The underlying pathophysiology remains poorly understood [10], posing challenges in the everyday management of these mildly affected patients. How should cognitive impairment be detected in routine practice? Should those found to be affected have their HAART regimen changed, to emphasize antiretrovirals with better central nervous system penetration? Should additional therapies, such as anti-excitotoxic agents or drugs

FDA-approved Drug Library cell assay targeting neurodegenerative changes, be added to their treatment? If such changes are made, how should the effects be monitored? The answers to such questions require better tools to assess cognition in HIV-infected individuals. The ideal measure should not only establish the diagnosis, but also quantify the severity of impairment. It should also be free, brief, easy to administer Linsitinib with minimal training by any health professional, and available to clinics where HIV-infected patients receive their care. The present study describes the initial steps in the development of such a method to measure cognition across the intact to mildly impaired range in HIV-positive patients. Current approaches have limitations [11]. The clinical history alone is inadequate, as self-reported

cognitive symptoms may not be predictive of objective performance [12–14]. Full neuropsychological assessment is the gold standard for the diagnosis of HAND, and consensus recommendations

on appropriate tests exist. However, such tests require highly trained personnel and so are available only in specialized centres [9]. They may be replaced with briefer neuropsychological screening batteries [15], but this reduces precision, and in any case still requires a neuropsychologist, limiting feasibility in most settings. Resource limitations aside, existing CYTH4 cognitive assessment tools have focused on diagnosis, and may not be optimal for the measurement of cognition. Measurement of cognitive impairment is related to, but not synonymous with, diagnosis, and has distinct clinical goals. Cognitive measurement refers to the quantification of a person’s performance with reference to a continuous unit of measurement along a scale representing the full spectrum of cognitive ability. Precise quantification of cognitive ability is required for comparing different treatment groups or for tracking changes in cognition in an individual patient, both goals of obvious clinical relevance in this population. Pencil-and-paper tools for cognitive assessment are brief and easily administered, but fall short of the ideal in other respects. Tools such as the HIV Dementia Scale (HDS), the International HDS, and the Folstein Mini-Mental Status Examination (MMSE) are relatively insensitive to the milder cognitive signs that predominate in the HAART era [14,16].