1 diabetic patients who had severe/recurrent hypoglycaemia. J Diabetes Complications 2018; 32:1040-1045. [PMID: 30121207 DOI: 10.1016/j.jdiacomp.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/16/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
AIMS To detect whether adults with type 1 diabetes mellitus (T1DM) have lower cognitive performance than healthy individuals and to detect risk factors for low cognitive performance. METHODS Twenty-six adults with T1DM and twenty-six healthy subjects matched for age, gender and educational level were compared for cognitive performance by a chronometric computerized test measuring visuo-spatial working memory (N-Back) and by two validated neuropsychological tests (Mini Mental State Examination, Animal Naming Test). Clinical data about diabetes duration, average daily insulin dosage, glycated haemoglobin, retinopathy, urine albumin-creatinine ratio, previous hypoglycaemic coma and awareness of hypoglycaemia were obtained from medical records. Basal pre-test glycemia and blood pressure were measured for each patient. RESULTS No differences were found between patients (n = 26) and healthy controls (n = 26) in neuropsychological tests. Within diabetic patients, those with impaired awareness of hypoglycaemia (n = 7) or history of coma in the recent 1-3 years (n = 5) had psychomotor slowing at the N-Back test (592 ± 35 vs. 452 ± 21 ms and 619 ± 40 vs. 462 ± 19 ms, respectively; both p < 0.01). The variables related to diabetic severity did not show a relationship with reaction times of the N-Back test. CONCLUSION Psychomotor speed slowing is detectable in patients with T1DM who have a history of previous hypoglycaemic episodes or coma.
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Affiliation(s)
- Stefano Bortolotti
- Unit of Internal Medicine 5, Department of Medicine, University of Padova, Padova 35128, Italy
| | - Lisa Zarantonello
- Unit of Internal Medicine 5, Department of Medicine, University of Padova, Padova 35128, Italy
| | - Ambra Uliana
- Unit of Metabolic Disease, Department of Medicine, University of Padova, Padova 35128, Italy
| | - Nicola Vitturi
- Unit of Metabolic Disease, Department of Medicine, University of Padova, Padova 35128, Italy
| | - Sami Schiff
- Unit of Internal Medicine 5, Department of Medicine, University of Padova, Padova 35128, Italy
| | - Patrizia Bisiacchi
- Department General Psychology and CIRMANMEC, University of Padova, Padova 35128, Italy
| | - Angelo Avogaro
- Unit of Metabolic Disease, Department of Medicine, University of Padova, Padova 35128, Italy
| | - Piero Amodio
- Unit of Internal Medicine 5, Department of Medicine, University of Padova, Padova 35128, Italy.
| | - Alberto Maran
- Unit of Metabolic Disease, Department of Medicine, University of Padova, Padova 35128, Italy
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Mukherjee T, Sakthivel R, Fong HY, McStea M, Chong ML, Omar SF, Chin AV, Kamaruzzaman S, Kamarulzaman A, Rajasuriar R, Cysique LA. Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia. AIDS Behav 2018; 22:3226-3233. [PMID: 29508103 PMCID: PMC6123290 DOI: 10.1007/s10461-018-2073-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study determines the optimal cut-off scores for the Montreal Cognitive Assessment (MoCA) to detect HIV-associated neurocognitive disorders (HAND) in a multi-ethnic Malaysian HIV-positive cohort by developing demographically corrected normative standards among 283 HIV-negative community-based controls with overlapping demographic characteristics. The norms (corrected for age, sex, education, ethnicity) were applied to 342 HIV-positive virally suppressed individuals on cART. Impairment rates were classified using the Global Deficit Score (GDS ≥ .5) method. The MoCA was also scored according to the recommended cut-off of ≤ 26, and functional decline was applied to both impairment definitions to classify HAND per the Frascati criteria. The ≤ 26 cut-off considerably overestimated cognitive impairment in both samples (59.4% HIV-negative; 69.3% HIV-positive). In contrast, corrected scores yielded impairment rates consistent with what has been reported internationally in virally suppressed cohorts (23.4% with 83.3% mild impairment, 16.7% moderate impairment). A supplemental file allowing the computation of corrected MoCA scores and impairment status is included.
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Affiliation(s)
- Trena Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rishanantini Sakthivel
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Ho Yen Fong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Megan McStea
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Meng Li Chong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Sharifah Faridah Omar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Vyrn Chin
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia.
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.
| | - Lucette A Cysique
- Neuroscience Research Australia, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
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Sanou AS, Diallo AH, Holding P, Nankabirwa V, Engebretsen IMS, Ndeezi G, Tumwine JK, Meda N, Tylleskar T, Kashala-Abotnes E. Effects of schooling on aspects of attention in rural Burkina Faso, West Africa. PLoS One 2018; 13:e0203436. [PMID: 30183764 PMCID: PMC6124811 DOI: 10.1371/journal.pone.0203436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to study the effects of schooling on aspects of attention using the Test of Variables of Attention (TOVA) among children in rural Burkina Faso. Methods We re-enrolled children of a previously community-based cluster randomized exclusive breastfeeding trial in rural Burkina Faso. A total of 534 children (280 boys and 254 girls) aged 6 to 8 years were assessed using the TOVA. We examined the effect size difference using Cohen’s d, ANOVA and conducted regression analyses. Results Forty nine percent of the children were in school. Children not in school performed poorly with a small effect size difference for ‘Response Time’, ‘Errors of omission’, and ‘Errors of commission’ compared to children in school. The effect size difference was moderate for ‘Response Time Variability’, and ‘D prime score’. Conclusion Schooling affects different aspects of attention in rural Burkina Faso. In settings where literacy and schooling rate is low, public sensitizations of the benefits of schooling need to be reinforced and advice on sending children to school need to be provided continuously.
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Affiliation(s)
- Anselme Simeon Sanou
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- * E-mail:
| | - Abdoulaye Hama Diallo
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Victoria Nankabirwa
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Marie S. Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Nicolas Meda
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Thorkild Tylleskar
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Esperance Kashala-Abotnes
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Askari S, Fellows L, Brouillette MJ, Moriello C, Duracinsky M, Mayo NE. Development of an Item Pool Reflecting Cognitive Concerns Expressed by People With HIV. Am J Occup Ther 2018; 72:7202205070p1-7202205070p9. [PMID: 29426385 DOI: 10.5014/ajot.2018.023945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The overall aim of this study is to create an item pool reflecting the cognitive concerns expressed by people with HIV as a first step toward developing such a measure. METHOD Semiqualitative interviews with 292 people with HIV were carried out. Their concerns were mapped to neurocognitive domains to identify concern content areas and were compared with existing cognitive questionnaires. A questionnaire was developed to estimate the prevalence and importance of the items. RESULTS Sixty of 125 items were retained in the questionnaire based on ratings of their prevalence, importance, and clarity. Memory and behavioral and emotional concerns were the most common content areas (15 each); other domains were attention (7), executive function (6), language (5), and cognitive change (12). CONCLUSION People living with HIV experience difficulties in all domains of cognition. By recognizing all domains, this new measure can help clinicians better understand areas of perceived cognitive difficulty and plan interventions accordingly.
