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Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia

Published online by Cambridge University Press:  19 November 2010

J. M. Foley ,
M. J. Wright ,
A. L. Gooding ,
M. Ettenhofer ,
M. Kim ,
M. Choi ,
S. A. Castellon ,
J. Sadek ,
R. K. Heaton  and
W. G. van Gorp
...Show all authors
J. M. Foley*
Affiliation:
UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, U.S.A.
M. J. Wright
Affiliation:
UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, U.S.A.
A. L. Gooding
Affiliation:
VA Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A.
M. Ettenhofer
Affiliation:
UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, U.S.A.
M. Kim
Affiliation:
VA Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A.
M. Choi
Affiliation:
UCSD Department of Psychiatry, San Diego, California, U.S.A.
S. A. Castellon
Affiliation:
UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, U.S.A. VA Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A.
J. Sadek
Affiliation:
University of New Mexico Department of Psychiatry, Albuquerque, New Mexico, U.S.A.
R. K. Heaton
Affiliation:
UCSD Department of Psychiatry, San Diego, California, U.S.A.
W. G. van Gorp
Affiliation:
Columbia University Medical Center Department of Psychiatry, New York, U.S.A.
T. D. Marcotte
Affiliation:
UCSD Department of Psychiatry, San Diego, California, U.S.A.
C. H. Hinkin
Affiliation:
UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, U.S.A. VA Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A.
*
Correspondence should be addressed to: Jessica Foley, PhD, 150 S, Huntington Avenue, Boston, MA 02130, U.S.A. Phone: +1 954-600-1518; Fax: +1 310-591-8024. Email: [email protected].
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Abstract

Background: This study applies the updated HIV-Associated Neurocognitive Disorders (HAND) diagnostic algorithm.

Methods: Participants were 210 HIV-infected-adults, classified using proposed HAND criteria: HIV-Associated Dementia (HAD), Mild Neurocognitive Disorder (MND), Asymptomatic Neurocognitive Impairment (ANI).

Results: The algorithm yielded: normal = 32.8%, ANI = 21.4%, MND = 34.3%, and HAD = 11.4%. Normal participants performed superior to HAND-defined participants on cognition, and HAD participants performed more poorly on global cognition and executive functioning. Two distinct subgroups of interest emerged: (1) functional decline without cognitive impairment; (2) severe cognitive impairment and minimal functional compromise.

Conclusions: The algorithm discriminates between HIV-infected cognitively impaired individuals. Diagnosis yields two unique profiles requiring further investigation. Findings largely support the algorithm's utility for diagnosing HIV-cognitive-impairment, but suggest distinct subsets of individuals with discrepant cognitive/functional performances that may not be readily apparent by conventional application of HAND diagnosis.

Keywords

HIVcognitive impairmentclassificationdementia
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 5 , June 2011 , pp. 835 - 843
Copyright
Copyright © International Psychogeriatric Association 2010

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