TABLE 1.

HIV-associated neurocognitive disorder (HAND) criteria

Asymptomatic neurocognitive impairment (ANI)*

Acquired impairment in cognitive functioning involving at least two ability domains, documented by performance of at least 1.0 SD below the mean for age-education-appropriate norms on standardized neuropsychological tests†. The cognitive impairment does not interfere with everyday functioning. The cognitive impairment does not meet criteria for delirium or dementia. There is no evidence of another pre-existing cause for the ANI‡.

Mild neurocognitive disorder (MND)*

Acquired impairment in cognitive functioning involving at least two ability domains, documented by performance of at least 1.0 SD below the mean for age-education-appropriate norms on standardized neuropsychological tests†. Typically, this would correspond to a Memorial Sloan Kettering scale stage of 0.5 to 1.0. The cognitive impairment produces at least mild interference in daily functioning (at least one of the following): Self-report of reduced mental acuity, inefficiency in work, homemaking or social functioning. Observation by knowledgeable others that the individual has undergone at least mild decline in mental acuity with resultant inefficiency in work, homemaking or social functioning. The cognitive impairment does not meet criteria for delirium or dementia. There is no evidence of another pre-existing cause for the MND‡.

HIV-associated dementia (HAD)*

Marked acquired impairment in cognitive functioning involving at least two ability domains, typically the impairment is in multiple domains, especially in learning new information, slowed information processing and defective attention/concentration. The cognitive impairment must be ascertained by neurological testing with at least two domains 2 SD or greater than the demographically corrected means. Note that where neuropsychological testing is not available, standard neurological evaluation and simple bedside testing may be used, but this should be performed as indicated in the algorithm (Figure 2). Typically, this would correspond to a Memorial Sloan Kettering scale stage of 2.0 or greater. The cognitive impairment produces marked interference with day-to-day functioning (work, home life, social activities). The pattern of cognitive impairment does not meet criteria for delirium (eg, clouding of consciousness is not a prominent feature); or, if delirium is present, criteria for dementia need to have been met on a previous examination when delirium was not present. There is no evidence of another, pre-existing cause for dementia (eg, other central nervous system (CNS) infection, CNS neoplasm, cerebrovascular disease, pre-existing neurologic disease, or severe substance abuse compatible with CNS disorder)†.

^*If there is a previous diagnosis of ANI, MND or HAD, but currently the individual does not meet criteria, the diagnosis of ANI, MND or HAD in remission can be made;

^†Neuropsychological assessment must survey at least the following abilities: verbal/language, attention/working memory, abstraction/executive, memory (learning recall), speed of information processing, sensory-perceptual, motor skills;

^‡If the individual with suspected ANI, MND or HAD also satisfied criteria for a major depressive episode or substance dependence, the diagnose of HAND should be deferred to a subsequent examination conducted at a time when the major depression has remitted or at least one month after cessation of substance use (Adapted from references 3 and 4)