A screening algorithm for HIV‐associated neurocognitive disorders

Background

HIV physicians have limited time for cognitive screening. Here we developed an extra‐brief, clinically based tool for predicting HIV‐associated neurocognitive impairment (HAND) in order to determine which HIV‐positive individuals require a more comprehensive neurological/neuropsychological (NP) assessment.

Methods

Ninety‐seven HIV‐positive individuals with advanced disease recruited in an HIV out‐patient clinic received standard NP testing. A screening algorithm was developed using support vector machines, an optimized prediction procedure for classifying individuals into two groups (here NP‐impaired and NP‐normal) based on a set of predictors.

Results

The final algorithm utilized age, current CD4 cell count, past central nervous system HIV‐related diseases and current treatment duration and required approximately 3 min to complete, with a good overall prediction accuracy of 78% (against the gold standard; NP‐impairment status derived from standard NP testing) and a good specificity of 70%.

Conclusion

This noncognitive‐based algorithm should prove useful to identify HIV‐infected patients with advanced disease at high risk of HAND who require more formal assessment. We propose staged guidelines, using the algorithm, for improved HAND therapeutic management. Future larger, international studies are planned to test the predictive effect of nadir CD4 cell count, hepatitis C virus infection, gender, ethnicity and HIV viral clade. We recommend the use of this first version for HIV‐infected Caucasian men with advanced disease.     

Validation of the language component of the Addenbrooke's Cognitive Examination – Revised (ACE‐R) as a screening tool for aphasia in stroke patients

Aim: Several tests are available for aphasia screening following stroke. However, some of them have shortcomings such as need of specialist knowledge, low sensitivity and/or specificity and lengthy administration time. Our study aims to evaluate the language component of the Addenbrooke's Cognitive Examination – Revised (ACE‐R) as a screening tool for aphasia in stroke patients. Methods: The language component of ACE‐R was administered to consecutive patients admitted to a post‐acute stroke unit. Patients who were medically unstable or had a significant history of sensory impairment or mental health issues were excluded. The test was administered by two junior doctors with basic training in ACE‐R administration. Patients recruited were also assessed by an experienced speech and language therapist (SLT). The results of the two assessments were documented by a different member of the team and the SLT results were used as the benchmark to calculate the ACE‐R language component sensitivity and specificity. Results: Fifty‐nine participants were recruited and 27 of them were women. The mean age was 72 (SD 11.9). Thirty‐four participants had left and 11 right hemisphere stroke. Fourteen had bilateral affection. Six participants were left handed. A cut‐off value of 22/26 of ACE‐R language component showed 100% specificity and 83.1% sensitivity, while a cut‐off value of 16/26 had 88.2% specificity and 100% sensitivity. Conclusion: Our results suggest that the language component of ACE‐R has a satisfactory sensitivity and specificity compared with other screening tests used in strokes. It is easy to administer and free to use.     

Validation of Alzheimer’s disease CSF and plasma biological markers: The multicentre reliability study of the pilot European Alzheimer’s Disease Neuroimaging Initiative (E-ADNI)

Background

Alzheimer’s Disease Neuroimaging Initiatives (“ADNI”) aim to validate neuroimaging and biochemical markers of Alzheimer’s disease (AD). Data of the pilot European-ADNI (E-ADNI) biological marker programme of cerebrospinal fluid (CSF) and plasma candidate biomarkers are reported.

Methods

Six academic EADC centres recruited 49 subjects (healthy controls, subjects with mild cognitive impairment (MCI) and AD). We measured CSF β-amyloid 42 (CSF Aβ42), total tau-protein (t-tau), phosphorylated tau-proteins (P-tau181, P-tau231), plasma β-amyloid 40 and 42 (Aβ40/Aβ42). Immediate fresh shipment was compared to freezing and later shipment on dry ice.

Results

CSF T-tau (fresh samples) was increased in AD versus controls (p = 0.049), CSF Aβ42 (frozen samples) was decreased in MCI and AD (p = 0.02), as well as plasma Aβ40 (fresh and frozen samples) in AD (p = 0.049 and p = 0.016). Pooled values of neurochemical parameters and ratios thereof were different between centres (p < 0.005). Analysis of frozen samples yielded higher diagnostic accuracy than immediate fresh shipment with 100% (fresh: 100%) correctly classified in control subjects, 100% (78%) in MCI, 91% (91%) in AD.

Conclusion

The use of frozen rather than fresh samples renders higher diagnostic accuracy within a multicentre context. We confirmed the feasibility of a multicentre AD biomarker programme for future clinical trials.     

Performance of the St George’s Respiratory Questionnaire in patients with connective tissue disease‐associated interstitial lung disease

Background and objective

The St George’s Respiratory Questionnaire (SGRQ) is a self‐administered questionnaire used to assess health‐related quality of life (HRQoL) in various chronic respiratory diseases. Few studies have assessed the performance of the SGRQ in patients with connective tissue disease‐associated interstitial lung disease (CTD‐ILD). We aimed to examine the SGRQ’s performance characteristics and generate data to support its reliability and validity in patients with CTD‐ILD.

Methods

We used data from 193 CTD‐ILD patients evaluated at Tosei General Hospital from May 2007 to July 2016 to assess the cross‐sectional and longitudinal validity of the SGRQ.

Results

The mean age of the patients was 64.2 years and 122 (63.2%) were women. There were no significant differences in SGRQ scores between any of the CTD groups. Internal consistency (Cronbach’s α = 0.905) and repeatability (intraclass correlation coefficient (ICC) = 0.873) for the SGRQ total score were excellent. At baseline, SGRQ total score was significantly associated with clinically meaningful measures of physiological function, exercise capacity and dyspnoea. Change in SGRQ total score over 6 months was also associated with change in other measures. Cox proportional hazards models showed that higher baseline SGRQ total score was a significant predictor of mortality. The estimated minimal clinically important difference of SGRQ total score was 4–13 points.

Conclusion

These data support the validity and reliability of SGRQ as a sensitive measure for capturing HRQoL in patients with CTD‐ILD.

     

Natural killer (NK) cell leukaemia in a patient with a B cell non‐Hodgkin’s lymphoma

Summary We describe a 74‐year‐old woman with the diagnosis of natural killer (NK)‐cell leukaemia and autoimmune pathology. Four years previously, a diffuse large B cell non‐Hodgkin’s lymphoma had been diagnosed and treated effectively. Although NK‐cell leukaemia has been thought to be a distinct highly aggressive clinicopathological entity, our case shows no further evolution at the present time. As far as we know, this association has not been previously described in the literature.