Prevalence estimates of cognitive impairment in HIV disease vary widely. Here we used multivariate normative comparison (MNC) with identify individuals with impaired cognition, and to compare the results with those using the Frascati and Gisslén criteria.
The current project used data collected before October 2014 from bisexual/gay men from the Multicenter AIDS Cohort Study. A total of 2904 men (mean age 39.7 years, 52.7% seropositive) had complete data in six cognitive domains at their first neuropsychological evaluation. T-scores were computed for each domain and the MNC was applied to detect impairment among seronegative and seropositive groups.
The MNC classified 6.26% of seronegative men as being impaired using a predetermined 5% false discovery rate. By contrast, the Frascati and the Gisslén criteria identified 24.54 and 11.36% of seronegative men as impaired. For seropositive men, the percentage impairment was 7.45, 25.73, and 11.69%, respectively, by the MNC, Frascati and Gisslén criteria. When we used seronegative men without medical comorbidities as the control group, the MNC, the Frascati and the Gisslén criteria identified 5.05, 27.07, and 4.21% of the seronegative men, and 4.34, 30.95, and 4.48% of the seropositive men as having cognitive impairment. For each method, serostatus was not associated with cognitive impairment.
The MNC controls the false discovery rate and therefore avoids the low specificity that characterizes the Frascati and Gisslén criteria. More research is needed to evaluate the sensitivity of the MNC method in a seropositive population that may be sicker and older than the current study sample and that includes women.
aDepartment of Statistics
bDepartment of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
cPopulation Health Sciences, Harvard University, Cambridge, Massachusetts
dDepartment of Epidemiology
eDepartment of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
fDepartment of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California
gDepartment of Psychiatry, Rush University School of Medicine, Chicago, Illinois
hDepartment of Psychiatry
iDepartment of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
jDepartment of Radiology, Northwestern University, Evanston, Illinois
kDepartment of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
lDepartment of Psychiatry
mDepartment of Neurology
nDepartment of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Correspondence to James T. Becker, PhD, Department of Psychiatry; Department of Neurology; Department of Psychology, University of Pittsburgh, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15213, USA. Tel: +1 412 246 6970; e-mail: firstname.lastname@example.org
Received 30 October, 2018
Revised 26 April, 2019
Accepted 3 June, 2019
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