Screening for Cognitive Impairment in Human Immunodeficiency Virus

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.

The Montreal Cognitive Assessment to Screen for Cognitive Impairment in HIV Patients Older Than 60 Years

“…11 The Montreal Cognitive Assessment (MoCA) more broadly evaluates domains known to be affected by HIV and has sensitivity for the detection of Mild Cognitive Impairment (MCI) and milder Alzheimer's disease in the general population. 12 The few studies that have examined the utility of the MoCA in an HIV population show promise; but, to date, none have examined performance in a sample of elder people with HIV.…”

Depressive Symptoms and Neurocognitive Performance Among HIV-Infected Women

“…In this study, it is particularly worrying that HIV-infected patients remain at significant risk of depressive symptoms and neurocognitive impairment, factors that may interfere with adherence to HAART (Hinkin et al, 2004;Valcour et al, 2011), significantly affect quality of life (Parsons et al, 2006;Osowiecki et al, 2000;Tozzi et al, 2004), and may hasten progression to AIDS. Accordingly, these results underscore the importance of early diagnosis and monitoring of depressive symptoms in this vulnerable population.…”

Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults

“…Nevertheless, more recent research efforts with other language groups have made substantial progress. For example, Valcour, Paul, Chiao, Wendelken, and Miller (2011) have an excellent review of screening measures for HAND in aging HIV-positive cohorts. In addition, Overton et al (2013) found that the Montreal Cognitive Assessment (MoCA) and the Alzheimer's Disease (AD-8) screening tools correlated with formal neuropsychological testing in an HIV-positive sample, but reported that the sensitivity and specificity of these instruments were moderate in predictive accuracy.…”