Utility of the HIV dementia scale in assessing risk for significant HIV-related cognitive-motor deficits in a high-risk urban adult sample

Abstract

Considerable literature reflects the range of HIV-related neurocognitive complications, including relatively poor performance on tests of: movement and coordination; attention and concentration; reaction time; and mental flexibility. Efforts to develop appropriate screening techniques include the HIV Dementia Scale (HDS), a brief measure that has demonstrated promise but is lacking extensive independent evaluation. The present study examines the utility of the HDS in a sample of HIV-seropositive adults with a co-morbid history of psychiatric and substance use disorders. Forty subjects (65% male; mean age 41 years; mean education 12.2 years; 55% African American, 30% Caucasian) recruited for a study of the impact of brief psychotherapy on adherence to medications and medical appointments, relapse prevention, and/or enhancement of mental health functioning completed a battery of neuropsychological measures, including the HDS. Forty percent were identified as at high risk for significant cognitive-motor disorder (HDS total score ≤ 10). After controlling for age, education, illness (absolute CD₄), and depressed mood, high-risk participants performed significantly worse on measures of simple and sustained divided attention, psychomotor speed, and working memory. However, only 25 of 40 (63%) were correctly classified based on their performance on traditional tests of neuropsychological functioning. Implications and limitations of the study are discussed.

Acknowledgments

This work was supported by the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a collaboration of six Federal entities within the US Department of Health and Human Services (DHHS): The Center for Mental Health Services (CMHS), which had the lead administrative responsibility, and the Center for Substance Abuse Treatment (CSAT), both components of the Substance Abuse and Mental Health Services Administration (SAMHSA); the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA); the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), all parts of the National Institutes of Health (NIH). The content of this publication does not necessarily reflect the views or policies of these or any other agencies of the DHHS.

Portions of this study were presented at the 32nd Annual Meeting of the International Neuropsychological Society, February 2004, Baltimore, MD.