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Normative scores for a brief neuropsychological battery for the detection of HIV-associated neurocognitive disorder (HAND) among South Africans

Dinesh Singh1*, John A Joska2, Karl Goodkin34, Enrique Lopez34, Landon Myer25, Robert H Paul6, Sally John7 and Henry Sunpath7

Author Affiliations

1 Department of Psychiatry, University of Kwa-Zulu Natal, Durban, South Africa

2 University of Cape Town, Observatory, South Africa

3 Department of Psychiatry and Behavioral Neurosciences of Cedars-Sinai Medical Center, Los Angeles, USA

4 Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA

5 Mailman School of Public Health, Columbia University, USA

6 Department of Psychology, University of Missouri, St Louis, USA

7 McCord Hospital, Durban, South Africa

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BMC Research Notes 2010, 3:28  doi:10.1186/1756-0500-3-28

Published: 29 January 2010



There is an urgent need to more accurately diagnose HIV-associated neurocognitive disorder (HAND) in Africa. Rapid screening tests for HIV-associated dementia are of limited utility due to variable sensitivity and specificity. The use of selected neuropsychological tests is more appropriate, but norms for HIV seronegative people are not readily available for sub-Saharan African populations. We sought to derive normative scores for two commonly used neuropsychological tests that generate four test scores -- namely the Trail-Making Test (Parts A and B) and the Digit Span Test [Forward (DSF) and Backward (DSB)]. To assess memory and recall, we used the memory item of the International HIV Dementia Scale (IHDS).


One hundred and ten HIV seronegative participants were assessed at McCord Hospital, Durban, South Africa between March 3rd and October 31st, 2008. We excluded people with major depressive disorder, substance use abuse and dependence and head injuries (with or without loss of consciousness). All the participants in this study were African and predominantly female with an average age of 28.5 years and 10 years of education. Age and gender influenced neuropsychological functioning, with older people performing worse. The effect of gender was not uniform across all the tests.


These two neuropsychological tests can be administered with the IHDS in busy antiretroviral clinics. Their performance can be measured against these norms to more accurately diagnose the spectrum and progression of HAND.