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A Brief and Feasible Paper-Based Method to Screen for Neurocognitive Impairment in HIV-Infected Patients: The NEU Screen

Muñoz-Moreno, Jose A. PhD*,†; Prats, Anna MS*,†; Pérez-Álvarez, Núria MS*,‡; Fumaz, Carmina R. PhD*,†; Garolera, Maite PhD§,‖; Doval, Eduardo PhD; Negredo, Eugènia PhD*,†; Ferrer, Maria J. MS*,†; Clotet, Bonaventura PhD*,†,¶for the NEU Study Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2013 - Volume 63 - Issue 5 - p 585–592
doi: 10.1097/QAI.0b013e31829e1408
Clinical Science

Objective: Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder.

Methods: A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ∼2 hours). Multiple score combinations were compared to find a paper-based method that took ≤10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated.

Results: Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individuals (48%) and was associated with lower nadir CD4 count (P < 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P < 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of attention/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper-based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ∼35 minutes).

Conclusions: The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV-infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.

*Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;

Universitat Autònoma de Barcelona, Bellaterra, Spain;

Universitat Politècnica de Catalunya, Barcelona, Spain;

§Consorci Sanitari Hospital de Terrassa, Terrassa, Spain;

Universitat de Barcelona, Grup de Recerca Consolidat en Neuropsicologia, Barcelona, Spain; and

Institut per la Recerca de la SIDA, Fundació IrsiCaixa, Badalona, Spain.

Correspondence to: Jose A. Muñoz-Moreno, PhD, Lluita contra la SIDA Foundation, HIV Unit, Germans Trias i Pujol University Hospital, 2a Planta, Edifici de Maternal Ctra. del Canyet, SN, CP 08916, Badalona, Barcelona, Catalonia, Spain (e-mail:

The members of the NEU Study Group are listed in Appendix I.

Supported by the Spanish Foundation for AIDS Research and Prevention (FIPSE, Fundación para la Investigación y la Prevención del SIDA en España, grant 24673/07), the Spanish AIDS Network (RIS, Red Temática Cooperativa de Investigación en SIDA, RD06/0006), and a research grant from ViiV Healthcare.

Presented in part at the 11th International Symposium on Neurovirology, May 29–June 2, 2012, New York, NY (Abstract P154 and Abstract P155).

The authors have no conflicts of interest to disclose.

Received March 07, 2013

Accepted May 28, 2013

© 2013 by Lippincott Williams & Wilkins