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Affiliation(s)
- Sorayya Askari
- Sorayya Askari, PhD, is Occupational Therapist, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lesley Fellows
- Lesley Fellows, MD, DPhil, is Assistant Dean, Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Brouillette
- Marie-Josée Brouillette, MD, is Associate Professor, Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Carolina Moriello
- Carolina Moriello, is Research Assistant, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Martin Duracinsky
- Martin Duracinsky, MD, PhD, is Scientific Director, Patient-Centered Outcomes Research, Université Paris Diderot, Sorbonne Paris Cité, France, and Médecin, Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Nancy E Mayo
- Nancy E. Mayo, PhD, is James McGill Professor, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada, and Research Scientist, Center of Outcome Research and Evaluation, Research Institute of McGill University Health Center, Montreal, Quebec, Canada;
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Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry 2018; 33:379-388. [PMID: 28731508 DOI: 10.1002/gps.4756] [Citation(s) in RCA: 446] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) is a cognitive screening tool that aims to differentiate healthy cognitive aging from Mild Cognitive Impairment (MCI). Several validation studies have been conducted on the MoCA, in a variety of clinical populations. Some studies have indicated that the originally suggested cutoff score of 26/30 leads to an inflated rate of false positives, particularly for those of older age and/or lower education. We conducted a systematic review and meta-analysis of the literature to determine the diagnostic accuracy of the MoCA for differentiating healthy cognitive aging from possible MCI. METHODS Of the 304 studies identified, nine met inclusion criteria for the meta-analysis. These studies were assessed across a range of cutoff scores to determine the respective sensitivities, specificities, positive and negative predictive accuracies, likelihood ratios for positive and negative results, classification accuracies, and Youden indices. RESULTS Meta-analysis revealed a cutoff score of 23/30 yielded the best diagnostic accuracy across a range of parameters. CONCLUSIONS A MoCA cutoff score of 23, rather than the initially recommended score of 26, lowers the false positive rate and shows overall better diagnostic accuracy. We recommend the use of this cutoff score going forward. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicole Carson
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Larry Leach
- Department of Psychology, Glendon College, Toronto, Ontario, Canada
| | - Kelly J Murphy
- Department of Neuropsychology and Cognitive Health, Baycrest Health Sciences and Departments of Psychology, University of Toronto and York University, Toronto, Ontario, Canada
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The Montreal Cognitive Assessment-Basic (MoCA-B) is not a reliable screening tool for cognitive decline in HIV patients receiving combination antiretroviral therapy in rural South Africa. Int J Infect Dis 2017; 67:36-40. [PMID: 29183843 DOI: 10.1016/j.ijid.2017.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 10/25/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorders (HAND) are frequently occurring comorbidities in HIV-positive patients, diagnosed by means of a neuropsychological assessment (NPA). Due to the magnitude of the HIV-positive population in Sub-Saharan Africa, easy-to-use cognitive screening tools are essential. METHODS This was a cross-sectional clinical trial involving 44 HIV-positive patients (on stable cART) and 73 HIV-negative controls completing an NPA, the International HIV Dementia Scale (IHDS), and a culturally appropriate cognitive screening tool, the Montreal Cognitive Assessment-Basic (MoCA-B). HAND were diagnosed by calculating Z-scores using internationally published normative data on NPA, as well as by using data from the HIV-negative group to validate the MoCA-B. RESULTS One hundred and seventeen patients were included (25% male, median age 35 years, median 11 years of education). A moderate correlation was found between the MoCA-B and NPA total Z-score (Pearson's r=0.36, p=0.02). Area under the curve (AUC) values for MoCA-B and IHDS were 0.59 and 0.70, respectively. The prevalence of HAND in HIV-positive patients was 66% when calculating Z-scores using published normative data versus 48% when using the data from the present HIV-negative cohort. CONCLUSION The MoCA-B appeared not to be a valid screening tool for HAND in this setting. The prevalence of HAND in this setting is high, but appeared overestimated when using published norms.
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28
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Can a tablet-based cancellation test identify cognitive impairment in older adults? PLoS One 2017; 12:e0181809. [PMID: 28742136 PMCID: PMC5524401 DOI: 10.1371/journal.pone.0181809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 07/09/2017] [Indexed: 11/24/2022] Open
Abstract
Background and objective There has been a growing interest in using computerized cognitive assessment to detect age-related cognitive disorders. We have developed a tablet-based cancellation test (e-CT), previously shown as a reliable measure of executive functions and free of effect of familiarity with computer-based devices in healthy older adults. This study aimed to investigate the influence of demographics and current daily use of computer-based devices in older adults with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD). We further studied the ability of the e-CT to discriminate MCI and AD patients from older adults with normal cognition (NC). Methods The e-CT was administered to 325 older adults (NC = 112, MCI = 129, AD = 84). Subjects also performed the K-T test, a paper-and-pencil cancellation test from which the e-CT was developed. Multiple linear regression analyses were conducted to assess the contribution of demographics and current daily use of computer-based devices on the e-CT in patient groups. The Receiver Operating Characteristic (ROC) curves and the Area Under the Curve (AUC) were established to compare the efficacy of the e-CT and the K-T test to classify subjects into diagnostic groups. Results In the MCI group, age (B = -0.37, p<0.001) and current daily use of computer-based devices (B = 5.85, p<0.001) were associated with the number of correct cancellations of the e-CT. In the AD group, only current daily use of a computer-based device was a significant contributor (B = 6.28, p<0.001). The e-CT (AUC = 0.811; 95% confidence interval [CI]: 0.756–0.867) and the K-T (AUC = 0.837; CI: 0.787–0.887) showed good and comparable diagnostic accuracy to discriminate between MCI and NC subjects. To discriminate between NC and AD, both tests showed high diagnostic accuracy, with the AUC values of 0.923 (CI: 0.876–0.971) and 0.929 (95%CI: 0.886–0.972) for the e-CT and the K-T, respectively. Conclusion The e-CT presents satisfying discriminative validity and is a promising tool for detection of early cognitive impairment in older adults.
