The University of California San Diego performance-based skills assessment: a useful tool to detect mild everyday functioning difficulties in HIV-infected patients with very good immunological condition.

Everyday functioning (EF) impairment is frequent in people living with HIV (PLWH). Our aim was to better explore EF and its association with PLWH cognition, by administering both the IADL scale, the most common functional scale, and a new and ecologic multi-domain (communication and financial skills) tool to measure EF as the University of California San Diego (UCSD) Performance-Based Skills Assessment-Brief Version (UPSA-B). Eighty-five PLWH on cART with very good immunological condition and 23 age- and education-matched healthy controls (HC) were enrolled. PLWH underwent a standardized neuropsychological battery plus IADL, and cognitive impairment was defined according to Frascati criteria. Both groups underwent the UPSA-B. Only 6 subjects (7%) were affected by cognitive impairment (asymptomatic profile). While IADL score was at ceiling for all patients, the UPSA-B total score was significantly worse in PLWH when compared with HC [mean 82.1 (SD 9.3) vs 89.2 (SD 6.2); p < 0.001]. At communication subtest, PLWH group and HC were significantly different (p = 0.002), while no difference emerged at financial skills (p = 0.096). Higher score at UPSA-B was independently associated with better global cognitive performance (composite Z-score) (ß 7.79; p < 0.001). Also considering each single cognitive domain, UPSA-B performance (both total and at subtests) confirmed the association with neurocognitive performance. In conclusion, UPSA-B seems to better discriminate EF impairment than IADL in PLWH, and it was associated with cognitive functions, also in the absence of symptomatic cognitive impairment. Thus, it appears a promising tool in the context of HIV infection to avoid misdiagnosis and to better detect also mild EF.

Neuropsychological screening tools in Italian HIV+ patients: a comparison of Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE).

OBJECTIVE: Despite the progress in HIV treatments, mild forms of cognitive impairment still persist. Brief and sensitive screening tools are needed. We evaluated the accuracy of the Montreal Cognitive Assessment (MoCA) compared to the Mini Mental State Examination (MMSE) to detect cognitive impairment in HIV-infected participants. METHOD: HIV-infected patients were consecutively enrolled during routine outpatient visits at a single institution. The MoCA, the MMSE, and a comprehensive neuropsychological battery were administered. Patients were considered as affected by cognitive impairment if they showed decreased cognitive function in at least two ability domains based on age and education adjusted Italian normative cut-offs. RESULTS: Ninety-three HIV-infected participants (75% males, median age 47, all on antiretroviral therapy; 90% HIV-RNA <50copies/mL, median CD4 644 cells/µL) were enrolled. Thirteen participants (14%) were diagnosed as cognitively compromised via a comprehensive neuropsychological examination. The area under the curve of the adjusted MMSE and MoCA scores to detect cognitive impairment were .51 (95% CI = .31-.72, p = .877) and .70 (95% CI = .53-.86, p = .025), respectively. A MoCA score <22 was able to predict the cognitive impairment with 62% of sensitivity and 76% of specificity. CONCLUSIONS: Our findings suggested that the prognostic performance of the MoCA to detect cognitive impairment among mildly impaired HIV-infected participants was only moderate. Further investigations are needed to identify optimal cognitive tests to screen HIV-infected individuals or to explore whether a combination of cognitive tests might represent a viable alternative to a single screening tool.