Table 1.

Screening Tools for Human Immunodeficiency Virus–Associated Neurocognitive Disorders

	Description	Benefits	Limitations	Recommendation	Estimated time needed to complete
HIV dementia scale (HDS) [Powers, JAIDS 1995]	5-item set of tests completed by clinician include a memory task, motor speed task, cube drawing, and evaluation of eye movements	Validated in HIV, quick to perform	Requires training; questionable consistency for saccadic eye movement portion of evaluation; less sensitive for non–HIV related impairment/neurodegenerative disorders and all but the most severe form of HAND	Prefer use of modified HDS or international HDS over HDS given high proportion of non-Caucasians in US HIV epidemic and potential challenges with consistent interpretation of eye movements	10 minutes
Modified HIV dementia scale (mHDS) [Davis AIDS Reader, 2002]	HDS with eye movement portion removed	Validated in HIV, quick to perform	Less sensitive for non–HIV related impairment/neurodegenerative disorders and all but the most severe form of HAND	Reasonable to consider in younger age (<65 years) recognizing limitations in all but severe disease	5 minutes
International HIV dementia scale (iHDS) [Sacktor AIDS, 2005]	4-item set of tests completed by clinician include memory task, finger tapping, a sequential motor task (Luria Sequence) and recall	Validated in HIV (internationally), quick to perform	Requires less training than saccadic eye movements, may not be sensitive to non–HIV related impairment/neurodegenerative disorders	Reasonable to consider in younger age (<65 years) recognizing limitations in all but severe disease, may have less cultural influence than mHDS in US setting	5 minutes
Mini mental state exam (MMSE) [Folstein J Psychiatr Res, 1975]	30-item test heavily weighted on orientation (10 items) rather than psychomotor speed	Familiar to many clinicians	Copyright protected, not sensitive to HIV-related injury	Not recommended as not likely to identify HIV-related impairment	10 minutes
Assessment of symptoms using standardized questions such as the Medical Outcomes Survey	Subjective reporting of cognitive symptoms	Easy to perform, can be done by patients in waiting room	Only identifies symptomatic disease (likely to miss most participants with impaired testing performance); not sensitive for neuropsychological testing impairment	May be useful in concert with objective screening instruments or considered as an initial screen with follow-up testing (will not identify ANI)	Variable
Neuropsychological testing	Tailored set of tests that can test a broad area of cognitive domains	Comprehensive assessment of function, likely most sensitive to cognitive impairment	Impractical for primary care setting due to time needed to perform testing and specialized training to interpret	Best reserved for referral of concerned cases and research	1–4 hours
Montreal cognitive assessment (MoCA) [Nasreddine JAGS, 2005]	30-item test that taps multiple domains subserved by cortical and subcortical regions	May have broader applicability to milder impairment in the era of cART and to heterogeneity of disease potentially seen in elder HIV patients; free, available online and translated into multiple languages	Not validated in HIV; initial pilot study with less than optimal performance characteristics	Reasonable choice but more work is needed	10 minutes
Computerized assessments	Several available and test multiple domains including attention, reaction time, memory and psychomotor speed	Can be done in doctor’s office with little supervision, time-saving comprehensive evaluation than simple screening instruments	Often costly, limitations in assessing learning efficiency; sometimes require trained interpretation	More work is needed before recommendations can be made	Variable

 Summary of neuropsychological screening tools and their sensitivity to detection of cognitive impairment in HIV.

 Abbreviations: HAND, human immunodeficiency virus--associated neurocognitive disorders; HIV, human immunodeficiency virus.