Which screening test best classified HIV-associated neurocognitive disorders?

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Because HIV-associated neurocognitive disorders (HAND) share similarities with neurodegenerative dementias and executive dysfunction is frequent among HIV-positive patients, researchers evaluated the accuracy of four HAND screening tools: the Frontal Assessment Battery, Clock-Drawing Test, Three Questions Test and International HIV Dementia Scale.

This single-center cross-sectional study was conducted from 2010 to 2017. The four screening tools were the index tests, and the reference standard was a comprehensive neurocognitive battery assessing 10 cognitive domains. A trained infectious diseases physician screened patients; those with International HIV Dementia Scale scores ≤ 10 and/or complaints of neurocognitive symptoms were then evaluated by a trained neuropsychologist.

In total, 650 patients were screened, and 281 received the full neurocognitive evaluation. HAND was diagnosed in 140 individuals.

Sensitivity, specificity, correct classification rate and area under the receiver operating characteristic curve (AUROC), respectively, were: Frontal Assessment Battery, 40.7%, 95.1%, 68.3% and 0.81; International HIV Dementia Scale, 74.4%, 56.8%, 65.4% and 0.73; Clock-Drawing Test, 30.9%, 73.4%, 53.8% and 0.56. For the Three Questions Test, sensitivity, specificity and correct classification rate were 37.3%, 54.1% and 45.7%, respectively; no AUROC was reported in the abstract.

At a raised Frontal Assessment Battery cut-off of ≤ 16, sensitivity was 78.0%, specificity was 63.9% and the correct classification rate was 70.8%. The researchers observed poor screening performance for the Three Questions and Clock-Drawing Tests. The International HIV Dementia Scale had poor specificity, while the Frontal Assessment Battery had the highest correct classification rate and showed promising performance at different exploratory cut-offs.