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Clinical validation of the NeuroScreen
Ronald J Ellis1, Scott R Evans, David B Clifford
1Department of Neurosciences, UCSD AntiViral Research Center and HIV Neurobehavioral Research Center, University of California, San Diego, California 92103, USA. roellis@ucsd.edu
Journal of Neurovirology
|December 13, 2005
Summary
The NeuroScreen effectively tracks HIV-associated cognitive and nerve disorders in large groups. While useful for population studies, its accuracy for individual patient diagnosis is limited by false positives and negatives.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) can cause cognitive disorders and peripheral neuropathy.
- Monitoring these neurological complications in large HIV-positive cohorts is crucial, especially with combination antiretroviral therapy.
- Existing diagnostic methods can be resource-intensive for large-scale studies.
Purpose of the Study:
- To validate the NeuroScreen, a two-component tool (Brief NeuroCognitive Screen [BNCS] and Brief Peripheral Neuropathy Screen [BPNS]), for assessing HIV-associated neurological disorders.
- To evaluate the diagnostic accuracy of the NeuroScreen components against established neurodiagnostic evaluations in HIV-positive individuals.
Main Methods:
- 301 HIV-positive subjects from two large cohort studies were administered the NeuroScreen and a comprehensive neurodiagnostic evaluation.
- BNCS performance was assessed using a demographically adjusted mean z-score (NPZ3) and compared to a neuropsychological evaluation.
- BPNS performance was compared to a modified Total Neuropathy Score (TNS) administered by a neurologist.
Main Results:
- The BNCS demonstrated an area under the ROC curve of 0.74, with a cut-point of -0.33 yielding a 68% correct classification rate (65% sensitivity, 72% specificity).
- At 30% prevalence, the BNCS had a positive predictive value (PPV) of 86% for cognitive impairment.
- The BPNS achieved a 78% correct classification rate (49% sensitivity, 88% specificity) and a 72% PPV for distal sensory polyneuropathy (DSPN) at 40% prevalence.
Conclusions:
- The NeuroScreen shows utility in tracking the prevalence of HIV-associated neurological disease in large cohorts during the combination antiretroviral therapy era.
- The tool's predictive values suggest usefulness for epidemiological surveillance.
- However, the presence of substantial false positives and negatives indicates limitations for individual patient diagnosis.