Summary

This research article focuses on a brief assessment tool called the Brief Cognitive AbilityMeasure (B-CAM) for measuring cognitive function in people living with HIV. The study aimed to determine if the B-CAM could accurately measure changes in cognition over time. The researchers performed the B-CAM in 102 HIV-positive individuals three times over a six-month period. They used advanced statistical methods to analyze the data and assess any changes in cognitive performance. The results showed that the B-CAM was able to measure cognitive changes effectively, and the observed improvements were within the expected range of measurement error. The study concluded that the B-CAM is a promising tool for assessing cognitive function and detecting meaningful changes in people living with HIV. This research contributes to better understanding and monitoring of cognitive difficulties in this population.

Abstract

Background

Mild cognitive impairment is common in chronic HIV infection and there is concern that it may worsen with age. Distinguishing static impairment from on-going decline is clinically important, but the field lacks well-validated cognitive measures sensitive to decline and feasible for routine clinical use. Measures capable of detecting improvement are also needed to assess interventions. The objective of this study is to estimate the extent of change on repeat administration of three different forms of a brief computerized cognitive assessment battery (B-CAM) developed for assessing cognitive ability in the mildly-impaired to normal range in people living with HIV. We hypothesized no change over a six-month period in people on effective antiretroviral therapy.

Methods

102 HIV+ individuals completed a set of computerized cognitive tasks on three occasions over a six-month period. Rasch analysis was used to determine if change over time (i.e. improvement due to practice) was uniform across tasks and to refine scoring in order to produce three forms of the B-CAM of equivalent level of difficulty. Group-based trajectory analysis (GBTA) was then applied to determine if performance at baseline influenced the magnitude of practice-related improvement on the battery as a whole over the course of follow-up.

Results

Two cognitive tasks (fluency and word recall) had different levels of difficulty across test sessions, related to the different forms of the tasks. These two items were split by testing session. For all other items, the level of difficulty remained constant across all three time points. GBTA showed that the sample was composed of three distinct groups of people with unique trajectories, defined mainly by level of cognitive ability at baseline. Only the highest group showed an apparent improvement over time, but this change fell within measurement error.

Conclusions

Rasch analysis provides mathematical confirmation that these three forms of the B-CAM are of equivalent difficulty. GBTA demonstrates that no adjustment of the total score is required to correct for practice effects. Application of these modern statistical methods paves the way towards rapid and robust quantification of change in cognition.

DOI: https://doi.org/10.1371/journal.pone.0213908

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