Comparison of scales to evaluate the progression of HIV-associated neurocognitive disorder
Comparison of scales to evaluate the progression of HIV-associated neurocognitive disorder
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DOI：
10.2217/hiv.10.23
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发表时间：
2010-05-01
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影响因子：
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通讯作者：
Sacktor, Ned
中科院分区：
文献类型：
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作者：
Gandhi, Nishiena S.;Moxley, Richard T.;Sacktor, Ned
目的：首先，比较美国神经病学学会(AAN)和纪念斯隆-凯特林(MSK)现有痴呆评定量表与2007年共识(Frascati)分类得出的HIV相关性神经认知障碍(HAND)较轻阶段的神经认知障碍的特征。第二，在一年的随访中确定潜在的手部进展的社会人口学和临床预测因素。方法：对现有队列系统中的104名HIV感染者进行病史、检查、神经心理测试和功能评估。用AAN、MSK和Frascati量表评定手的程度。确定各量表之间的一致性程度。此外，45名受试者在1年的随访中重新评估了他们的神经认知状态的变化。研究对象包括年龄、教育程度、性别、抑郁程度、药物滥用、种族、丙型肝炎血清水平、CD4计数和手部疾病进展之间的关系。结果：Frascati评分、MSK评分和AAN评分之间有很好的一致性(Gamma>；0.8)。在AAN量表上被评定为轻度认知运动障碍的受试者(n=45)被平均分为Frascati无症状性神经认知障碍分级(n=24)和轻度神经认知障碍(n=21)。在45名受试者的I年随访中，31%的患者病情恶化，13%的患者好转，56%的患者病情稳定。进展的预测因素包括年龄大于50岁(优势比：5.57；p=0.013)和女性(优势比：3.13；p=0.036)。结论：Frascati手功能评定量表与已有的神经认知功能评定量表具有较好的一致性，可以更好地表征认知功能损害的较轻阶段。年龄较大的人和女性似乎更有可能表现出神经认知进步。
Aim: First, to compare the characterization of neurocognitive deficits in milder stages of HIV-associated neurocognitive disorder (HAND) derived from existing dementia rating scales of the American Academy of Neurology (AAN) and Memorial Sloan Kettering (MSK) with the 2007 consensus ('Frascati') classification. Second, to identify potential sociodemographic and clinical predictors of HAND progression during 1-year follow-up. Methods: 104 HIV-infected subjects in an existing cohort system were evaluated with a medical history, exam, neuropsychological test battery and functional assessments. The degree of HAND was rated using the AAN, MSK and Frascati scales. The degree of concordance among these scales was determined. In addition, 45 subjects were reassessed for changes in their neurocognitive status at 1-year follow-up. Associations between age, education, sex, depression ratings, substance abuse, race, hepatitis C serostatus, CD4 count and progression of HAND were examined. Results: There was excellent concordance (gamma > 0.8) among the Frascati, MSK and AAN ratings. Subjects rated as having minor cognitive motor disorder on the AAN scale (n = 45) were evenly split between Frascati rating of asymptomatic neurocognitive impairment (n = 24) and mild neurocognitive disorder (n = 21). At I-year follow-up of 45 subjects, 31% had worsened, 13% had improved and 56% were stable. Predictors of progression included age older than 50 years (odds ratio: 5.57; p = 0.013) and female gender (odds ratio: 3.13; p = 0.036). Conclusion: The Frascati HAND rating scale has excellent concordance with previous neurocognitive rating scales and can be used to better characterize milder stages of cognitive impairment. Older individuals and women appeared to be more likely to show neurocognitive progression.