Neurology 2003;60:1467-1473
© 2003 American Academy of Neurology
Inter-rater reliability of a clinical staging of HIV-associated cognitive impairment
K. Marder, MD MPH,
S. M. Albert, PhD,
M. P. McDermott, PhD,
J. C. McArthur, MBBS MPH,
G. Schifitto, MD,
O. A. Selnes, PhD,
N. Sacktor, MD,
Y. Stern, PhD,
D. Palumbo, PhD,
K. Kieburtz, MD MPH,
B. Cohen, MD,
C. Orme, BA and
L. G. Epstein, MD
From the Departments of Neurology (Drs. Marder, Albert, and Stern), Psychiatry (Drs. Marder and Stern), Sergievsky Center (Drs. Marder, Albert, and Stern), and The Taub Institute for Alzheimer’s Disease and the Aging Brain (Drs. Marder and Stern), Mailman School of Public Health, Columbia University (Dr. Albert), New York; Departments of Biostatistics (Dr. McDermott) and Neurology (Dr. Schifitto, Palumbo, and Kieburtz, C. Orme), University of Rochester, NY; Department of Neurology (Drs. Selnes and Sacktor, J.C. McArthur), Johns Hopkins University, Baltimore, MD; and Departments of Neurology (Dr. Cohen) and Pediatric Neurology (Dr. Epstein), Northwestern University, Evanston, IL.
Address correspondence and reprint requests to Dr. Karen Marder, Sergievsky Center, 630 W. 168th St. Unit 16, New York, NY 10032; e-mail: ksm1{at}columbia.edu
Objective: To determine the inter-rater reliability of a modification of the Memorial Sloan-Kettering (MSK) Staging for HIV-associated cognitive impairment.
Methods: Data were abstracted on neurologic, neuropsychological, and functional status on 100 individuals participating at four sites in the Northeast AIDS Dementia (NEAD) Consortium cohort study, a longitudinal study of predictors of cognitive impairment in HIV-infected individuals. Neuropsychological performance was defined 1) based on the neuropsychologist’s global impression and 2) solely based on neuropsychological test scores. Raters at each site used the abstracted data to assign an MSK stage to each subject blind to any identifying information. Inter-rater reliability was assessed using kappa statistics. Agreement between computer-generated ratings and site-generated ratings was also assessed.
Results: Kappa statistics for pair-wise agreement among the sites regarding MSK stage ranged from 0.70–0.91, representing good to excellent agreement between sites. Agreement between computer-generated ratings and site-generated ratings was in the good to excellent range (0.62–0.79).
Conclusions: The authors have modified the MSK rating scale and developed a reliable instrument that can be used in multicenter studies. This instrument will be useful in staging HIV-dementia in future longitudinal studies and will be valuable in increasing accuracy of clinicopathologic studies.
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