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The Alzheimer’s disease-8 and Montreal Cognitive Assessment as screening tools for neurocognitive impairment in HIV-infected persons

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Abstract

The diagnosis of human immunodeficiency virus (HIV)-associated neurocognitive impairment is time-intensive and often omitted in busy outpatient settings. Brief screening tools are needed. The Montreal Cognitive Assessment (MoCA) and the Alzheimer’s disease (AD)-8 have been used in neurodegenerative disorders. We evaluated the sensitivity and specificity of these brief screening tools in HIV-infected persons. The AD-8, MoCA, and formal neuropsychological testing were administered to 200 HIV-infected patients who were followed at a single institution. Normalized scores on formal neuropsychological testing were used to define neurocognitive impairment. The sensitivity and specificity of the MoCA and AD-8 were assessed to diagnose the impairment. Neurocognitive impairment was highly prevalent in this cohort: 127 persons (64 %) were diagnosed with neurocognitive impairment based on formal testing. Using the AD-8 and MoCA, 113 (57 %) and 101 (51 %) persons were identified with neurocognitive impairment, respectively. The sensitivity and specificity of MoCA were 63 % and 71 %, respectively. The sensitivity and specificity of AD-8 were 61 % and 51 %, respectively. Our findings highlight that brief screening tools correlate with formal neuropsychological testing. However, the sensitivities of these screening tools are lower than desired. Nevertheless, given their ease in administration, these tools could assist as a first line for identifying individuals who may subsequently require formal neuropsychological testing.

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Authors and Affiliations

  1. Department of Medicine, University of Alabama Birmingham, CCB Rm 325, 908 20th St South, Birmingham, AL, 35294, USA

    Edgar Turner Overton

  2. Department of Neurology, Washington University in Saint Louis, Saint Louis, MO, USA

    Tej D. Azad, Neva Parker, Elizabeth Westerhaus, David B. Clifford & Beau M. Ances

  3. Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA

    Debra Demarco Shaw, Judy Frain & Teresa Spitz

  4. Department of Psychology, University of Missouri in Saint Louis, Saint Louis, MO, USA

    Robert Paul

  5. Department of Biomedical Engineering, Washington University in Saint Louis, Saint Louis, MO, USA

    Beau M. Ances

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  1. Edgar Turner Overton
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  2. Tej D. Azad
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  3. Neva Parker
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  4. Debra Demarco Shaw
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  5. Judy Frain
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  6. Teresa Spitz
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  7. Elizabeth Westerhaus
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  8. Robert Paul
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  9. David B. Clifford
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  10. Beau M. Ances
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Correspondence to Edgar Turner Overton.

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Funding sources

This project was supported by an unrestricted research grant from the ViiV HIV Collaborative Investigator Research Award Program. BMA is currently receiving a grant (K23MH081786) from the National Institute of Mental Health at the National Institute of Health, the National Institute of Nursing Research at the National Institute of Health (R01NR012907 and R01NR012657).

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Overton, E.T., Azad, T.D., Parker, N. et al. The Alzheimer’s disease-8 and Montreal Cognitive Assessment as screening tools for neurocognitive impairment in HIV-infected persons. J. Neurovirol. 19, 109–116 (2013). https://doi.org/10.1007/s13365-012-0147-5

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