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29
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Evaluating the performance of the Montreal Cognitive Assessment in early stage Parkinson's disease. Parkinsonism Relat Disord 2017; 37:58-64. [DOI: 10.1016/j.parkreldis.2017.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/19/2016] [Accepted: 01/25/2017] [Indexed: 11/17/2022]
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Fazeli PL, Casaletto KB, Paolillo E, Moore RC, Moore DJ, the HNRP Group. Screening for neurocognitive impairment in HIV-positive adults aged 50 years and older: Montreal Cognitive Assessment relates to self-reported and clinician-rated everyday functioning. J Clin Exp Neuropsychol 2017; 39:842-853. [DOI: 10.1080/13803395.2016.1273319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. L. Fazeli
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - K. B. Casaletto
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - E. Paolillo
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - R. C. Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
- Stein Institute for Research on Aging, University of California, San Diego, CA, USA
- Veterans Administration San Diego Health Care System, San Diego, CA, USA
| | - D. J. Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
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Milanini B, Ciccarelli N, Fabbiani M, Baldonero E, Limiti S, Gagliardini R, Borghetti A, D'Avino A, Mondi A, Colafigli M, Cauda R, Di Giambenedetto S. Neuropsychological screening tools in Italian HIV+ patients: a comparison of Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). Clin Neuropsychol 2016; 30:1457-1468. [PMID: 27180611 DOI: 10.1080/13854046.2016.1183048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite the progress in HIV treatments, mild forms of cognitive impairment still persist. Brief and sensitive screening tools are needed. We evaluated the accuracy of the Montreal Cognitive Assessment (MoCA) compared to the Mini Mental State Examination (MMSE) to detect cognitive impairment in HIV-infected participants. METHOD HIV-infected patients were consecutively enrolled during routine outpatient visits at a single institution. The MoCA, the MMSE, and a comprehensive neuropsychological battery were administered. Patients were considered as affected by cognitive impairment if they showed decreased cognitive function in at least two ability domains based on age and education adjusted Italian normative cut-offs. RESULTS Ninety-three HIV-infected participants (75% males, median age 47, all on antiretroviral therapy; 90% HIV-RNA <50copies/mL, median CD4 644 cells/μL) were enrolled. Thirteen participants (14%) were diagnosed as cognitively compromised via a comprehensive neuropsychological examination. The area under the curve of the adjusted MMSE and MoCA scores to detect cognitive impairment were .51 (95% CI = .31-.72, p = .877) and .70 (95% CI = .53-.86, p = .025), respectively. A MoCA score <22 was able to predict the cognitive impairment with 62% of sensitivity and 76% of specificity. CONCLUSIONS Our findings suggested that the prognostic performance of the MoCA to detect cognitive impairment among mildly impaired HIV-infected participants was only moderate. Further investigations are needed to identify optimal cognitive tests to screen HIV-infected individuals or to explore whether a combination of cognitive tests might represent a viable alternative to a single screening tool.
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Affiliation(s)
- Benedetta Milanini
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Nicoletta Ciccarelli
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Massimiliano Fabbiani
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Eleonora Baldonero
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Silio Limiti
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Roberta Gagliardini
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Alberto Borghetti
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Alessandro D'Avino
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Annalisa Mondi
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Manuela Colafigli
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Roberto Cauda
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Simona Di Giambenedetto
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
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Mayo NE, Brouillette MJ, Fellows LK. Understanding and optimizing brain health in HIV now: protocol for a longitudinal cohort study with multiple randomized controlled trials. BMC Neurol 2016; 16:8. [PMID: 26762403 PMCID: PMC4712501 DOI: 10.1186/s12883-016-0527-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/05/2016] [Indexed: 11/26/2022] Open
Abstract
Background Chronic HIV infection commonly affects both cognition and mental health, even with excellent systemic viral control. The causes of compromised brain health are likely to be a multi-factorial combination of HIV-related biological factors, co-morbidities such as aging and cerebrovascular disease, and the erosion of coping skills, physical health, and social supports resulting from the strains of living with a chronic illness. Methods/design This study aims to provide a better understanding of the relationship between cognitive complaints, depression, and objectively measured cognitive impairment in HIV, and of the key factors, whether biological or personal, which relate to these presentations and to their evolution over time. Characterization of this heterogeneity will permit more focused pathophysiological studies, and allow more targeted interventions. The project makes extensive use of Web-based research and health care delivery tools, aiming to provide cost-effective, “clinic ready” tools to improve brain health in HIV. This project has two overarching aims, reflecting our dual goals of understanding and improving brain health in HIV, focusing on cognitive impairment, its contributors and consequences. The objectives are to contribute evidence for the validity of a brief brain health assessment, to estimate the extent to which HIV-related cognition-relevant clinical factors and patient-centered outcomes inter-relate and evolve over time, allowing identification of the mechanisms underpinning longitudinal change in brain health and to contribute evidence for the feasibility, effectiveness potential, acceptability, and underlying mechanisms of promising interventions for optimizing brain health. We adopt a cohort multiple randomized control trials design. A total of 900 participants will be characterized prospectively over a 27-month period to answer questions about the evolution of outcomes of interest. All participants will be offered basic brain health self-management information. Sub-groups will participate in pilot studies of specific, more intensive interventions to provide pragmatic evidence for feasibility, effectiveness, and comparative effectiveness. Discussion This work will provide needed estimates of the burden, heterogeneity, evolution, and mechanisms underlying compromised brain health in HIV, and test a range of promising non-pharmacological interventions. This is an on-going study; the trials nested within this cohort that are currently recruiting participants were registered on 7 October 2015 (Clinicaltrials.gov NCT02571504 and NCT02571595).
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Affiliation(s)
- Nancy E Mayo
- Department of Medicine and School of Physical and Occupational Therapy, McGill University, Ross Pavilion R4.29, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada. .,Division of Clinical Epidemiology and Division of Geriatrics, McGill University Health Center, Royal Victoria Hospital Site, Montreal, Canada.
| | - Marie-Josée Brouillette
- Department of Psychiatry, McGill University; Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.
| | - Lesley K Fellows
- Department of Neurology & Neurosurgery, McGill University, Montreal Neurological Institute, 3801 University St, Montreal, QC, H3A 2B4, Canada.
