ABSTRACT

Introduction: There is debate about the optimal approach to diagnose neurocognitive impairment in people with HIV disease. The current “gold-standard” uses normative data to determine whether performance is below that of demographically comparable peers. This study investigated the utility of a discrepancy analysis approach, which compares normative neurocognitive performance directly to estimated premorbid intellectual functioning.

Method: A total of 570 adults with and without HIV disease completed a comprehensive neurocognitive battery and the Wechsler Test of Adult Reading (WTAR), an oral word reading measure that was used to estimate premorbid verbal IQ. Normative scores for six neurocognitive domains were subtracted from the WTAR standardized score to calculate discrepancy scores where higher scores indicated greater discrepancies.

Results: In models adjusting for relevant confounds, an interaction between HIV serostatus and domain discrepancy scores emerged such that persons with HIV had significantly higher discrepancy scores than seronegative participants, specifically in the domains of attention and episodic memory. Of clinical relevance, persons with HIV were two to three times more likely than their seronegative counterparts to have clinically discordant performance relative to premorbid verbal IQ in these domains. Additionally, the standard normative approach and discrepancy analysis method had fair to moderate agreement for classifying attention and episodic memory impairment in the participants with HIV disease.

Conclusions: HIV disease is associated with discrepancies between premorbid IQ estimates and the domains of attention and memory, consideration of which may be a clinically useful complement to standard normative approaches to diagnosing HIV-associated neurocognitive disorders.

摘要

简介：关于诊断艾滋病毒感染者神经认知障碍的最佳方法存在争议。当前的“黄金标准”使用规范数据来确定性能是否低于人口可比的同行。这项研究调查了差异分析方法的效用，该方法将规范性神经认知表现直接与估计的病前智力功能进行了比较。

方法：共有570名患有和未患有HIV疾病的成年人完成了全面的神经认知训练，并完成了Wechsler成年人阅读测验（WTAR），这是一种用于估计病态前言语智商的口头阅读手段。从WTAR标准化分数中减去六个神经认知域的规范分数，以计算差异分数，其中较高的分数表示较大的差异。

结果：在针对相关混杂因素进行调整的模型中，出现了HIV血清状况和领域差异评分之间的相互作用，从而使HIV感染者的差异得分明显高于血清阴性参与者，特别是在注意力和情节记忆领域。就临床而言，在这些领域，相对于病态口头智商，艾滋病毒感染者的临床表现较其血清阴性者高2至3倍。此外，标准的规范性方法和差异分析方法在将HIV疾病参与者的注意力和情节性记忆障碍分类方面具有中等至中等的共识。

结论： HIV疾病与病前智商估计值与注意力和记忆范围之间的差异有关，考虑这一点可能是对诊断与HIV相关的神经认知障碍的标准规范方法的临床有用补充。