Utility of the HIV Dementia Scale (HDS) in identifying HIV dementia in a South African sample.

BACKGROUND

The Mini Mental State Examination (MMSE) has been traditionally used to screen for cognitive impairment in a variety of dementing illnesses, including HIV associated dementia. More recently, the HIV Dementia Scale (HDS) was developed as a bedside evaluation test to differentiate patients with HIV-associated frank dementia from those who are cognitively normal.

OBJECTIVE

This study assessed the sensitivity and specificity of the HDS (using the MMSE as the gold standard) in a sample of 474 patients attending anti-retroviral (ARV) services in the Cape Town metropole of South Africa. None of these patients had a pre-existing clinical diagnosis of dementia based on a review of the medical records.

RESULTS

The HDS and MMSE were significantly correlated and showed significant agreement. Nonetheless, the HDS identified more participants demonstrating cognitive impairment than the MMSE. An ROC curve analysis revealed that an HDS cut-off of < or =10 yielded a sensitivity of 80%, specificity of 80%, and discriminated between the presence and absence of cognitive impairment 90% of the time.

CONCLUSION

Our findings suggest that the HDS may be a more sensitive screening instrument for HIV associated dementia in patients attending ARV services.