Clinical validation of the NeuroScreen
Clinical validation of the NeuroScreen
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DOI：
10.1080/13550280500384966
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发表时间：
2005-12-01
影响因子：
3.2
通讯作者：
Robertson, K
中科院分区：
文献类型：
--
作者：
Ellis, RJ;Evans, SR;Robertson, K
NeuroScreen包括两个易于管理的组件：简明神经认知筛查（BNCS），旨在估计人类免疫缺陷病毒（HIV）相关认知障碍的频率;和简明周围神经病变筛查（BPNS），用于HIV患者的远端感觉多发性神经病（DSPN）。在这项研究中，NeuroScreen和更广泛的标准化验证神经诊断评估都被用于在多个研究中心的两项大型队列研究中招募的HIV阳性受试者（N = 301）。以人口统计学校正的平均z评分（NPZ 3）的形式总结BNCS性能。与参考标准神经心理学（NP）评估相比，BNCS的受试者工作特征（ROC）曲线下面积为0.74（95%置信区间[CI] 0.69，0.79）。在NPZ 3上使用-0.33的临界点提供了68%的正确分类率，灵敏度（65%）和特异性（72%）大致平衡。假设认知功能障碍的患病率为30%，计算出的BNCS阳性预测值（PPV）为86%。相对于其参考标准，由神经科医生进行的改良总神经病变评分（TNS），BPNS给出了相似的正确诊断分类率78%;灵敏度49% [95%CI 37%，60%];特异性88% [95%CI 82%，91%]。假设DSPN的患病率为40%，BPNS的PPV为72%。这些预测值表明，在联合抗逆转录病毒治疗的时代，NeuroScreen将有助于跟踪大型队列中HIV相关神经系统疾病的流行趋势。然而，由于它产生大量的假阳性和假阴性，NeuroScreen在评估个体患者时可能不太有用。
The NeuroScreen comprises two easily administered components: the Brief NeuroCognitive Screen (BNCS), designed to estimate the frequency of human immunodeficiency virus (HIV)-associated cognitive disorders; and the Brief Peripheral Neuropathy Screen (BPNS), for distal sensory polyneuropathy (DSPN) in HIV. In this study, both the NeuroScreen and a more extensive standardized validation neurodiagnostic evaluation were administered to HIV-positive subjects (N = 301) enrolled in two large cohort studies at multiple sites. BNCS performance was summarized in the form of a demographically adjusted mean z-score, the NPZ3. The area under the receiver-operating characteristic (ROC) curve for the BNCS as compared to the reference standard neuropsychological (NP) evaluation was 0.74 (95% confidence interval [CI] 0.69, 0.79). Using a cut-point of -0.33 on the NPZ3 provided a correct classification rate of 68%, with roughly balanced sensitivity (65%) and specificity (72%). Under the assumption of a 30% prevalence of cognitive impairment, the calculated positive predictive value (PPV) of the BNCS was 86%. Relative to its reference standard, a modified Total Neuropathy Score (TNS) administered by a neurologist, the BPNS gave a similar correct diagnostic classification rate of 78%; sensitivity 49% [95% CI 37%, 60%]; specificity 88% [95% CI 82%, 91%]. Under the assumption of a 40% prevalence of DSPN, the PPV of the BPNS was 72%. These predictive values suggest that the NeuroScreen will be useful for tracking trends in the prevalence of HIV- associated neurologic disease in large cohorts in the era of combination antiretroviral therapy. However, because it yields substantial numbers of false positives and negatives, the NeuroScreen may be less useful in evaluating individual patients.