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Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study
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Discussion
BRACE was developed to briefly screen for cognitive impairment, particularly mild impairment that is not readily detectable by the practicing clinician. In our sample of 404 adults with HIV seeking outpatient clinical care, we demonstrated that this brief, self-administered screener of cognitive impairment can be self-administered rather rapidly in clinic (approximately 7-10 minutes; slightly longer in older adults, approximately 12 minutes) during routine clinic visits. Important to note is that our sample comprised predominately older, African-American/Black individuals with low education and a high burden of mental and behavioral health disorders, hypertension, and metabolic disorders based on electronic medical record. Thus, one of the strengths of the tool is that it can be used in persons who are nonreaders or with low literacy; the tests are not literacy dependent as both written and verbal instructions (via video) are provided. Importantly, the tool has excellent test–retest reliability, no practice effects over a 30-day or a median of approximately 10 months, strongly correlates to a briefer cognitive test battery, and has good classification accuracy compared to the lengthier cognitive test battery, which required 20 to 30 minutes to complete.
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