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Sullivan EV, Brumback T, Tapert SF, Fama R, Prouty D, Brown SA, Cummins K, Thompson WK, Colrain IM, Baker FC, De Bellis MD, Hooper SR, Clark DB, Chung T, Nagel BJ, Nichols BN, Rohlfing T, Chu W, Pohl KM, Pfefferbaum A. Cognitive, emotion control, and motor performance of adolescents in the NCANDA study: Contributions from alcohol consumption, age, sex, ethnicity, and family history of addiction. Neuropsychology 2016; 30:449-73. [PMID: 26752122 DOI: 10.1037/neu0000259] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate development of cognitive and motor functions in healthy adolescents and to explore whether hazardous drinking affects the normal developmental course of those functions. METHOD Participants were 831 adolescents recruited across 5 United States sites of the National Consortium on Alcohol and NeuroDevelopment in Adolescence 692 met criteria for no/low alcohol exposure, and 139 exceeded drinking thresholds. Cross-sectional, baseline data were collected with computerized and traditional neuropsychological tests assessing 8 functional domains expressed as composite scores. General additive modeling evaluated factors potentially modulating performance (age, sex, ethnicity, socioeconomic status, and pubertal developmental stage). RESULTS Older no/low-drinking participants achieved better scores than younger ones on 5 accuracy composites (general ability, abstraction, attention, emotion, and balance). Speeded responses for attention, motor speed, and general ability were sensitive to age and pubertal development. The exceeds-threshold group (accounting for age, sex, and other demographic factors) performed significantly below the no/low-drinking group on balance accuracy and on general ability, attention, episodic memory, emotion, and motor speed scores and showed evidence for faster speed at the expense of accuracy. Delay Discounting performance was consistent with poor impulse control in the younger no/low drinkers and in exceeds-threshold drinkers regardless of age. CONCLUSIONS Higher achievement with older age and pubertal stage in general ability, abstraction, attention, emotion, and balance suggests continued functional development through adolescence, possibly supported by concurrently maturing frontal, limbic, and cerebellar brain systems. Determination of whether low scores by the exceeds-threshold group resulted from drinking or from other preexisting factors requires longitudinal study. (PsycINFO Database Record
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Ty Brumback
- Department of Psychiatry, University of California, San Diego
| | - Susan F Tapert
- Psychology Service, Veterans Affairs San Diego Healthcare System
| | - Rosemary Fama
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | - Sandra A Brown
- Department of Psychiatry, University of California, San Diego
| | - Kevin Cummins
- Department of Psychiatry, University of California, San Diego
| | | | | | | | - Michael D De Bellis
- Healthy Childhood Brain Development Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine
| | | | - Tammy Chung
- Department of Psychiatry, University of Pittsburgh
| | - Bonnie J Nagel
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health and Sciences University
| | - B Nolan Nichols
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | | | - Kilian M Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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Kim WJ, Ku NS, Lee YJ, Ahn JY, Kim SB, Ahn HW, Hong KW, Song JY, Cheong HJ, Kim WJ, Kim JM, Namkoong K, Choi JY, Kim E. Utility of the Montreal Cognitive Assessment (MoCA) and its subset in HIV-associated neurocognitive disorder (HAND) screening. J Psychosom Res 2016; 80:53-7. [PMID: 26721548 DOI: 10.1016/j.jpsychores.2015.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/12/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The Montreal Cognitive Assessment (MoCA) is a useful screening tool for mild cognitive impairment. We aimed to know whether the full MoCA and subsets of the full test are effective for detecting HIV-associated neurocognitive disorder (HAND). METHODS We examined the socio-demographic, clinical, functional, and neuropsychological levels of 194 HIV-infected patients. We compared total scores and scores from each cognitive domain of MoCA between patients with and without HAND. We also examined the utility of subsets of the full test using a few selective domains. The diagnostic accuracies of MoCA and subset composition were evaluated. RESULTS The total scores of MoCA (P<0.001) and scores from Trail Making Test-B (P=0.020), attention domain (P=0.005), and immediate (P=0.003) and delayed recall (P=0.002) differed between patients with and without HAND. A subset composed of Trail Making Test-B, rescored serial subtraction, and immediate/delayed recall showed a 69.2% accuracy. CONCLUSIONS Our results suggest that the MoCA and its subsets alone are not sufficient in screening for HAND. Further studies will be needed to develop a simpler and easier screening tool for HAND based on this study.
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Affiliation(s)
- Woo Jung Kim
- Department of Psychiatry, Seonam University College of Medicine, Myongji Hospital, Goyang, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Young-Joon Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jin Young Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Sun Bean Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Hye-Won Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Kyung-Wook Hong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea.
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
| | - June Myung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Kee Namkoong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Eosu Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
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Abstract
BACKGROUND A large proportion of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) suffer from neurocognitive impairment (NCI). The causes of the NCI are multifold in HIV infection although a subset of HIV/AIDS patients are affected by the spectrum syndrome, HIV-associated neurocognitive disorder (HAND). We investigated the Montreal Cognitive Assessment (MoCA) in relation to clinical, demographic and laboratory findings as well as its ability to predict symptomatic HAND (sHAND) among patients with HIV/AIDS. METHODS All subjects were receiving regular HIV care including CD4+ T cell counts, plasma viral load measurements, clinical evaluations and antiretroviral therapy. The diagnosis of sHAND was based upon clinical, neuroimaging, and neuropsychological assessments. RESULTS Among HIV-1 seropositive subjects (n=125), ethnicity, education and employment were positively correlated with their MoCA scores (p<0.05). In contrast, polypharmacy, central nervous system penetration-effectiveness (CPE) score, antiretroviral drug exposure, substance use and nucleoside/nucleotide reverse transcriptase inhibitor side effects were negatively correlated with MoCA scores (p<0.05). Of note, MoCA scores were not associated with CD4 T cell nadir levels, age, peak viral load, or veterans aging cohort study index. In subjects with or without sHAND, mean MoCA scores differed (sHAND, 22.8±3.51; non-HAND 25.2±2.64) (p<0.05) with a receiver operating characteristic curve showing an area under curve of 0.71 and an optimal MoCA cut-off value of 23.5 when compared to the established diagnostic paradigm. CONCLUSIONS MoCA scores were generally lower in this HIV/AIDS population compared to reported scores in the general population. MoCA performance was associated with multiple clinical variables but displayed limited predictive utility in detecting sHAND.
