Abstract
Background: The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective: The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods: Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results: The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group). Conclusions: The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.
Original language | English (US) |
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Article number | e26406 |
Journal | JMIR Formative Research |
Volume | 5 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2021 |
Funding
We thank the team at the DarDar clinic in Dar es Salaam, Tanzania who collected these data (Esther Kayichile, Joyce Ghatty, Claudia Gasana, Filmon Sulle, Pascal Donard, Godfrey Njau, Matilda Kabeho, and Betty Mchaki). We thank the team at Creare, LLC that assembled and tested the hearing testing systems. We appreciate the support of Erika Kafwimi and Sabrina Yegela who helped with building the video questionnaire and translating the questions. This work was supported by the National Institute on Deafness and Other Communication Disorders (grant R01DC009972) and by the National Institutes of Health (grant number 5R01DC009972-10; JB principal investigator). The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Keywords
- Auditory
- Auditory perception
- Central auditory function
- Cognition
- Cognitive dysfunction
- Cognitive function
- HIV
- Longitudinal
- Monitoring
- Nervous system
- Neurocognitive deficit
- Screening
- Surveillance
- Testing
ASJC Scopus subject areas
- Health Informatics
- Medicine (miscellaneous)