Accepted for/Published in: JMIR Mental Health
Date Submitted: Nov 10, 2020
Date Accepted: May 25, 2021
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Cognitive function assessed via a brief iPad-based assessment among people with HIV seeking adult clinical care
ABSTRACT
Background:
Neurological complications including cognitive impairment (CI) persist among people with HIV (PWH) on antiretrovirals. However, cognitive screening is not routinely.
Objective:
We used an iPAD-based CI screener to cross-sectionally assess CI burden among adults seeking HIV care.
Methods:
A convience sample of participants completed BrainBaseline Assessment of Cognition and Everyday Functioning (BRACE), an iPAD-based CI screener developed by Digital Artefacts/UCSD. BRACE includes the following tests: 1)Trail Making Tests (TMT)-Part-A measuring attention/concentration; 2)TMT-Part-B measuring executive function; 2)Stroop-Color measuring processing speed; and 4)Visual-spatial Learning Test (VSLT) measuring visual-spatial memory. Impairment on each test was defined as a T-score ≤ 40. Gobal neuropsychological(NP) function was estimated by averaging T-score performance of the four outcomes with impairment defined as a T-score ≤ 40. A sub-group completed an NP battery concurrently to assess validity of BRACE. An additional sub-group repeated BRACE 4-weeks or >6-months after completing the first tests to evaluate intra-person test-retest reliability. Relevant factors were abstracted from electronic medical records.
Results:
404 PWH (mean age=53.6; 82% Black; 58% male; 99% on ART) completed BRACE. Impairment for each test was: TMT-A: 34%, TMT-B: 44%, Stroop-Color: 40%, VSLT: 17%; global impairment was 25%. The correlation between global impairment on the gold standard battery and BRACE was 0.63 (n=61; P<0.001), with 84% sensitivity and 94% specificity to impairment on the full battery.
Conclusions:
BRACE estimated CI burden in PWH with good correlation with gold standard NP tests, suggesting the validity of this easy-to-use tool in the clinical setting. Even in PWH on ART, CI remains a concern and will continue to affect the care needs of PWH. Clinical Trial: na
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