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DeVaughn S, Müller-Oehring EM, Markey B, Brontë-Stewart HM, Schulte T. Aging with HIV-1 Infection: Motor Functions, Cognition, and Attention--A Comparison with Parkinson's Disease. Neuropsychol Rev 2015; 25:424-38. [PMID: 26577508 PMCID: PMC5519342 DOI: 10.1007/s11065-015-9305-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/08/2015] [Indexed: 12/31/2022]
Abstract
Recent advances in highly active anti-retroviral therapy (HAART) in their various combinations have dramatically increased the life expectancies of HIV-infected persons. People diagnosed with HIV are living beyond the age of 50 but are experiencing the cumulative effects of HIV infection and aging on brain function. In HIV-infected aging individuals, the potential synergy between immunosenescence and HIV viral loads increases susceptibility to HIV-related brain injury and functional brain network degradation similar to that seen in Parkinson's disease (PD), the second most common neurodegenerative disorder in the aging population. Although there are clear diagnostic differences in the primary pathology of both diseases, i.e., death of dopamine-generating cells in the substantia nigra in PD and neuroinflammation in HIV, neurotoxicity to dopaminergic terminals in the basal ganglia (BG) has been implied in the pathogenesis of HIV and neuroinflammation in the pathogenesis of PD. Similar to PD, HIV infection affects structures of the BG, which are part of interconnected circuits including mesocorticolimbic pathways linking brainstem nuclei to BG and cortices subserving attention, cognitive control, and motor functions. The present review discusses the combined effects of aging and neuroinflammation in HIV individuals on cognition and motor function in comparison with age-related neurodegenerative processes in PD. Despite the many challenges, some HIV patients manage to age successfully, most likely by redistribution of neural network resources to enhance function, as occurs in healthy elderly; such compensation could be curtailed by emerging PD.
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Affiliation(s)
- S DeVaughn
- Bioscience Division, Neuroscience Program, SRI International, 333 Ravenswood Ave, Menlo Park, CA, USA
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - E M Müller-Oehring
- Bioscience Division, Neuroscience Program, SRI International, 333 Ravenswood Ave, Menlo Park, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - B Markey
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - H M Brontë-Stewart
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - T Schulte
- Bioscience Division, Neuroscience Program, SRI International, 333 Ravenswood Ave, Menlo Park, CA, USA.
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA.
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Brouillette MJ, Fellows LK, Palladini L, Finch L, Thomas R, Mayo NE. Quantifying cognition at the bedside: a novel approach combining cognitive symptoms and signs in HIV. BMC Neurol 2015; 15:224. [PMID: 26563353 PMCID: PMC4643497 DOI: 10.1186/s12883-015-0483-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 11/01/2015] [Indexed: 11/24/2022] Open
Abstract
Background Up to half of all people with HIV infection have some degree of cognitive impairment. This impairment is typically mild, but nonetheless often disabling. Although early detection of cognitive impairment offers the greatest hope of effective intervention, there are important barriers to this goal in most clinical settings. These include uncertainty about how self-reported cognitive symptoms relate to objective impairments, and the paucity of bedside measurement tools suitable for mild deficits. Clinicians need guidance in interpreting cognitive symptoms in this population, and a brief cognitive measurement tool targeted to mild impairment. We addressed these two problems together here. The objective of this study was to determine the extent to which performance on cognitive tests and self-reported cognitive symptoms form a unidimensional construct. Methods Two hundred three HIV+ individuals completed the Montreal Cognitive Assessment, computerized cognitive tasks and a questionnaire eliciting cognitive symptoms. Rasch measurement theory was applied to determine whether patient-reported and performance items could be combined to measure cognition as a unidimensional latent construct. Results Performance-based items and cognitive symptoms are arranged hierarchically along the same continuum of cognitive ability, forming a measure with thresholds covering a broad spectrum of ability that has good internal reliability. The cognitive symptoms that fit the measurement model relate to important aspects of everyday life, providing evidence that the identified construct is meaningful. Conclusions This finding lays the foundation for a rapid measure of cognitive ability in people with HIV infection that is feasible for routine clinical use, and shows that some cognitive symptoms are systematically related to performance in this population.
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Affiliation(s)
- Marie-Josée Brouillette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada. .,Chronic Viral Illness Service, McGill University Health Center, Montreal, QC, Canada. .,Research Institute of the McGill University Health Centre, Montreal, QC, Canada. .,McGill University Health Centre, Glen site, 1001 Decarie, D02.4110, Montreal, QC, H4A 3J1, Canada.
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada. .,Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - Lisa Palladini
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Lois Finch
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, QC, Canada.
| | | | - Nancy E Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada. .,Division of Clinical Epidemiology, McGill University Health Center, Montreal, QC, Canada.
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Wu YH, Vidal JS, de Rotrou J, Sikkes SAM, Rigaud AS, Plichart M. A Tablet-PC-Based Cancellation Test Assessing Executive Functions in Older Adults. Am J Geriatr Psychiatry 2015; 23:1154-61. [PMID: 26238229 DOI: 10.1016/j.jagp.2015.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/25/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine older adults' performance on a newly developed tablet-PC-based cancellation test (e-CT) and to study its psychometric properties. METHODS 94 older adults with normal cognitive functioning were recruited. The effects of age, education, sex, and experience with computer-based devices on the e-CT were examined. Construct validity was tested by correlating the e-CT with established measures of executive functions (EF) and episodic memory. Correlation coefficients were used to assess short-term test-retest reliablity. RESULTS The mean age of participants was 74.6 (SD: 7.3) years and 78% were women. Sixty-nine percent had higher education level (> high school) and 76% used computer-based devices daily. The correct cancellations (CC) on the e-CT ranged from 18 to 56, with a mean (SD) of 40.3 (5.7). The CC was inversely correlated with advancing age (rs = -0.59, N = 94, p <0.001) and positively associated with higher education level (U(94) = 646.5, p = 0.02). No relationship was observed between the e-CT and sex or computer-based device experience. In multivariate analysis, only age remained significantly associated with CC (β = -0.46, SE = 0.07, t = -6.47, df = 93, p <0.001). The e-CT correlated significantly with most of measures of EF. Highest correlations were found between the e-CT and the K-T test, a paper-and-pencil cancellation test (rs = 0.63, N = 90, p <0.001) and TMT-B (rs = -0.41, N = 85, p <0.001). The e-CT did not correlate with the RL-RI 16 episodic memory test. The correlation between the first and second e-CT indicated good reliability (rs = 0.89, N = 13, p <0.001). CONCLUSIONS Results suggested that e-CT has good psychometric properties and may be useful for assessing EF in older adults.
