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<p>Objective: The prevalence of cognitive impairment in HIV-positive patients is estimated
to be 39% in Uganda [1]. Despite the high prevalence of impairment, routine HIV management
in Uganda does not include neuropsychological assessment. The objective of this study
was to compare performance on the gold standard neuropsychological exam and on the
CogState computerized exam. We hypothesized that there would be a high degree of correlation
between performance on the two exams. </p><p>Methods: This cross-sectional survey
was conducted from August to October 2011. Each participant completed the standard
neuropsychological exam, which consisted of 10 tasks across 7 cognitive ability domains.
Patients also completed CogState, which consisted of 4 tasks using playing cards.
Performance for each exam was standardized using normative data from HIV seronegative
controls to produce z-scores. The primary outcome measures were average z-scores of
performance for each exam.</p><p>Results: Out of 181 patients tested, 130 (72%) were
classified as impaired on the gold standard neuropsychological exam, while 104 (57%)
were classified as impaired on CogState. The sensitivity of CogState compared to the
gold standard was 65% (95% CI = 56% - 73%) and the specificity was 63% (95% CI = 48%
- 73%). The Pearson's correlation of cumulative performance between the exams is 0.552,
which is significant at the 0.01 level. Finally, those patients with normal cognition
performed the best on CogState, while those with the most severe impairment performed
the worst. </p><p>Conclusions: Our findings suggest that CogState is a feasible and
useful tool to screen for and monitor impairment in HIV-positive patients, especially
in resource-limited settings. Future studies are needed to examine how individual
performance on CogState changes over time.</p>
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