The Montreal Cognitive Assessment–Basic (MoCA-B) is not a reliable screening tool for cognitive decline in HIV patients receiving combination antiretroviral therapy in rural South Africa

• Published in: International journal of infectious diseases Vol. 67; no. C; pp. 36 - 40
• Main Authors: Hakkers, C.S., Beunders, A.J.M., Ensing, M.H.M., Barth, R.E., Boelema, S., Devillé, W.L.J., Tempelman, H.A., Coutinho, R.A., Hoepelman, A.I.M., Arends, J.E., van Zandvoort, M.J.E.
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.02.2018; Elsevier
• Subjects: Africa; HAND; HIV; MoCA; Screening; Screening; MoCA; HIV; HAND; Africa
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2017.11.024

•The Montreal Cognitive Assessment–Basic (MoCA-B) is not a valid screening tool in resource-limited settings.•The prevalence of HIV-associated neurocognitive disorders (HAND) was high in a rural cohort in Sub-Saharan Africa.•The use of appropriate norms in scoring a neuropsychological assessment is important.•Published norms can overestimate the prevalence of HAND. HIV-associated neurocognitive disorders (HAND) are frequently occurring comorbidities in HIV-positive patients, diagnosed by means of a neuropsychological assessment (NPA). Due to the magnitude of the HIV-positive population in Sub-Saharan Africa, easy-to-use cognitive screening tools are essential. This was a cross-sectional clinical trial involving 44 HIV-positive patients (on stable cART) and 73 HIV-negative controls completing an NPA, the International HIV Dementia Scale (IHDS), and a culturally appropriate cognitive screening tool, the Montreal Cognitive Assessment–Basic (MoCA-B). HAND were diagnosed by calculating Z-scores using internationally published normative data on NPA, as well as by using data from the HIV-negative group to validate the MoCA-B. One hundred and seventeen patients were included (25% male, median age 35 years, median 11 years of education). A moderate correlation was found between the MoCA-B and NPA total Z-score (Pearson’s r=0.36, p=0.02). Area under the curve (AUC) values for MoCA-B and IHDS were 0.59 and 0.70, respectively. The prevalence of HAND in HIV-positive patients was 66% when calculating Z-scores using published normative data versus 48% when using the data from the present HIV-negative cohort. The MoCA-B appeared not to be a valid screening tool for HAND in this setting. The prevalence of HAND in this setting is high, but appeared overestimated when using published norms.