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Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale

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Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale

Auteurs : Sara Cross ; Nur Önen ; Amber Gase ; Edgar Turner Overton ; Beau M. Ances

Source :

Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology [ 1557-1890 ] ; 2013.

RBID : PMC:4039628

Abstract

HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65%) and African American (68%); and 41% had cognitive impairment. On multivariate analysis, African American race (p=2.21), older age (p=1.03), high school education or less (p=2.03) and depression (p=1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV− populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039628

DOI: 10.1007/s11481-013-9505-1
PubMed: 24114509
PubMed Central: 4039628

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PMC:4039628

Le document en format XML

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<author><name sortKey="Cross, Sara" sort="Cross, Sara" uniqKey="Cross S" first="Sara" last="Cross">Sara Cross</name>
<affiliation><nlm:aff id="A1">Department of Medicine, Washington University School of Medicine, St. Louis, Missouri</nlm:aff>
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<author><name sortKey="Onen, Nur" sort="Onen, Nur" uniqKey="Onen N" first="Nur" last="Önen">Nur Önen</name>
<affiliation><nlm:aff id="A1">Department of Medicine, Washington University School of Medicine, St. Louis, Missouri</nlm:aff>
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<author><name sortKey="Gase, Amber" sort="Gase, Amber" uniqKey="Gase A" first="Amber" last="Gase">Amber Gase</name>
<affiliation><nlm:aff id="A1">Department of Medicine, Washington University School of Medicine, St. Louis, Missouri</nlm:aff>
</affiliation>
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<author><name sortKey="Overton, Edgar Turner" sort="Overton, Edgar Turner" uniqKey="Overton E" first="Edgar Turner" last="Overton">Edgar Turner Overton</name>
<affiliation><nlm:aff id="A2">Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama</nlm:aff>
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<author><name sortKey="Ances, Beau M" sort="Ances, Beau M" uniqKey="Ances B" first="Beau M." last="Ances">Beau M. Ances</name>
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<author><name sortKey="Onen, Nur" sort="Onen, Nur" uniqKey="Onen N" first="Nur" last="Önen">Nur Önen</name>
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<author><name sortKey="Overton, Edgar Turner" sort="Overton, Edgar Turner" uniqKey="Overton E" first="Edgar Turner" last="Overton">Edgar Turner Overton</name>
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<front><div type="abstract" xml:lang="en"><p id="P1">HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65%) and African American (68%); and 41% had cognitive impairment. On multivariate analysis, African American race (<italic>p</italic>
=2.21), older age (<italic>p</italic>
=1.03), high school education or less (<italic>p</italic>
=2.03) and depression (<italic>p</italic>
=1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV− populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.</p>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <pmc-dir>properties manuscript</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-journal-id">101256586</journal-id>
<journal-id journal-id-type="pubmed-jr-id">33820</journal-id>
<journal-id journal-id-type="nlm-ta">J Neuroimmune Pharmacol</journal-id>
<journal-id journal-id-type="iso-abbrev">J Neuroimmune Pharmacol</journal-id>
<journal-title-group><journal-title>Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology</journal-title>
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<issn pub-type="ppub">1557-1890</issn>
<issn pub-type="epub">1557-1904</issn>
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<article-id pub-id-type="pmc">4039628</article-id>
<article-id pub-id-type="doi">10.1007/s11481-013-9505-1</article-id>
<article-id pub-id-type="manuscript">NIHMS583333</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Cross</surname>
<given-names>Sara</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Önen</surname>
<given-names>Nur</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gase</surname>
<given-names>Amber</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Overton</surname>
<given-names>Edgar Turner</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ances</surname>
<given-names>Beau M.</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri</aff>
<aff id="A2"><label>2</label>
Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama</aff>
<aff id="A3"><label>3</label>
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri</aff>
<aff id="A4"><label>4</label>
Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri</aff>
<aff id="A5"><label>5</label>
Department of Bioengineering, Washington University School of Medicine, St. Louis, Missouri</aff>
<author-notes><corresp id="FN1">Corresponding author: Beau M. Ances, MD, PhD, Department of Neurology, Washington University in St. Louis, Box 8111, 660 South Euclid, Saint Louis, Missouri USA 63110, <email>bances@wustl.edu</email>
, Telephone: 314-747-8423, FAX: 314-747-8427</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>14</day>
<month>5</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>10</day>
<month>10</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub"><month>12</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>30</day>
<month>5</month>
<year>2014</year>
</pub-date>
<volume>8</volume>
<issue>5</issue>
<fpage>1114</fpage>
<lpage>1122</lpage>
<pmc-comment>elocation-id from pubmed: 10.1007/s11481-013-9505-1</pmc-comment>
      <abstract><p id="P1">HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65%) and African American (68%); and 41% had cognitive impairment. On multivariate analysis, African American race (<italic>p</italic>
=2.21), older age (<italic>p</italic>
=1.03), high school education or less (<italic>p</italic>
=2.03) and depression (<italic>p</italic>
=1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV− populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.</p>
</abstract>
<kwd-group><kwd>HIV</kwd>
<kwd>International HIV Dementia Scale (IHDS)</kwd>
<kwd>HIV associated neurocognitive disorders (HAND)</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>

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Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale

Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale

Source :

Abstract

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