Doctoral Degrees (Psychiatry)

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Browsing Doctoral Degrees (Psychiatry) by Author "Cilliers, Melanie"

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    Measuring neurocognitive functioning in HIV infected adults : South African norms and the development of a shortened version of the HNRC International Neurobehavioral Battery
    (Stellenbosch : Stellenbosch University, 2020-12) Cilliers, Melanie; Seedat, Soraya, 1966-; Spies, Georgina; Suliman, Sharain; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY: The human immunodeficiency virus (HIV) is capable of inducing neurological injury, which manifests as a spectrum of neurocognitive (NC) disorders collectively known as HIV-associated neurocognitive disorders (HAND). The HIV Neurobehavioral Research Centre’s International Neurobehavioral Battery (HNRC Battery) is an extensive NC battery that is culturally valid in the South African context and is sensitive to the NC effects of HIV infection. However, its lengthy administration time and a lack of demographically adjusted South African norms makes it impractical in clinical and research settings in South Africa. The current study therefore aimed to (1) develop demographically corrected South African norms for the HNRC Battery and (2) develop a shortened version of the HNRC Battery for use in clinical and research settings in South Africa. The study was divided into three distinct phases. The first phase entailed the development of demographically corrected South African norms for the HNRC Battery using the data from 500 HIVnegative adults. The second phase involved the development of a shortened version of the HNRC Battery by comparing the NC test performances of HIV-positive (n = 103) and HIV-negative (n = 135) participants. The measures that best discriminated between the HIV-positive and HIV-negative groups, that best predicted group inclusion, or that maximised practicality in clinical settings were prioritised in the selection process. In the final phase, the abbreviated HNRC Battery was validated against the original battery. The sensitivity and specificity of the abbreviated HNRC Battery was measured using the data collected from the HIV-positive participants in the second phase (n = 103). Furthermore, the impairment rates of the 103 HIV-positive participants who completed the full HNRC Battery were compared to the impairment rates of 52 HIV-positive participants who only completed the abbreviated battery. Demographically-corrected South African norms were presented for the HNRC Battery. Age, education, ethnicity, gender and NC test administration language were found to be significant predictors of performance. Additionally, the HNRC battery (with an administration time of ±2.5 hours) was shortened to a 28-minute screening battery. Six measures (i. e. the Hopkins Verbal Learning Test – Revised; WAIS-III Symbol Search test; Controlled Oral Word Association – FAS; WMS-III Spatial Span; Grooved Pegboard Test – non-dominant hand; and the Stroop Color-Word Test) that each measured a separate cognitive domain evaluated by the full battery, were selected for the shortened version of the HNRC Battery. Compared to the full HNRC battery, the abbreviated battery showed a good sensitivity (75.0%) and specificity (93.7%). Furthermore, impairment rates identified in an HIV-positive sample who completed the abbreviated HNRC battery (28.9%) were similar to impairment rates found in an HIVpositive- sample who completed the full battery (23.1%). In conclusion, this study provided much-needed NC normative data for the HNRC Battery that can facilitate both clinicians and researchers in identifying NC impairment in the South African context. Furthermore, the newly developed shortened version of the HNRC Battery showed adequate diagnostic accuracy in identifying NC impairment in an HIV-positive South African sample with a significant reduction in administration time, making it more practical in busy clinics.