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Affiliation(s)
- Ya-Huei Wu
- Assistance Publique - Hôpitaux de Paris, Broca Hospital, and University Paris Descartes, Paris, France.
| | - Jean-Sébastien Vidal
- Assistance Publique - Hôpitaux de Paris, Broca Hospital, and University Paris Descartes, Paris, France
| | - Jocelyne de Rotrou
- Assistance Publique - Hôpitaux de Paris, Broca Hospital, and University Paris Descartes, Paris, France
| | - Sietske A M Sikkes
- Alzheimer Center and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Anne-Sophie Rigaud
- Assistance Publique - Hôpitaux de Paris, Broca Hospital, and University Paris Descartes, Paris, France
| | - Matthieu Plichart
- Assistance Publique - Hôpitaux de Paris, Broca Hospital, and University Paris Descartes, Paris, France
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Abstract
Objective: Existing screening tools for HIV-Associated Neurocognitive Disorders (HAND) may lack the accuracy required for clinical use. We hypothesized that the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) as a screening tool for HAND might be improved with a stronger scoring methodology. Design: Two hundred HIV-positive participants aged 18–65 years completed the MoCA and a battery of neuropsychological tests. Methods: HAND diagnosis was established according to the Frascati criteria, and an NPZ-8 score was also calculated. Rasch analysis was applied to the MoCA items to create a quantitative score. Results: The optimal cut-off on the quantitative MoCA for detecting impairment as per Frascati criteria yielded a sensitivity of 0.74 and a specificity of 0.68. Overall accuracy was 0.79 (95% CI: 0.73–0.85), an improvement over standard scoring methods. However, whether cognition was quantified with the quantitative MoCA or with NPZ-8, there was substantial overlap between diagnostic categories; several individuals categorized as impaired had better overall cognitive function as assessed by NPZ-8 or quantitative MoCA than those classified as normal using standard criteria. Conclusion: Quantifying performance on MoCA items through Rasch analysis improves its accuracy as a screening tool for HAND, and demonstrates that cognition can be measured as a unidimensional construct in HIV, at least at the level of precision of bedside testing. However, the current categorical diagnostic approach to HAND is poorly aligned with summary measures of cognitive ability. Measuring cognition as a quasi-continuous construct may be more relevant than conventional HAND diagnostic categories for many clinical purposes.
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40
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Janssen MAM, Bosch M, Koopmans PP, Kessels RPC. Validity of the Montreal Cognitive Assessment and the HIV Dementia Scale in the assessment of cognitive impairment in HIV-1 infected patients. J Neurovirol 2015; 21:383-90. [PMID: 25678141 PMCID: PMC4510920 DOI: 10.1007/s13365-015-0324-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/22/2015] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
The gold standard for evaluating cognitive impairments in HIV-infected patients is to administer an extensive neuropsychological assessment. This may, however, be time-consuming and hence not always feasible in the clinic. Therefore, several brief screening tools have been developed. This study determined the validity of the Montreal Cognitive Assessment (MoCA) and the HIV Dementia Scale (HDS) in detecting cognitive impairment using both the Frascati and cognitive impairment, no dementia (CIND) criteria to classify cognitive impairment in HIV-1 infected patients. The MoCA, HDS, and an extensive neuropsychological assessment, covering nine cognitive domains, were administered in a group of 102 HIV-infected patients who were all on cART and virologically suppressed for at least 1 year. Results show that the areas under the curve (AUCs) for both the MoCA and the HDS were statistically significant, using both the Frascati and the CIND criteria as gold standard. However, the AUCs for the MoCA and HDS did not differ significantly, regardless of the used classification criteria (Frascati: z = 0.37, p = 0.35; CIND: z = -0.62, p = 0.27). Sensitivity of both the MoCA and HDS were low for the recommended cutoff scores (Frascati: MoCA (<26) = 0.56, HDS (<11) = 0.26; CIND: MoCA (<26) = 0.55, HDS (<11) = 0.36). Cutoff scores with good sensitivity and adequate specificity could not be determined for both screening instruments. Therefore, the HDS and MoCA are not recommended as sole instruments to diagnose HIV-associated cognitive impairment.
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Affiliation(s)
- M A M Janssen
- Department of Medical Psychology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Watkins CC, Treisman GJ. Cognitive impairment in patients with AIDS - prevalence and severity. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 7:35-47. [PMID: 25678819 PMCID: PMC4319681 DOI: 10.2147/hiv.s39665] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression), minor cognitive-motor dysfunction, and HIV-associated dementia.
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Affiliation(s)
- Crystal C Watkins
- The Memory Center in Neuropsychiatry, Sheppard Pratt Health System, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Glenn J Treisman
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Milanini B, Wendelken LA, Esmaeili-Firidouni P, Chartier M, Crouch PC, Valcour V. The Montreal cognitive assessment to screen for cognitive impairment in HIV patients older than 60 years. J Acquir Immune Defic Syndr 2015; 67:67-70. [PMID: 24872137 DOI: 10.1097/qai.0000000000000220] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Progress in HIV treatments has led to HIV-infected patients living into their 60s and older. Because HIV-associated neurocognitive disorder (HAND) in older age is associated with more executive dysfunction, cognitive screening instruments tapping this domain may be optimal. We examined the Montreal Cognitive Assessment to identify HAND in 67 HIV-infected patients older than 60 years, of which 40% were diagnosed with HAND. Receiver operating characteristic curve identified an optimal cutpoint of ≤ 25 for HAND with a sensitivity of 72% and specificity of 67%. We conclude that the Montreal Cognitive Assessment has only moderate performance characteristics for cognitive screening of HIV-infected elders.
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Affiliation(s)
- Benedetta Milanini
- *Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy; †Memory and Aging Center, Department of Neurology, University of California-San Francisco, San Francisco, CA; ‡Department of Veterans Affairs Medical Center San Francisco San Francisco, CA; §Department of Community Health Systems, School of Nursing, University of California-San Francisco, San Francisco, CA; and ‖Division of Geriatric Medicine, Department of Medicine, University of California-San Francisco, San Francisco, CA
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Chartier M, Crouch PC, Tullis V, Catella S, Frawley E, Filanosky C, Carmody T, McQuaid J, Lampiris H, Wong JK. The Montreal Cognitive Assessment: A Pilot Study of a Brief Screening Tool for Mild and Moderate Cognitive Impairment in HIV-Positive Veterans. J Int Assoc Provid AIDS Care 2014; 14:197-201. [PMID: 25487428 DOI: 10.1177/2325957414557270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
HIV-associated neurocognitive disorders (HANDs) are common, often go undetected, and can impact treatment outcomes. There is limited evidence on how to perform routine cognitive screening in HIV clinical settings. To address this, 44 HIV-positive males were recruited from a Veteran Affairs Infectious Disease clinic and completed the Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), and Depression Anxiety and Stress Scale-21. In all, 50% scored below the MoCA cutoff and 36% scored below the IHDS cutoff. Current CD4 was the strongest predictor of an abnormal MoCA score (P = .007, 95% confidence interval [CI]: 0.987-0.998) and elevated depression was the second strongest predictor (P = .008, CI: 1.043-1.326). Combination antiviral therapy use and age were not significant predictors in this model. The MoCA appeared to be a reasonable screening tool to detect cognitive impairment in HIV-positive patients, and although it is not sufficient to diagnose HAND, it has the potential to provide meaningful clinical data.
