Cognitive function assessed via a brief iPad-based assessment among people with HIV seeking adult clinical care (Preprint)

BACKGROUND Neurological complications including cognitive impairment (CI) persist among people with HIV (PWH) on antiretrovirals. However, cognitive screening is not routinely. OBJECTIVE We used an iPAD-based CI screener to cross-sectionally assess CI burden among adults seeking HIV care. METHODS A convience sample of participants completed BrainBaseline Assessment of Cognition and Everyday Functioning (BRACE), an iPAD-based CI screener developed by Digital Artefacts/UCSD. BRACE includes the following tests: 1)Trail Making Tests (TMT)-Part-A measuring attention/concentration; 2)TMT-Part-B measuring executive function; 2)Stroop-Color measuring processing speed; and 4)Visual-spatial Learning Test (VSLT) measuring visual-spatial memory. Impairment on each test was defined as a T-score ≤ 40. Gobal neuropsychological(NP) function was estimated by averaging T-score performance of the four outcomes with impairment defined as a T-score ≤ 40. A sub-group completed an NP battery concurrently to assess validity of BRACE. An additional sub-group repeated BRACE 4-weeks or >6-months after completing the first tests to evaluate intra-person test-retest reliability. Relevant factors were abstracted from electronic medical records. RESULTS 404 PWH (mean age=53.6; 82% Black; 58% male; 99% on ART) completed BRACE. Impairment for each test was: TMT-A: 34%, TMT-B: 44%, Stroop-Color: 40%, VSLT: 17%; global impairment was 25%. The correlation between global impairment on the gold standard battery and BRACE was 0.63 (n=61; P<0.001), with 84% sensitivity and 94% specificity to impairment on the full battery. CONCLUSIONS BRACE estimated CI burden in PWH with good correlation with gold standard NP tests, suggesting the validity of this easy-to-use tool in the clinical setting. Even in PWH on ART, CI remains a concern and will continue to affect the care needs of PWH. CLINICALTRIAL na