HIV-associated neurocognitive disorders (HAND) remain prevalent despite effective anti-retroviral treatments. Cognitive impairments in the current treatment era are often mild and not readily detectable because current screening measures (e.g., the HIV Dementia Scale) lack sensitivity to detect subtle impairments in cognitive function. Although more sensitive tests may exist, the time and cost associated with their administration and interpretation limits the feasibility of their widespread use in detecting HAND during routine clinic visits. Thus, there is a need for sensitive measures that can be routinely implemented within a busy clinic environment. Tablet computing tools, such as the Apple iPad, are increasingly ubiquitous, and offer an opportunity to potentially implement an intuitive interface for primarily self-directed brief cognitive assessments with automated scoring, data aggregation, preliminary determination of cognitive impairment in real-time, thus minimizing clinician and staff burden. In Phase I we will develop a brief, iPad-based cognitive screening, adapt it for use in functioning clinics, and validate its utility in detecting cognitive impairment within an HIV+ patient cohort.
The aims of this study are to: 1) develop a brief, iPad-based multi-domain cognitive screen capable of detecting subtle neurocognitive impairments in individuals with HIV infection, 2) examine the feasibility of incorporating the new measure in HIV clinics, and 3) conduct a preliminary study examining the (a) reliability and (b) validity of the screen. To accomplish these aims, we will adapt the existing Brainbaseline suite of measures, based upon preliminary work with HIV+ participants using more time-intensive tests, in order to reduce assessment time to less than 10 minutes. The screening measure will then be deployed in local HIV clinics in order to gather both cognitive performance data, as well as information on its usability and acceptability with patients and care providers. Eighty HIV+ patients will complete the iPad-based assessment in a clinic setting. A subset of 40 HIV+ participants will also be assessed at the HIV Neurobehavioral Research Program, where they will receive a comprehensive evaluation to determine a diagnosis of HIV-associated neurocognitive disorder (HAND). Twenty HIV seronegatives controls will also be evaluated on both the iPad and full neuropsychological test battery, in order to provide a point of comparison for the data collected in the HIV+ participants, as well as examine the relationship between the iPad tests and common neuropsychological tests in individuals without brain dysfunction. All participants (n = 100) will also complete a retesting on the iPad approximately 3 months later, in order to assess the test-retest reliability and possible practice effects associated with the measure. This would be the first study to develop an iPad-based cognitive screening test targeting HAND, and would provide us with critical information regarding the feasibility of such a measure. Should the overall project be successful, it would provide clinicians with a novel and highly-implementable tool for evaluating patient cognition, and position Digital Artefacts in a key leadership role in te development of user- and clinician- friendly screening measures for HAND and other neurologic conditions.
Difficulties with memory, concentration, and thinking speed remain common in individuals with HIV infection, despite effective medical treatments. Current screening tests are not effective at detecting such impairments. We aim to address this gap in care by developing a brief iPad- based test that would alert physicians to cognitive difficulties, and which could potentially result in alternative treatment strategies for patients.
