Defining neurocognitive impairment in HIV: Deficit scores versus clinical ratings

K. Blackstone; D. J. Moore; D. R. Franklin; D. B. Clifford; A. C. Collier; C. M. Marra; B. B. Gelman; J. C. McArthur; S. Morgello; D. M. Simpson; R. J. Ellis; J. H. Atkinson; I. Grant; R. K. Heaton

doi:10.1080/13854046.2012.694479

Defining neurocognitive impairment in HIV: Deficit scores versus clinical ratings

K. Blackstone, D. J. Moore, D. R. Franklin, D. B. Clifford, A. C. Collier, C. M. Marra, B. B. Gelman, J. C. McArthur, S. Morgello, D. M. Simpson, R. J. Ellis, J. H. Atkinson, I. Grant, R. K. Heaton

School of Medicine

Research output: Contribution to journal › Article › peer-review

115 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	894-908
Number of pages	15
Journal	Clinical Neuropsychologist
Volume	26
Issue number	6
DOIs	https://doi.org/10.1080/13854046.2012.694479
State	Published - Aug 2012

Keywords

Assessment
Cognition
Infectious disease

ASJC Scopus subject areas

Neuropsychology and Physiological Psychology
Developmental and Educational Psychology
Clinical Psychology
Arts and Humanities (miscellaneous)
Psychiatry and Mental health

Access to Document

10.1080/13854046.2012.694479

Cite this

Blackstone, K., Moore, D. J., Franklin, D. R., Clifford, D. B., Collier, A. C., Marra, C. M., Gelman, B. B., McArthur, J. C., Morgello, S., Simpson, D. M., Ellis, R. J., Atkinson, J. H., Grant, I., & Heaton, R. K. (2012). Defining neurocognitive impairment in HIV: Deficit scores versus clinical ratings. Clinical Neuropsychologist, 26(6), 894-908. https://doi.org/10.1080/13854046.2012.694479

@article{411d576d5a2246a0850f729e0016c11c,

title = "Defining neurocognitive impairment in HIV: Deficit scores versus clinical ratings",

abstract = "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.",

keywords = "Assessment, Cognition, Infectious disease",

author = "K. Blackstone and Moore, {D. J.} and Franklin, {D. R.} and Clifford, {D. B.} and Collier, {A. C.} and Marra, {C. M.} and Gelman, {B. B.} and McArthur, {J. C.} and S. Morgello and Simpson, {D. M.} and Ellis, {R. J.} and Atkinson, {J. H.} and I. Grant and Heaton, {R. K.}",

note = "Funding Information: The CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) is supported by award N01 MH22005 from the National Institutes of Health. Funding Information: The HIV Neurobehavioral Research Center (HNRC) is supported by Center award MH 62512 from NIMH.",

year = "2012",

month = aug,

doi = "10.1080/13854046.2012.694479",

language = "English (US)",

volume = "26",

pages = "894--908",

journal = "Clinical Neuropsychologist",

issn = "1385-4046",

publisher = "Swets & Zeitlinger",

number = "6",

}

TY - JOUR

T1 - Defining neurocognitive impairment in HIV

T2 - Deficit scores versus clinical ratings

AU - Blackstone, K.

AU - Moore, D. J.

AU - Franklin, D. R.

AU - Clifford, D. B.

AU - Collier, A. C.

AU - Marra, C. M.

AU - Gelman, B. B.

AU - McArthur, J. C.

AU - Morgello, S.

AU - Simpson, D. M.

AU - Ellis, R. J.

AU - Atkinson, J. H.

AU - Grant, I.

AU - Heaton, R. K.

N1 - Funding Information: The CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) is supported by award N01 MH22005 from the National Institutes of Health. Funding Information: The HIV Neurobehavioral Research Center (HNRC) is supported by Center award MH 62512 from NIMH.

PY - 2012/8

Y1 - 2012/8

N2 - 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.

AB - 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.

KW - Assessment

KW - Cognition

KW - Infectious disease

UR - http://www.scopus.com/inward/record.url?scp=84871876872&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871876872&partnerID=8YFLogxK

U2 - 10.1080/13854046.2012.694479

DO - 10.1080/13854046.2012.694479

M3 - Article

C2 - 22708483

AN - SCOPUS:84871876872

SN - 1385-4046

VL - 26

SP - 894

EP - 908

JO - Clinical Neuropsychologist

JF - Clinical Neuropsychologist

IS - 6

ER -

Defining neurocognitive impairment in HIV: Deficit scores versus clinical ratings

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this