Validation of a novel multivariate method of defining HIV-associated cognitive impairment

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Title: Validation of a novel multivariate method of defining HIV-associated cognitive impairment
Authors: Underwood, J
De francesco, D
Cole, JH
Caan, MWA
Van Zoest, RA
Schmand, BA
Sharp, D
Sabin, CA
Reiss, P
Winston, A
Item Type: Journal Article
Abstract: Background The optimum method of defining cognitive impairment in virally suppressed people-living-with-HIV is unknown. We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patient reported outcome measures (PROMs) and neuroimaging markers of brain structure across three cohorts. Methods Differences in the prevalence of cognitive impairment, PROMs and neuroimaging data from the COBRA, CHARTER and POPPY cohorts (total n=908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS) and NMM criteria. Results The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (e.g. 48% for HAND vs. 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints were generally weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (p’s<0.05). There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean cortical thickness in both hemispheres (p’s<0.05), as well as smaller brain volumes (p<0.01). The associations with measures of white matter microstructure and brain-predicted age were generally weaker. Conclusion Different methods of defining cognitive impairment identify different people with varying symptomatology and measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer self-reported health status. This may be due to the statistical advantage of using a multivariate approach.
Issue Date: 3-May-2019
Date of Acceptance: 18-Apr-2019
ISSN: 2328-8957
Publisher: Oxford University Press
Journal / Book Title: Open Forum Infectious Diseases
Copyright Statement: © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is anOpen Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided theoriginal work is properly cited
Publication Status: Published online
Online Publication Date: 2019-05-03
Appears in Collections:Department of Medicine
Faculty of Medicine

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