Hopkins lit review offers guidance on choosing cognitive screening tools for HIV clinical care settings
HIV-associated dementia is a concern as people living with HIV (PLWH) live longer—and, as a result, longitudinal tools are needed to screen for cognitive impairment. This structured literature review identifies three highly-ranked tools and makes recommendations for selecting the best tool in a particular clinical setting or with a specific patient population.
About This Study
“Selection of cognitive impairment screening tools for longitudinal implementation in an HIV clinical care setting” was published online on Feb. 21, 2023, in AIDS Care. The lead author is Meghana L. Dantuluri of the Department of General Internal Medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland.
Key Research Findings
Researchers assessed the strengths and weaknesses of 10 validated tools that screen PLWH for cognitive impairment. Based on the criteria they identified, the three highest-ranking tools were: BRACE (Brain Baseline Assessment of Cognitive and Everyday Functioning), NeuroScreen, and NCAD (Novel Computerized Cognitive Assessment Device).
Ranking criteria included the tool’s validity in PLWH, the acceptability and feasibility of its use, and who owned the data generated by the screening. The selection of which tool to use in a particular clinic depends on the characteristics of the patients who are screened, available settings (e.g., quiet space to complete the assessment), and technological facilities (e.g., data security, ability to link to the electronic health record), the study authors wrote.
Patient characteristics to consider include how many have a history of substance use or little education, as well as patients’ average age. Physical limitations, such as visual impairment or arthritis, may also be a factor since they could make interaction with a touch screen difficult.
Discussion Highlights and Implications for Practice
After the literature review, researchers developed a list of questions to guide clinicians in choosing the best tool for their own settings, matching the strengths of each tool. Considerations included accuracy in their patient population, adherence to privacy requirements, fit with clinic flow, and cost within budget.
For example, the authors noted that:
Substance use has been shown to affect the performance of tools.
A low educational level could affect the reading level needed for comprehension of written material.
Older patients may not be comfortable with new technology such as iPads.
Those with vision or hearing impairments or arthritic hands may require assistance for which staff must be available.
Once a tool has been identified, a pilot test should be performed to assess actual tool performance, and technical staff should be consulted to ensure integration into the clinic’s electronic medical record systems and maintenance of the devices used for the screenings, the study authors recommended.
By Barbara Jungwirth
Source : TheBodyPro