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

Type: Poster
Title: Deficit scores versus clinical ratings: Defining neurocognitive impairment in HIV.
Authors: Blackstone K, Moore DJ, Franklin DR, Woods SP, Clifford DB, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, Rivera-Mindt M, Ellis RJ, Atkinson JH, Grant I, Heaton RK, for the CHARTER Group
Date: 02-15-2012
Abstract:Background: Due to mild and variable HIV-related neurocognitive profiles, clinical ratings (CR) and global deficit scores (GDS) are recommended for detecting impairment as opposed to mean group differences. The CR-approach requires impairment in at least two ability domains, whereas the GDS considers impairment across all measures. The current study examines the appropriateness and correlates of each method. Participants and Method: 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 based on the two impairment classification approaches (Dually-normal, CR-only impaired, GDS-only impaired, or Dually-impaired). Discrepant classifications were examined across HIV-disease, daily functioning, and demographic measures. Results: There was 86% concordance between CR and GDS neurocognitive classifications. Less than 1% were classified as GDS-only impaired; 14% were classified as only CR-only impaired. As compared to Dually-normal, CR-only impaired participants were more likely to be unemployed, have AIDS, and reported more everyday cognitive complaints (p’s < 0.05). However, the CR-only impaired participants reported fewer everyday cognitive complaints than participants classified as Dually-impaired (p’s < 0.05). Conclusion: Cognitive impairment classifications were in high agreement. In discrepant classifications, assuring impairment in at least two neurocognitive domains resulted in more detection of intermediate-level functional problems (e.g., advanced HIV disease, increased unemployment and functional complaints). Although there is high overlap between approaches, clinicians and researchers should recognize the strengths and weaknesses of each when evaluating neurocognitive complications in HIV.