The generalizability of neurocognitive test/retest data derived from a nonclinical sample for detecting change among two HIV+ cohorts

Objective methods for determining clinically relevant neurocognitive change are useful for clinicians and researchers, but the utility of such methods requires validation studies in order to assess their accuracy among target populations. We examined the generalizability of regression equations and reliable change indexes (RCI) derived from a healthy sample to two HIV-infected samples, one similar in demographic makeup to the normative group and the other dissimilar. Measures administered at baseline and follow-up included the Trail Making Test, Controlled Oral Word Association Test (COWAT), Grooved Pegboard, and Digit Span. Frequencies of decline, improvement, or stability were determined for each measure. Among the demographically similar clinical cohort, elevated rates of decline among more immunologically impaired participants were indicated by simple regression method on measures of psychomotor speed and attention, while RCI addressing practice effects (RCI-PE) indicated improvement on most measures regardless of immunostatus. Conversely, among the demographically dissimilar cohort, simple regression indicated high rates of decline across all measures, while RCI-PE indicated elevated rates of decline on psychomotor and attention measures. Thus, the accuracy of the two methods examined for determining clinically significant change among HIV+ cohorts differs depending upon their similarity with the normative sample.