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Clinical Manifestations.

Roslyn Valdespino1, Gabrielle Hromas1, Chen-Pin Wang1

  • 1University of Texas Health San Antonio, San Antonio, TX, USA.

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Summary
This summary is machine-generated.

The tablet-based Cognitive Assessment Tool (TabCAT) effectively identifies cognitive impairment (CI) in Sub-Saharan Africa, including people living with HIV (PLWH). This digital tool shows promise for widespread use in diverse populations.

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Area of Science:

  • Neurology
  • Gerontology
  • Infectious Diseases

Background:

  • Sub-Saharan Africa (SSA) is experiencing a demographic shift with increasing numbers of older adults, individuals living with HIV (PLWH), and a rising prevalence of Alzheimer's Disease (AD).
  • The region faces significant challenges in diagnosing cognitive impairment (CI) due to a shortage of healthcare professionals and a lack of culturally relevant assessment tools.
  • The tablet-based Cognitive Assessment Tool (TabCAT) offers a potential solution, being a brief, digitally administered battery with automated scoring suitable for diverse populations.

Purpose of the Study:

  • To evaluate the performance and validity of the tablet-based Cognitive Assessment Tool (TabCAT) for identifying cognitive impairment (CI) in a Sub-Saharan African (SSA) context.
  • To assess TabCAT's utility in a prospective cohort study involving older adults, including people living with HIV (PLWH) and HIV-uninfected individuals in Uganda.
  • To determine if TabCAT is a reliable tool for cognitive assessment across diverse cultural backgrounds, languages, and education levels in SSA.

Main Methods:

  • TabCAT underwent translation and cultural adaptation using expert review and focus groups.
  • TabCAT scores were compared against a validated reference-standard cognitive testing battery used in Uganda.
  • The study employed Z-scores adjusted for age, sex, and education, and used Jak/Bondi criteria for CI definition. Receiver Operating Characteristic (ROC) curves assessed discriminative ability.

Main Results:

  • TabCAT demonstrated acceptable face and content validity from local experts and focus groups.
  • The study included 563 participants (mean age 60, 50% female, 51% with less than primary education, 49% PLWH).
  • The TabCAT composite score showed good to excellent ability in identifying CI (c-statistic 0.79), performing similarly in people living with HIV (PLWH).

Conclusions:

  • TabCAT exhibits content, concurrent, and criterion validity for detecting CI in a Sub-Saharan African population, including PLWH.
  • Despite some variability in concurrent validity, TabCAT is a promising brief tool for CI identification, applicable across diverse demographics and HIV statuses.
  • Further research is planned to explore TabCAT's validity for diagnosing Alzheimer's Disease (AD) and related dementias in Uganda and similar resource-limited settings.