Attention or Memory Deficits? An HIV Study in Shanghai Using Local and Norm-Based Controls

Chuan ChenFengxiang SongChen PengShi YuxinDan-Chao Cai^*

• Shanghai Public Health Clinical Center, Fudan University, Shanghai, China

Objective: HIV-associated neurocognitive disorder is a major complication in people living with HIV (PLWH), with standardized neuropsychological tests being essential for clinical diagnosis. However, the selection of healthy controls significantly influences the interpretation of test results. This study compares neuropsychological outcomes using two control methods, local HIV-negative controls versus decades-old norms, to evaluate neurocognitive impairments in Shanghai and assess the applicability of existing norms to contemporary populations.Methods: A total of 244 PLWH who attended the Shanghai Public Health Clinical Center between 2019 and 2024, along with 132 HIV-negative controls, participated in the study. Standardized neuropsychological tests covering seven cognitive domains were administered to provide a comprehensive cognitive function assessment. Neurocognitive impairments were defined by comparing them with either local controls or previously established norms.Results: After adjusting for age, sex, and education level, PLWH demonstrated significantly lower standardized scores compared to people living without HIV (PLWoH) in attention/working memory (49.2±7.62 vs. 53.1±6.34, Bonferroni-corrected p < .001). Executive function scores showed a marginal difference (49.3±6.61 vs. 51.5±6.22, Bonferroni corrected p = 0.052). No significant group differences were observed in other cognitive domains. Norm-based analyses identified impairments in attention/working memory and executive function among PLWH, with 12% and 13% impairment rates, respectively. In contrast, impairment rates in memory (32%), learning (20%), and motor (14%) were higher, although they did not differ significantly between PLWH and PLWoH.Conclusion: Neurocognitive impairments in PLWH from Shanghai primarily involve attention/working memory and executive function. However, norm-based analysis emphasized impairments in memory and learning, underscoring significant discrepancies between local controls and outdated norms. These findings underscore the limitations of relying on outdated norms for evaluating neurocognitive impairment and emphasize the importance of developing updated, localized norms for accurate diagnosis and effective interventions.