Defining neurocognitive impairment in HIV: deficit scores versus clinical ratings.

TitleDefining neurocognitive impairment in HIV: deficit scores versus clinical ratings.
Publication TypeJournal Article
Year of Publication2012
AuthorsBlackstone, K, Moore, DJ, Franklin, DR, Clifford, DB, Collier, AC, Marra, CM, Gelman, BB, McArthur, JC, Morgello, S, Simpson, DM, Ellis, RJ, Atkinson, JH, Grant, I, Heaton, RK
JournalClin Neuropsychol
Date Published2012
KeywordsAdult, Analysis of Variance, CHARTER, Chi-Square Distribution, Cognition Disorders, Depression, Female, HIV, HIV Infections, Human Immunodeficiency Virus Proteins, Humans, Internal, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Severity of Illness Index

Because HIV-related neurocognitive impairment is usually mild and variable, clinical ratings (CR) and global deficit scores (GDS) are recommended for detecting HIV-associated neurocognitive disorders (HAND). The CR approach requires impairment in at least two ability domains while the GDS considers number and severity of impairments across all measures. We examined classification agreement and clinical correlates of the two methods. Neurocognitive functioning of 1574 HIV-infected participants was assessed via a comprehensive, seven-domain neuropsychological battery. Global neurocognitive impairment was defined for each participant independently by CR and GDS. Participants were classified into four categories (Dually-normal, [impaired by] CR-only, [impaired by] GDS-only, or Dually-impaired). There was 83% concordance between CR and GDS classifications; in total, 56% of participants were deemed impaired by CR and 41% were classified as impaired by GDS. Impairment by GDS virtually guaranteed CR impairment, but 16% of participants were additionally classified as impaired only by CR. As compared to Dually-normal participants, those classified as Dually and CR-only impaired were more likely to have AIDS, have more severe co-occurring conditions, have more severe depressive symptoms, be unemployed, and have more everyday functioning complaints (ps < .05). Impairment classifications of the two methods were in high agreement; however, more people were classified as impaired using the CR approach compared to the GDS approach. Those impaired according to CR-only showed fewer neurocognitive and functional deficits than the Dually-impaired participants, but more of these deficits than Dually-normal participants. The CR approach may be most appropriate for detecting more subtle forms of neurocognitive impairment. Clinicians and researchers should recognize the strengths and weaknesses of each method when evaluating neurocognitive complications in HIV.

Alternate JournalClin Neuropsychol
PubMed ID22708483
PubMed Central IDPMC3848322
Grant ListN01 MH022005 / MH / NIMH NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
T32 DA031098 / DA / NIDA NIH HHS / United States
MH 62512 / MH / NIMH NIH HHS / United States