A brief iPad-based screening measure for HIV-associated neurocognitive disorders

尽管抗逆转录病毒治疗取得了重大进展，但艾滋病毒相关的神经认知障碍（HAND） 仍然普遍存在，并可能影响广泛的日常活动。一个有效的简短认知屏幕， 可以在忙碌的艾滋病诊所实施，在那里，临床医生只有有限的时间为患有 复杂的医疗、精神和认知状况，有可能显著影响患者护理， 识别可能需要额外治疗考虑的患者以及 来追踪认知随时间的变化。不幸的是，目前的简短认知屏幕缺乏敏感性， 与现代HAND相关的一般轻度和轻度至中度缺陷。第一阶段的发展 一个简短的，基于iPad的认知筛查工具，可以自我管理，并表现出良好的有效性 （相对于金标准神经心理学（NP）测试组合）和重测信度。4测试 组合，仅需6分钟即可完成，产生了非常好的分类精度，具有灵敏度， 特异性、阳性和阴性预测值均约为80%。 第二阶段的目标是：1）增强基于iPad的认知 为患者和临床医生进行筛查，2）提高基于iPad的认知筛查的临床相关性 工具，和3）建立修订工具的临床效用。 为了实现这些目标，我们将改进现有的界面， 根据高级临床医生的输入，并对其进行调整，以用户友好且易于解释的方式呈现结果 方式，并添加额外的简短问题，解决情绪和日常运作的问题。第1年 我们将根据125名健康成年人制定人口统计学调整的标准，包括6岁和6岁以下的标准。 12-一个月的随访评估，以优化随时间推移用于监测患者的工具。在第2年 我们将在圣地亚哥的艾滋病诊所和美国的合作诊所实施这一新的规范工具， States.至少150名HIV+受试者将在诊所完成iPad测量，并在6个月（或诊所访视）时完成 时间的推移）。这些人的一个子集（n = 100）也将提供更详细的 在临床或基于研究的评估期间捕获的神经心理学数据。然后我们将评估 该工具在基于金标准检测艾滋病毒相关认知障碍方面的有效性 考核 作为这个项目的结果，我们将有一个功能齐全，验证和适销对路的简要筛选措施 用于评估患者认知，改善HIV患者护理，促进HAND及其 这将使数字艺术品在用户开发中发挥关键领导作用， HAND以及潜在的其他神经系统疾病的临床友好筛查措施。

Despite significance advances in anti-retroviral treatments, HIV-associated neurocognitive disorder (HAND) remains prevalent, and can affect a broad range of everyday activities. An effective brief cognitive screen that could be implemented in busy HIV clinics, where clinicians have limited time to provide care for patients with complex medical, psychiatric, and cognitive conditions, has the potential to significantly impact patient care, in terms of both identifying patients who may warrant additional treatment considerations as well as the potential to track changes in cognition over time. Unfortunately, current brief cognitive screens have lacked sensitivity to the generally mild and mild-to-moderate deficits associated with modern HAND. Phase I saw the development of a brief, iPad-based cognitive screening tool that could be self-administered, and exhibited good validity (relative to a gold-standard neuropsychological (NP) test battery) and test-retest reliability. The 4-test combination, taking only 6 minutes to complete, produced very good classification accuracy, with sensitivity, specificity, positive and negative predictive values all approximately 80%. The aims of Phase II are to 1) enhance the technical capabilities and usability of the iPad-based cognitive screen for both patients and clinicians, 2) improve the clinical relevance of the iPad-based cognitive screening tool, and 3) establish the clinical utility of the revised tool. To accomplish these aims, we will improve the existing interface by creating a revised dashboard based upon input from senior clinicians and adapt it to present results in a user-friendly and easily interpretable manner, and add additional brief questions address mood and problems with everyday functioning. In year 1 we will develop demographically-adjusted norms based upon 125 healthy adults, including norms for 6- and 12-month follow-up assessments in order to optimize the tool for use in monitoring patients over time. In year 2 we will implement this new, normed tool in HIV clinics in both San Diego and collaborating clinics in the United States. At least 150 HIV+ participants will complete the iPad measure in clinics, and at a 6-month (or clinic visit approximating that time) follow-up. A subset of these individuals (n = 100) will also provide more detailed neuropsychological data captured during a clinic or research-based evaluation. We will then assess the effectiveness of the tool in detecting HIV-related cognitive impairments based upon a gold-standard assessment. As a result of this project we will have a fully functional, validated and marketable brief screening measure for evaluating patient cognition, improving HIV patient care, facilitating future studies of HAND and its treatment, and which will position Digital Artefacts in a key leadership role in the development of user- and clinician-friendly screening measures for HAND, as well as potentially other neurologic conditions.