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Montreal Cognitive Assessment Performance in HIV/AIDS: Impact of Systemic Factors

  • Noshin Koenig (a1), Esther Fujiwara (a2), M. John Gill (a3) (a1) and Christopher Power (a3) (a1) (a2) (a4)

Abstract

Background: A large proportion of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) suffer from neurocognitive impairment (NCI). The causes of the NCI are multifold in HIV infection although a subset of HIV/AIDS patients are affected by the spectrum syndrome, HIV-associated neurocognitive disorder (HAND). We investigated the Montreal Cognitive Assessment (MoCA) in relation to clinical, demographic and laboratory findings as well as its ability to predict symptomatic HAND (sHAND) among patients with HIV/AIDS. Methods : All subjects were receiving regular HIV care including CD4+ T cell counts, plasma viral load measurements, clinical evaluations and antiretroviral therapy. The diagnosis of sHAND was based upon clinical, neuroimaging, and neuropsychological assessments. Results: Among HIV-1 seropositive subjects (n=125), ethnicity, education and employment were positively correlated with their MoCA scores (p<0.05). In contrast, polypharmacy, central nervous system penetration-effectiveness (CPE) score, antiretroviral drug exposure, substance use and nucleoside/nucleotide reverse transcriptase inhibitor side effects were negatively correlated with MoCA scores (p<0.05). Of note, MoCA scores were not associated with CD4 T cell nadir levels, age, peak viral load, or veterans aging cohort study index. In subjects with or without sHAND, mean MoCA scores differed (sHAND, 22.8±3.51; non-HAND 25.2±2.64) (p<0.05) with a receiver operating characteristic curve showing an area under curve of 0.71 and an optimal MoCA cut-off value of 23.5 when compared to the established diagnostic paradigm. Conclusions: MoCA scores were generally lower in this HIV/AIDS population compared to reported scores in the general population. MoCA performance was associated with multiple clinical variables but displayed limited predictive utility in detecting sHAND.

Résultats du Montreal Cognitive Assessment chez des patients atteints de VIH/SIDA : impact de facteurs systémiques. Contexte: Une grande proportion des individus porteurs du virus de l’immunodéficience humain/syndrome de l’immunodéficience acquise (VIH/SIDA) sont atteints de déficits neurocognitifs (DNC). Les causes des DNC sont multiples dans l’infection par le VIH, bien qu’un sous-groupe de patients atteints de VIH/SIDA présente le spectre des troubles neurocognitifs liés à l’infection par le VIH (TNCV). Nous avons examiné le Montreal Cognitive Assessment (MoCA) en lien avec les observations cliniques, démographiques et biochimiques ainsi que la capacité de ce test à prédire les TNCV symptomatique (TNCVs) chez des patients atteints de VIH/SIDA. Méthode: Tous les sujets recevaient des soins réguliers pour l’infection par le VIH incluant un décompte des cellules T CD4+, une mesure de la charge virale, des évaluations cliniques et un traitement antirétroviral. Le diagnostic de TNCVs était basé sur la clinique, la neuroimagerie et les évaluations neuropsychologiques. Résultats: Parmi les sujets séropositifs pour le VIH-1 (n=125), l’ethnicité, le niveau de scolarité et l’emploi étaient corrélés positivement aux score du MoCA (p=0,05). Inversement, la polypharmacie, le score d’efficacité de pénétration à travers la barrière hémato-encéphalique, l’exposition à des antirétroviraux, la consommation de drogues et les effets secondaires dus à des inhibiteurs nucléosidiques/nucléotidiques de la transcriptase inverse étaient corrélés négativement aux scores du MoCa (p=0,05). Il est à noter que les scores du MoCA n’étaient pas associés aux décomptes les plus bas de cellules T CD4+, à l’âge, aux charges virales les plus élevées, à l’indice du Veterans Aging Cohort Study (VACS). Chez les sujets avec ou sans TNCVs, les scores moyens du MoCA étaient différents (TNCVs, 22,8±3,51 ; non-TNCV 25,2±2,64) (p=0,05), la courbe ROC montrant une surface sous la courbe de 0,71 et une valeur seuil optimale du MoCA de 23,5 par rapport au paradigme diagnostique établi. Conclusions : Les scores du MoCA étaient généralement plus bas dans cette population de patients porteurs du VIH/SIDA par rapport aux scores rapportés pour la population en général. Les résultats du MoCA étaient associés à de multiples variables cliniques. Cependant, ils présentaient une utilité prédictive limitée pour détecter un TNCVs.

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Copyright

Corresponding author

Correspondence to: Christopher Power, Department of Medicine (Neurology), University of Alberta, Heritage Medical Research Centre, 6-11, Edmonton, T6G 2S2, Canada. Email: cp9@ualberta.ca.

References

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