Predictive Validity of a Computerized Battery for Identifying Neurocognitive Impairments Among Children Living with
Amelia E Van Pelt1,2, Tyler M Moore3,4, J Cobb Scott3,4,5
1Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Blockley Hall Office 107, Philadelphia, PA, USA. vanpel@pennmedicine.upenn.edu.
Insights
A new computerized cognitive test was validated for children with HIV in Botswana. This tool helps identify neurocognitive deficits in resource-limited settings.
Area of Science:
- Neuroscience
- Pediatrics
- Global Health
Background:
- Children living with HIV (HIV+) face higher risks of neurocognitive deficits.
- Standardized cognitive testing is often unavailable in low-resource, high-prevalence areas.
- The Penn Computerized Neurocognitive Battery (PennCNB) is a potential tool for assessing cognitive function.
Purpose of the Study:
- To evaluate the criterion validity of a locally adapted PennCNB version in Botswana.
- To assess the PennCNB's ability to identify neurocognitive impairment in HIV-positive children aged 10-17 years.
- To support the use of standardized cognitive assessments in resource-limited settings.
Main Methods:
- A cohort of 72 HIV-positive children (10-17 years) in Botswana participated.
- Participants completed the adapted PennCNB and a comprehensive consensus assessment (psychological tests, clinical interview, academic review).
- Statistical measures including sensitivity, specificity, and ROC curves were calculated to assess validity.
Main Results:
- The adapted PennCNB demonstrated acceptable discrimination between children with and without cognitive impairment.
- Predictive accuracy improved with less conservative thresholds for identifying impairment.
- The study provides evidence for the PennCNB's utility in this population.
Conclusions:
- The locally adapted PennCNB is a valid tool for assessing neurocognitive deficits in HIV-positive children in Botswana.
- This adaptation facilitates better cognitive health monitoring in resource-limited settings.
- The findings support the broader implementation of the PennCNB for pediatric HIV research and clinical care globally.
Abstract:
Children living with HIV (HIV+) experience increased risk of neurocognitive deficits, but standardized cognitive testing is limited in low-resource, high-prevalence settings. The Penn Computerized Neurocognitive Battery (PennCNB) was adapted for use in Botswana. This study evaluated the criterion validity of a locally adapted version of the PennCNB among a cohort of HIV+ individuals aged 10-17 years in Botswana. Participants completed the PennCNB and a comprehensive professional consensus assessment consisting of pencil-and-paper psychological assessments, clinical interview, and review of academic performance. Seventy-two participants were classified as cases (i.e., with cognitive impairment; N = 48) or controls (i.e., without cognitive impairment; N = 24). Sensitivity, specificity, positive predictive value, negative predictive value, and the area under receiver operating characteristic curves were calculated. Discrimination was acceptable, and prediction improved as the threshold for PennCNB impairment was less conservative. This research contributes to the validation of the PennCNB for use among children affected by HIV in Botswana.
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