The HIV dementia scale: Predictive power in mild dementia and HAART
The HIV dementia scale: Predictive power in mild dementia and HAART
复制标题
DOI：
10.1016/j.jns.2006.03.023
复制
发表时间：
2007-09-15
影响因子：
4.4
通讯作者：
Berger, Joseph R.
中科院分区：
文献类型：
--
作者：
Bottiggi, Kara Anne;Chang, Jason J.;Berger, Joseph R.
背景资料：HIV相关性痴呆（HIV-D）是一种皮质下痴呆，由认知和运动症状组成，最终影响多达20%的AIDS患者，并与显著的发病率和死亡率相关。随着高效抗逆转录病毒疗法（HAART）的出现，继续需要使用敏感和有效的HIV-D筛查试验来识别发展这种疾病的个体。目的：本研究的目的是比较艾滋病痴呆量表（HDS）与综合神经心理学程序在检测轻度认知和运动障碍（MCMD）和艾滋病方面的差异。方法：46例HIV血清阳性患者完成了HDS和一系列神经心理学测试，因为他们参加了MRI研究。每个人还根据临床神经系统检查分配了一个MSK评分。HDS评分10分被认为是认知未受损。进行了两项单独的敏感性分析。将8个单独神经心理子测试的平均全球Z评分（NPZ 8）与每个受试者的HDS评分进行比较。NPZ 8评分-2.0标准差（S.D.）低于平均值被用来定义HIV-D。此外，HIV-D定义为-2.0 S.D.低于一次测试的平均值或-1.0 S.D.低于NPZ 8的两个或多个测试的平均值，也与HDS进行了比较。最后，这些认知措施的性能被用来预测HAART在此sample.Results的持续时间：使用平均NPZ 8评分的基础上，美国神经病学学会的共识标准产生了一个测试的灵敏度为30%，特异性为0%，阳性预测值为0%，和阴性预测值为58%，相比，临床MSK评级。受损测试的数量与MSK严重程度的比较得出测试的敏感性为43%，特异性为91%，阳性预测值为83%，阴性预测值为61%。HDS分数是不太有效的预测存在的微妙和轻度的HIV-D在此sample.Conclusion：虽然HDS是一个有用的床边测试，医生可以迅速管理HIV血清阳性患者，以协助诊断疑似病例的坦率的HIV-D，HDS，作为一个屏幕，是不准确的检测HIV-D作为一个更彻底的神经心理学检查。随着引入HAART后HIV-D和轻微认知/运动障碍（MCMD）的患病率不断增加，必须制定更敏感的床边措施，以识别患有这些疾病的个体并监测治疗方案。(C)2007 Elsevier B. V.保留所有权利。
Background: HIV-associated dementia (HIV-D) is a subcortical dementia consisting of cognitive and motor symptoms that ultimately affects as many as 20% of patients with AIDS and is associated with significant morbidity and mortality. With the advent of highly active antiretroviral therapy (HAART), the use of sensitive and efficient screening tests for HIV-D continue to be needed for identifying individuals who develop this disorder.Objective: The objective of this study was to compare the HIV Dementia Scale (HDS) with comprehensive neuropsychological procedures in detecting both minor cognitive and motor disorder (MCMD) and HIV-D in a population of patients with varying durations of HAART.Methods: Forty-six HIV-seropositive patients completed both the HDS and a battery of neuropsychological tests as they enrolled in a MRI study. Each person was also assigned a MSK score based on clinical neurological examination. HDS score of 10 were considered cognitively unimpaired. Two separate sensitivity analyses were performed. Global Z scores (NPZ8) averaged from eight individual neuropsychological subtests were compared to the HDS score for each subject. An NPZ8 score -2.0 standard deviations (S.D.) below the mean was used to define HIV-D. Additionally, HIV-D, defined as -2.0 S.D. below the mean on one test or - 1.0 S.D. below the mean on two or more tests from the NPZ8, were also compared to the HDS. Finally, performance on these cognitive measures was used to predict duration of HAART in this sample.Results: Using the average NPZ8 score based on American Academy of Neurology consensus criteria yielded a test sensitivity of 30%, a specificity of 0%, a positive predictive value of 0%, and a negative predictive value of 58% when compared to clinical MSK ratings. Comparison of the number of impaired tests with MSK severity yielded a test sensitivity of 43%, a specificity of 91%, a positive predictive value of 83%, and a negative predictive value of 61%. HDS scores were less efficient in predicting the presence of subtle and mild HIV-D in this sample.Conclusion: While the HDS is a useful bedside test that a physician may quickly administer to HIV seropositive patients to assist in diagnosing suspected cases of frank HIV-D, the HDS, as a screen, is not as accurate in detecting HIV-D as a more thorough neuropsychological examination. With an increasing prevalence of HIV-D and minor cognitive/motor disorder (MCMD) following the introduction of HAART, the development of more sensitive bedside measures is essential in order to identify individuals with these disorders and monitor treatment regimens. (C) 2007 Elsevier B.V. All rights reserved.