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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Is it time to rethink how neuropsychological tests are used to diagnose mild forms of HIV-associated neurocognitive disorders? Impact of false-positive rates on prevalence and power
Neuroepidemiology, Volume 41, No. 3-4, Year 2013
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Description
Background: Between 0 and 48% of normal HIV-uninfected individuals score below threshold neuropsychological test scores for HIV-associated neurocognitive disorders (HAND) or are false positives. There has been little effort to understand the effect of varied interpretations of research criteria for HAND on false-positive frequencies, prevalence and analytic estimates. Methods: The proportion of normal individuals scoring below Z score thresholds drawn from research criteria for HAND, or false-positive frequencies, was estimated in a normal Kenyan population and a simulated normal population using varied interpretations of research criteria for HAND. We calculated the impact of false-positive frequencies on prevalence estimates and statistical power. Results: False-positive frequencies of 2-74% were observed for asymptomatic neurocognitive impairment/mild neurocognitive disorder and 0-8% for HIV-associated dementia. False-positive frequencies depended on the definition of an abnormal cognitive domain, Z score thresholds and neuropsychological battery size. Misclassification led to clinically important overestimation of prevalence and dramatic decreases in power. Conclusions: Minimizing false-positive frequencies is critical to decrease bias in prevalence estimates and minimize reductions in power in studies of association, particularly for mild forms of HAND. We recommend changing the Z score threshold to ≤-1.5 for mild impairment, limiting analysis to 3-5 cognitive domains and using the average Z score to define an abnormal domain. © 2013 S. Karger AG, Basel.
Authors & Co-Authors
Meyer, Ana Claire Lew
United States, San Francisco
University of California, San Francisco
Kenya, Nairobi
Kenya Medical Research Institute
John Boscardin, W.
United States, San Francisco
University of California, San Francisco
Kwasa, Judith K.
Kenya, Nairobi
Kenya Medical Research Institute
Price, Richard W.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 67
Authors: 4
Affiliations: 2
Identifiers
Doi:
10.1159/000354629
e-ISSN:
14230208
Research Areas
Infectious Diseases
Mental Health
Study Design
Cross Sectional Study