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Affiliation(s)
- Maggie Chartier
- Department of Veterans Affairs Medical Center, San Francisco VA Medical Center, San Francisco, CA, USA Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Pierre-Cédric Crouch
- Department of Veterans Affairs Medical Center, San Francisco VA Medical Center, San Francisco, CA, USA Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Stephanie Catella
- Department of Neurology, University of California San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Erin Frawley
- Seneca Center Family of Agencies, San Francisco, CA, USA
| | - Charles Filanosky
- Department of Veterans Affairs Medical Center, San Francisco VA Medical Center, San Francisco, CA, USA Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Timothy Carmody
- Department of Veterans Affairs Medical Center, San Francisco VA Medical Center, San Francisco, CA, USA Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - John McQuaid
- Department of Veterans Affairs Medical Center, San Francisco VA Medical Center, San Francisco, CA, USA Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Harry Lampiris
- Department of Veterans Affairs Medical Center, San Francisco VA Medical Center, San Francisco, CA, USA Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Joseph K Wong
- Department of Veterans Affairs Medical Center, San Francisco VA Medical Center, San Francisco, CA, USA Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Valcour V, Paul R, Chiao S, Wendelken LA, Miller B. Screening for cognitive impairment in human immunodeficiency virus. Clin Infect Dis 2014; 53:836-42. [PMID: 21921226 DOI: 10.1093/cid/cir524] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Recent publications estimate the prevalence of human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) exceeds 50%, and this rate is likely higher among older patients. Cognitive impairment may impact medication adherence, and symptomatic impairment has been linked to all-cause mortality providing some impetus for early detection. There are currently insufficient data to inform solid recommendations on screening methods. Most HIV-specific tools have poor performance characteristics for all but the most severe form of impairment, which accounts for <5% of cases. Reliance on symptoms is likely to miss a substantial proportion of individuals with HAND due to poor insight, confounding mood disturbances, and lack of well-informed proxies. In the aging HIV-positive population, broader screening tools may be required to allow sensitivity for both HIV and neurodegenerative disorders. We describe the clinical presentation of HAND, review existing data related to screening tools, and provide preliminary and practical recommendations in the absence of more definitive studies.
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Affiliation(s)
- Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California–San Francisco, USA.
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45
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Sanmarti M, Ibáñez L, Huertas S, Badenes D, Dalmau D, Slevin M, Krupinski J, Popa-Wagner A, Jaen A. HIV-associated neurocognitive disorders. J Mol Psychiatry 2014; 2:2. [PMID: 25945248 PMCID: PMC4416263 DOI: 10.1186/2049-9256-2-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/25/2014] [Indexed: 01/03/2023] Open
Abstract
Currently, neuropsychological impairment among HIV+ patients on antiretroviral therapy leads to a reduction in the quality of life and it is an important challenge due to the high prevalence of HIV-associated neurocognitive disorders and its concomitant consequences in relation to morbidity and mortality- including those HIV+ patients with adequate immunological and virological status. The fact that the virus is established in CNS in the early stages and its persistence within the CNS can help us to understand HIV-related brain injury even when highly active antiretroviral therapy is effective. The rising interest in HIV associated neurocognitive disorders has let to development new diagnostic tools, improvement of the neuropsychological tests, and the use of new biomarkers and new neuroimaging techniques that can help the diagnosis. Standardization and homogenization of neurocognitive tests as well as normalizing and simplification of easily accessible tools that can identify patients with increased risk of cognitive impairment represent an urgent requirement. Future efforts should also focus on diagnostic keys and searching for useful strategies in order to decrease HIV neurotoxicity within the CNS.
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Affiliation(s)
- Montserrat Sanmarti
- />Servei de Medicina Interna, Unitat VIH/Sida, Hospital Universitari MútuaTerrassa, Pl.Dr.Robert, 5, 088221 Terrassa, Barcelona, Spain
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Laura Ibáñez
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sonia Huertas
- />Servei de Neurologia, Hospital Universitari MútuaTerrassa, Barcelona, Spain
| | - Dolors Badenes
- />Servei de Neurologia, Hospital Universitari MútuaTerrassa, Barcelona, Spain
| | - David Dalmau
- />Servei de Medicina Interna, Unitat VIH/Sida, Hospital Universitari MútuaTerrassa, Pl.Dr.Robert, 5, 088221 Terrassa, Barcelona, Spain
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Mark Slevin
- />Department of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Jerzy Krupinski
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
- />Servei de Neurologia, Hospital Universitari MútuaTerrassa, Barcelona, Spain
- />Department of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Aurel Popa-Wagner
- />Clinic for Psychiatry and Psychotherapy, University of Medicine Rostock, Rostock, Germany
| | - Angeles Jaen
- />Fundació Docència i Recerca MútuaTerrassa, Terrassa, Barcelona, Spain
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Robbins RN, Brown H, Ehlers A, Joska JA, Thomas KGF, Burgess R, Byrd D, Morgello S. A Smartphone App to Screen for HIV-Related Neurocognitive Impairment. ACTA ACUST UNITED AC 2014; 3:23-26. [PMID: 24860624 DOI: 10.7309/jmtm.3.1.5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive Impairment (NCI) is one of the most common complications of HIV-infection, and has serious medical and functional consequences. However, screening for it is not routine and NCI often goes undiagnosed. Screening for NCI in HIV disease faces numerous challenges, such as limited screening tests, the need for specialized equipment and apparatuses, and highly trained personnel to administer, score and interpret screening tests. To address these challenges, we developed a novel smartphone-based screening tool, NeuroScreen, to detect HIV-related NCI that includes an easy-to-use graphical user interface with ten highly automated neuropsychological tests. AIMS To examine NeuroScreen's: 1) acceptability among patients and different potential users; 2) test construct and criterion validity; and 3) sensitivity and specificity to detect NCI. METHODS Fifty HIV+ individuals were administered a gold-standard neuropsychological test battery, designed to detect HIV-related NCI, and NeuroScreen. HIV+ test participants and eight potential provider-users of NeuroScreen were asked about its acceptability. RESULTS There was a high level of acceptability of NeuroScreen by patients and potential provider-users. Moderate to high correlations between individual NeuroScreen tests and paper-and-pencil tests assessing the same cognitive domains were observed. NeuroScreen also demonstrated high sensitivity to detect NCI. CONCLUSION NeuroScreen, a highly automated, easy-to-use smartphone-based screening test to detect NCI among HIV patients and usable by a range of healthcare personnel could help make routine screening for HIV-related NCI feasible. While NeuroScreen demonstrated robust psychometric properties and acceptability, further testing with larger and less neurocognitively impaired samples is warranted.
