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A new bedside test of cognition for patients with HIV infection
B N Jones1, E L Teng, M F Folstein
1Johns Hopkins Hospital, Baltimore, Maryland.
Insights
The new Mental Alternation Test (MAT) is a quick and accurate bedside tool for assessing cognition in patients with HIV infection. It effectively identifies cognitive impairment comparable to established tests like the MMSE.
Area of Science:
- Neuropsychology
- Infectious Diseases
- Medical Diagnostics
Background:
- Cognitive impairment is a significant concern in patients with HIV infection.
- Existing cognitive tests can be time-consuming or require specialized administration.
- There is a need for rapid, reliable bedside cognitive assessments in this population.
Purpose of the Study:
- To evaluate the Mental Alternation Test (MAT) as a novel, brief cognitive assessment tool.
- To compare the MAT's performance against the Mini-Mental State Exam (MMSE) and Trailmaking Test (TMT) parts A and B.
- To determine the utility of the MAT in identifying cognitive deficits in HIV-infected patients.
Main Methods:
- A cohort study was conducted with 62 inpatients diagnosed with HIV infection.
- Participants underwent assessments using the MMSE, TMT parts A and B, and the MAT.
- Correlation analyses, ANOVAs, and receiver operating characteristic (ROC) curves were employed to compare test scores and identify optimal MAT cutoffs.
Main Results:
- The MAT demonstrated significant correlations with both the MMSE (r=0.68) and TMT part B (r=-0.54) scores.
- An optimal MAT cutoff score of 15 showed high sensitivity and specificity in detecting impaired performance on the MMSE and TMT part B.
- The MAT exhibited excellent test-retest (r=0.80) and inter-rater (r=0.85) reliability, with administration time around 60 seconds.
Conclusions:
- The Mental Alternation Test is a sensitive, specific, and easily administered cognitive assessment.
- The MAT is a valuable tool for screening HIV-infected patients for potential cognitive deficits.
- This brief test can help identify individuals requiring further, more comprehensive cognitive evaluation.
Objective:
To compare the Mental Alternation Test, a new 60-second bedside test of cognition, with the Mini-Mental State Exam (MMSE) and the Trailmaking Test, parts A and B, in patients with human immunodeficiency virus (HIV) infection.
Design:
Cohort study.
Participants:
Sixty-two inpatients with HIV infection.
Setting:
The AIDS service of a referral hospital.
Measurements:
Scores on the MMSE; the Trailmaking Test, parts A and B; and the Mental Alternation Test were compared using correlation calculations and analyses of variance. Receiver operating curves were constructed to identify the best cutoff score on the Mental Alternation Test for detecting impaired performance on the MMSE and the Trailmaking Test.
Main Results:
The Mental Alternation Test score correlated significantly with MMSE (r = 0.68, P < 0.01) and Trailmaking Test, part B, scores (r = -0.54, P < 0.01). The receiver operating curves showed that a Mental Alternation Test cutoff score of 15 yielded the best results for the detection of abnormal performance on the MMSE (sensitivity, 95% [95% CI, 90% to 100%]; specificity, 79% [CI, 69% to 89%]) and the Trailmaking Test, part B (sensitivity, 78% [CI, 68% to 88%]; specificity 93% [CI, 90% to 100%]). Patients making fewer than 15 alternations in 30 seconds were significantly more likely to have abnormal MMSE (P < 0.0001) and Trailmaking Test, part B, scores (P < 0.0001). The Mental Alternation Test had good reproducibility; analyses of reliability included test-retest correlation (r = 0.80) and inter-rater reliability (r = 0.85, kappa = 0.84). Time of administration was approximately 60 seconds.
Conclusions:
The Mental Alternation Test of cognition has good sensitivity and specificity and is easily administered. It is a valuable test to identify patients who may need further cognitive evaluation.
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