[Cognition disorders in HIV infection. Validation of a brief neuropsychological evaluation battery]

The objective of our study was the elaboration and the validation of a brief neuropsychological battery sensitive to the main cognitive and psychomotor deficits in HIV+ patients with HIV encephalopathy and cognitive impairment associated with seropositivity. We evaluated the sensitivity of this brief battery with respect to a large neuropsychological battery of standardized tests.

A brief battery (BB) (30 mn, with simple and portable material) of 5 standardized subtests and 7 new elaborated tests and a large battery (LB) (2 h to 2 h 30) of 16 standardized subtests, were constituted. Both screened 6 major cognitive areas (attention, memory, visuospatial function, psychomotor speed, motor dexterity, language). On the LB, subjects' age and educational level were considered while appraising performances to determine whether subjects had normal cognitive status (less than 4 abnormal test scores), borderline cognitive impairment (4 or 5 abnormal test scores); on the BB norms for the new tests were generated from the results of 24 HIV+ subjects with normal cognitive status on the LB and 15 HIV- subjects of a control group; performance on the BB was considered normal if less than 3 test scores were abnormal, or impaired if more than 3 test scores were abnormal. Conclusions deduced from the assessments with BB were compared to those obtained from LB. For all subjects, a possible anxio-depressive component was evaluated on the basis of DSM III-R criteria and clinical scales (MADRS and STAXI). Subjects were included in the study notwithstanding mode of contamination and stage of illness and anxiodepressive antecedents; patients with identified brain disease or evolutive non neurological pathology were not included. 102 evaluations were performed on a population of HIV+ patients comprising 89 men and 13 women: 19 CDC II, 35 CDC III or IV C 2 and 48 CDC IV; 76 homosexuals, 8 heterosexuals, 16 drug users and 2 transfused.

the BB led to the same conclusions for 90.6% of the 53 impaired cases (on LB) and for 96% of the 24 normal cases. The reliability of the BB is therefore of 92%; there was only 1 false positive (less than 2%) and less than 6.5% false negatives. Among the 25 subjects with borderline cognitive impairment, half were impaired and half were normal on the BB; most (84%) presented with anxio-depressive symptoms.

The brief battery (BB) testing 6 cognitive functions could be considered as a sensitive, practical instrument for rapid detection of cognitive impairment in HIV+ patients, with a few rate of false positive or negative diagnosis. However, it is not adequate for determining whether psychiatric or/and organic brain pathology is at the origin of the deficit. Evaluation and follow-up of a possible anxio-depressive component has to be considered together before concluding.