Predictive validity of demographically adjusted normative standards for the HIV Dementia Scale

Abstract

The aim of the current study was to develop and validate demographically adjusted normative standards for the HIV Dementia Scale (HDS). Given the association between demographic variables and the HDS summary score, demographically adjusted normative standards may enhance the classification accuracy of the HDS. Demographically adjusted normative standards were derived from a sample of 182 seronegative healthy participants and were subsequently applied to a sample of 135 HIV-1 seropositive individuals with multidisciplinary case conference diagnoses of HIV-1-associated neurocognitive disorders (e.g., HIV-1-associated dementia and minor-cognitive/motor disorder) in proportions consistent with published epidemiologic reports. In the normative sample, age and education (and their interaction) emerged as the only demographic factors significantly associated with the HDS. In comparison to the traditional HDS cut score (raw score total ≤10), use of the demographically adjusted normative standards significantly improved the sensitivity (from 17.2% to 70.7%, respectively) and overall classification accuracy (increasing the odds ratio from 3 to approximately 6) of the HDS for identifying participants with HIV-1-associated neurocognitive disorders. The application of demographically adjusted normative standards on the HDS improves the clinical applicability and accuracy of this cognitive screening measure in the detection of HIV-1-associated neurocognitive disorders.

The HIV Neurobehavioral Research Center (HNRC) group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the San Diego Veterans Affairs Healthcare System, and it includes: Director, Igor Grant; Codirectors, J. Hampton Atkinson, J. Allen McCutchan; Center Manager, Thomas D. Marcotte; Naval Hospital San Diego, Mark R. Wallace; Neuromedical Component, J. Allen McCutchan, Ronald J. Ellis, Scott Letendre, Rachel Schrier; Neurobehavioral Component, Robert K. Heaton, Mariana Cherner, Lucette Cysique, Sharron Dawes, Steven Paul Woods; Imaging Component, Terry Jernigan, John Hesselink, Michael J. Taylor; Neuropathology Component, Eliezer Masliah, Dianne Langford; Clinical Trials Component, J. Allen McCutchan, J. Hampton Atkinson, Ronald J. Ellis, Scott Letendre; Data Management Unit, Anthony Gamst, Clint Cushman; Statistics Unit, Ian Abramson, Christopher Ake. The HNRC is supported by Center award MH 62512 from the National Institute of Mental Health. The research described was also supported by Grants DA12065 and MH59745 from the National Institutes of Health. Note that the views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the United States Government.