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Affiliation(s)
- Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York
| | | | | | - John A Joska
- The Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kevin G F Thomas
- ASCENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Rhonda Burgess
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Desiree Byrd
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Susan Morgello
- The Icahn School of Medicine at Mount Sinai, New York, New York
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Zou Y, Qing L, Zeng X, Shen Y, Zhong Y, Liu J, Li Q, Chen K, Lv Y, Huang D, Liang G, Zhang W, Chen L, Yang Y, Yang X. Cognitive function and plasma BDNF levels among manganese-exposed smelters. Occup Environ Med 2014; 71:189-94. [PMID: 24415644 DOI: 10.1136/oemed-2013-101896] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Yunfeng Zou
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Espeland MA, Katula JA, Rushing J, Kramer AF, Jennings JM, Sink KM, Nadkarni NK, Reid KF, Castro CM, Church T, Kerwin DR, Williamson JD, Marottoli RA, Rushing S, Marsiske M, Rapp SR. Performance of a computer-based assessment of cognitive function measures in two cohorts of seniors. Int J Geriatr Psychiatry 2013; 28:1239-50. [PMID: 23589390 PMCID: PMC3775886 DOI: 10.1002/gps.3949] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 01/29/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Computer-administered assessment of cognitive function is being increasingly incorporated in clinical trials; however, its performance in these settings has not been systematically evaluated. DESIGN The Seniors Health and Activity Research Program pilot trial (N = 73) developed a computer-based tool for assessing memory performance and executive functioning. The Lifestyle Interventions and Independence for Elders investigators incorporated this battery in a full-scale multicenter clinical trial (N = 1635). We describe relationships that test scores have with those from interviewer-administered cognitive function tests and risk factors for cognitive deficits and describe performance measures (completeness, intraclass correlations [ICC]). RESULTS Computer-based assessments of cognitive function had consistent relationships across the pilot and full-scale trial cohorts with interviewer-administered assessments of cognitive function, age, and a measure of physical function. In the Lifestyle Interventions and Independence for Elders cohort, their external validity was further demonstrated by associations with other risk factors for cognitive dysfunction: education, hypertension, diabetes, and physical function. Acceptable levels of data completeness (>83%) were achieved on all computer-based measures; however, rates of missing data were higher among older participants (odds ratio = 1.06 for each additional year; p < 0.001) and those who reported no current computer use (odds ratio = 2.71; p < 0.001). ICCs among clinics were at least as low (ICC < 0.013) as for interviewer measures (ICC < 0.023), reflecting good standardization. All cognitive measures loaded onto the first principal component (global cognitive function), which accounted for 40% of the overall variance. CONCLUSION Our results support the use of computer-based tools for assessing cognitive function in multicenter clinical trials of older individuals.
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Affiliation(s)
- Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem NC 27157 ;
| | - Jeffrey A. Katula
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC 27109
| | - Julia Rushing
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem NC 27157 ;
| | - Arthur F. Kramer
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL 61801 ()
| | - Janine M. Jennings
- Department of Psychology and, Wake Forest University, Winston-Salem, NC27109
| | - Kaycee M. Sink
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem NC 27157 ;
| | - Neelesh K. Nadkarni
- Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213 ()
| | - Kieran F. Reid
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA 02111 ()
| | - Cynthia M. Castro
- Stanford Prevention Research Center, Stanford University, Palo Alto, CA 94304()
| | - Timothy Church
- Pennington Biomedical Research Center, Baton Rouge, LA 70808 ()
| | - Diana R. Kerwin
- Departments of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 ()
| | - Jeff D. Williamson
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem NC 27157 ;
| | - Richard A. Marottoli
- Department of Medicine, Yale School of Medicine, New Haven, CT 06504 and VA Connecticut Healthcare System, West Haven, CT 06156 ()
| | - Scott Rushing
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem NC 27157 ;
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610 (,edu)
| | - Stephen R. Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem NC 27157
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A brief and feasible paper-based method to screen for neurocognitive impairment in HIV-infected patients: the NEU screen. J Acquir Immune Defic Syndr 2013; 63:585-92. [PMID: 24135776 DOI: 10.1097/qai.0b013e31829e1408] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder. METHODS A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ∼2 hours). Multiple score combinations were compared to find a paper-based method that took ≤10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated. RESULTS Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individuals (48%) and was associated with lower nadir CD4 count (P < 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P < 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of attention/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper-based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ∼35 minutes). CONCLUSIONS The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV-infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.
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Chan LG, Wong CS. HIV-Associated Neurocognitive Disorders—An Issue of Growing Importance. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n10p527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: HIV-associated neurocognitive disorders (HAND) comprise a wide spectrum of cognitive, motor, and mood abnormalities prevalent in people living with HIV and AIDS (PLWHAs). This field of HIV medicine has gained renewed prominence in recent years with evidence contending that anti-retroviral agents with increased central nervous system (CNS) penetration may improve neurocognitive outcomes in those affected. This review aims at evaluating the available evidence and postulating further study direction in Singapore. Materials and Methods: A PubMed search was carried out for original articles and systematic reviews on the subject of HIV-associated neurocognitive disorders, and the results reviewed by the authors. Results: There is a growing body of evidence that HAND is not uncommon, and the advent of highly active anti-retroviral therapy has increased its prevalence by improving the prognosis of HIV infection, and hence increasing the likelihood of diagnosing of this neurocognitive condition. Screening and diagnosing HAND is important, and requires clinical suspicion as well as validated test batteries for optimal accuracy. The authors recommend strategies for detection in the local context involving stepwise targeted screening. Anti-retroviral agents with good CNS penetration and activity, as well as adjunctive neuro-rehabilitative interventions, may improve the impairments experienced by affected individuals. Conclusion: Increased awareness of HAND, with earlier diagnosis and targeted, multi-disciplinary management of this challenging condition, may lead to better all-round outcomes for people living with HIV and AIDS in Singapore.
Key words: AIDS, Cognition, Dementia, HAART
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