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Evaluation of brief screening tools for neurocognitive impairment in HIV/AIDS: a systematic review of the literature

Zipursky, Amy R.a,b; Gogolishvili, Davida; Rueda, Sergioa,b; Brunetta, Jasonc; Carvalhal, Adrianab,d; McCombe, Jennifer A.e; Gill, M. Johne; Rachlis, Anitab,f; Rosenes, Rona; Arbess, Gordonb,d; Marcotte, Thomasg; Rourke, Sean B.a,b,d

doi: 10.1097/QAD.0b013e328363bf56
Clinical Science

Objective(s): To systematically review literature on brief screening tools used to detect and differentiate between normal cognition and neurocognitive impairment and HIV-associated neurocognitive disorders (HANDs) in adult populations of persons with HIV.

Design: A formal systematic review.

Methods: We searched six electronic databases in 2011 and contacted experts to identify relevant studies published through May 2012. We selected empirical studies that focused on evaluating brief screening tools (<20 min) for neurocognitive impairment in persons with HIV. Two reviewers independently reviewed retrieved literature for potential relevance and methodological quality. Meta-analyses were completed on screening tools that had sufficient data.

Results: Fifty-one studies met inclusion criteria; we focused on 31 studies that compared brief screening tools with reference tests. Within these 31 studies, 39 tools were evaluated and 67% used a comprehensive neuropsychological battery as a reference. The majority of these studies evaluated HIV-associated dementia (HAD). Meta-analyses demonstrated that the HIV Dementia Scale (HDS) has poor pooled sensitivity (0.48) and the International HIV Dementia Scale (IHDS) has moderate pooled sensitivity (0.62) in detecting a range of cognitive impairment. Five newer screening tools had relatively good sensitivities (>0.70); however, none of the tools differentiated HAND conditions well enough to suggest broader use. There were significant methodological shortcomings noted in most studies.

Conclusion: HDS and IHDS perform well to screen for HAD but poorly for milder HAND conditions. Further investigation, with improved methodology, is required to understand the utility of newer screening tools for HAND; further tools may need to be developed for milder HAND conditions.

Supplemental Digital Content is available in the text

aOntario HIV Treatment Network

bUniversity of Toronto

cMaple Leaf Clinic, Toronto, Ontario

dSt. Michael's Hospital, Toronto, Ontario

eSouthern Alberta HIV Clinic and University of Alberta, Edmonton, Alberta

fSunnybrook Hospital, Toronto, Ontario, Canada

gUniversity of California, San Diego, La Jolla, California, USA.

Correspondence to Dr Sean B. Rourke, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. Tel: +1 416 864 6060 ext 6482; fax: +1 416 864 5135; e-mail:

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Received April 5, 2013

Accepted May 29, 2013

© 2013 Lippincott Williams & Wilkins, Inc.