@Article{info:doi/10.2196/25660,
author="Rubin, Leah H
and Severson, Joan
and Marcotte, Thomas D
and Savin, Micah J
and Best, Allen
and Johnson, Shane
and Cosman, Joshua
and Merickel, Michael
and Buchholz, Alison
and Del Bene, Victor A
and Eldred, Lois
and Sacktor, Ned C
and Fuchs, Joelle-Beverlie
and Althoff, Keri N
and Moore, Richard D",
title="Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="9",
volume="8",
number="9",
pages="e25660",
keywords="cognitive complications; people with HIV; digital assessment; HIV; tablet; screening",
abstract="Background: Neurological complications including cognitive impairment persist among people with HIV on antiretrovirals; however, cognitive screening is not routinely conducted in HIV clinics. Objective: Our objective for this study was 3-fold: (1) to determine the feasibility of implementing an iPad-based cognitive impairment screener among adults seeking HIV care, (2) to examine the psychometric properties of the tool, and (3) to examine predictors of cognitive impairment using the tool. Methods: A convenience sample of participants completed Brain Baseline Assessment of Cognition and Everyday Functioning (BRACE), which included (1) Trail Making Test Part A, measuring psychomotor speed; (2) Trail Making Test Part B, measuring set-shifting; (3) Stroop Color, measuring processing speed; and (4) the Visual--Spatial Learning Test. Global neuropsychological function was estimated as mean T score performance on the 4 outcomes. Impairment on each test or for the global mean was defined as a T score ≤40. Subgroups of participants repeated the tests 4 weeks or >6 months after completing the first test to evaluate intraperson test--retest reliability and practice effects (improvements in performance due to repeated test exposure). An additional subgroup completed a lengthier cognitive battery concurrently to assess validity. Relevant factors were abstracted from electronic medical records to examine predictors of global neuropsychological function. Results: The study population consisted of 404 people with HIV (age: mean 53.6 years; race: 332/404, 82{\%} Black; 34/404, 8{\%} White, 10/404, 2{\%} American Indian/Alaskan Native; 28/404, 7{\%} other and 230/404, 58{\%} male; 174/404, 42{\%} female) of whom 99{\%} (402/404) were on antiretroviral therapy. Participants completed BRACE in a mean of 12 minutes (SD 3.2), and impairment was demonstrated by 34{\%} (136/404) on Trail Making Test A, 44{\%} (177/404) on Trail Making Test B, 40{\%} (161/404) on Stroop Color, and 17{\%} (67/404) on Visual-Spatial Learning Test. Global impairment was demonstrated by 103 out of 404 (25{\%}). Test--retest reliability for the subset of participants (n=26) repeating the measure at 4 weeks was 0.81 and for the subset of participants (n=67) repeating the measure almost 1 year later (days: median 294, IQR 50) was 0.63. There were no significant practice effects at either time point (P=.20 and P=.68, respectively). With respect for validity, the correlation between global impairment on the lengthier cognitive battery and BRACE was 0.63 (n=61; P<.001), with 84{\%} sensitivity and 94{\%} specificity to impairment on the lengthier cognitive battery. Conclusions: We were able to successfully implement BRACE and estimate cognitive impairment burden in the context of routine clinic care. BRACE was also shown to have good psychometric properties. This easy-to-use tool in clinical settings may facilitate the care needs of people with HIV as cognitive impairment continues to remain a concern in people with HIV. ",
issn="2368-7959",
doi="10.2196/25660",
url="https://mental.jmir.org/2021/9/e25660",
url="https://doi.org/10.2196/25660",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499048"
}