Performance of Community Screening Instrument for Dementia in Screening for HIV-Associated Neurocognitive Disorders in Nigeria
Background: Cognitive function of HIV-infected patients in Nigeria has been studied using the community screening instrument for dementia (CSI-D) battery. However, its ability to detect HIV-associated neurocognitive disorders (HAND) is unclear. The study assessed the CSI-D battery in detecting HAND. Methods: Age, sex and education matched 30 HIV-positive and 30 HIV-negative subjects were administered the CSI-D battery. An extensive multi-domain neuropsychological tests (MDNPT) battery was used as gold standard. Measures of functional status including personal assessment of own functioning inventory (PAOFI), instrumental activities of daily living (IADL) and Beck depression inventory (BDI) were also administered. Diagnostic accuracy indices of the CSI-D were determined from a receiver operator characteristic (ROC) curve. Linear associations were explored using correlation coefficient. Results: HIV-positive subjects performed significantly worse than HIV-negative subjects in several domains across the 2 batteries. Large effect sizes were found in verbal fluency (COWAT), verbal learning, memory recall and language comprehension. Significant correlations between the two batteries were seen in all the domains except motor function. Subjects with HAND but normal on CSI-D scored poorly on motor function test. The area under the ROC curve was 0.79; 95 % confidence interval (CI) of 0.68-0.90, p < 0.0001. At cut-off score of ≤ 63, the CSI-D had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 77%, 63%, 55% and 61% respectively. Conclusion: CSI-D has good psychometric properties for use as a screening tool for HAND. The addition of test of motor function is advisable to complement it.