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.

TitleScreening for neurocognitive impairment in HIV-positive adults aged 50 years and older: Montreal Cognitive Assessment relates to self-reported and clinician-rated everyday functioning.
Publication TypeJournal Article
Year of Publication2017
AuthorsFazeli, PL, Casaletto, KB, Paolillo, E, Moore, RC, Moore, DJ
JournalJ Clin Exp Neuropsychol
Volume39
Issue9
Pagination842-853
Date Published2017 Nov
ISSN1744-411X
KeywordsActivities of Daily Living, Aged, Aged, 80 and over, AIDS Dementia Complex, Cognitive Dysfunction, Executive function, Female, HIV Infections, Humans, Male, Middle Aged, Neuropsychological Tests, Psychometrics, Self Report, Sensitivity and Specificity
Abstract

As the HIV+ population ages, the risk for and need to screen for HIV-associated neurocognitive disorders (HAND) increases. The aim of this study is to determine the utility and ecological validity of the Montreal Cognitive Assessment (MoCA) among older HIV+ adults. A total of 100 HIV+ older adults aged 50 years or over completed a comprehensive neuromedical and neurocognitive battery, including the MoCA and several everyday functioning measures. The receiver operating characteristic curve indicates ≤26 as the optimal cut-off balancing sensitivity (84.2%) and specificity (55.8%) compared to "gold standard" impairment as measured on a comprehensive neuropsychological battery. Higher MoCA total scores are significantly (p < .01) associated with better performance in all individual cognitive domains except motor abilities, with the strongest association with executive functions (r = -0.49, p < .01). Higher MoCA total scores are also significantly (p <.01) associated with fewer instrumental activities of daily living declines (r = -0.28), fewer everyday cognitive symptoms (r = -0.25), and better clinician-rated functional status (i.e., Karnofsky scores; r = 0.28); these associations remain when controlling for depressive symptoms. HIV+ individuals who are neurocognitively normal demonstrate medium-to-large effect size differences in their MoCA performance compared to those with asymptomatic neurocognitive impairment (d = 0.85) or syndromic HAND (mild neurocognitive disorder or HIV-associated dementia; d = 0.78), while the latter two categories do not differ. Although limited by less than optimal specificity, the MoCA demonstrates good sensitivity and ecological validity, which lends support to its psychometric integrity as a brief cognitive screening tool among older HIV+ adults.

DOI10.1080/13803395.2016.1273319
Alternate JournalJ Clin Exp Neuropsychol
PubMed ID28122474
PubMed Central IDPMC5542876
Grant ListK99 AG048762 / AG / NIA NIH HHS / United States
P50 DA026306 / DA / NIDA NIH HHS / United States
R00 AG048762 / AG / NIA NIH HHS / United States
HHSN271201000030C / MH / NIMH NIH HHS / United States
HHSN271201000036C / MH / NIMH NIH HHS / United States
R24 MH059745 / MH / NIMH NIH HHS / United States
T32 DA031098 / DA / NIDA NIH HHS / United States
K23 MH107260 / MH / NIMH NIH HHS / United States
L30 AG045921 / AG / NIA NIH HHS / United States
N01MH22005 / MH / NIMH NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
U01 MH083506 / MH / NIMH NIH HHS / United States
N01 MH022005 / MH / NIMH NIH HHS / United States