Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment

Background Existing tools for rapid cognitive assessment in HIV-positive individuals with mild cognitive deficits lack sensitivity or do not meet psychometric requirements for tracking changes in cognitive ability over time. Methods Seventy-five nondemented HIV-positive patients were evaluated with the Montreal Cognitive Assessment (MoCA), a brief battery of standardized neuropsychological tests, and computerized tasks evaluating frontal-executive function and processing speed. Rasch analyses were applied to the MoCA data set and subsequently to the full set of data from all tests. Results The MoCA was found to adequately measure cognitive ability as a single, global construct in this HIV-positive cohort, although it showed poorer precision for measuring patients of higher ability. Combining the additional tests with the MoCA resulted in a battery with better psychometric properties that also better targeted the range of abilities in this cohort. Conclusion This application of modern test development techniques shows a path towards a quick, quantitative, global approach to cognitive assessment with promise both for initial detection and for longitudinal follow-up of cognitive impairment in patients with HIV infection.