Development and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive Impairment
Introduction: Neurocognitive impairment (NCI) remains common among people living with HIV (PWH), particularly in low- and middle-income countries where accurate diagnostic tools are limited. In Peru, the lack of locally validated neuropsychological (NP) normative data in Spanish poses a major barrie...
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| author | Mónica María Díaz Kimberly P. Enders Sofía Tovar-Ramirez Yamile Rodriguez-Angeles Valeria Roldán Marleny Nolasco Yating Zou Jane She Patricia Sotolongo Fernando Mejia Victor Valcour P. Mario García Maria Marquine Elena Tsoy |
| author_browse | Elena Tsoy Fernando Mejia Jane She Kimberly P. Enders Maria Marquine Marleny Nolasco Mónica María Díaz P. Mario García Patricia Sotolongo Sofía Tovar-Ramirez Valeria Roldán Victor Valcour Yamile Rodriguez-Angeles Yating Zou |
| author_facet | Mónica María Díaz Kimberly P. Enders Sofía Tovar-Ramirez Yamile Rodriguez-Angeles Valeria Roldán Marleny Nolasco Yating Zou Jane She Patricia Sotolongo Fernando Mejia Victor Valcour P. Mario García Maria Marquine Elena Tsoy |
| author_sort | Mónica María Díaz |
| collection | Producción científica |
| description | Introduction: Neurocognitive impairment (NCI) remains common among people living with HIV (PWH), particularly in low- and middle-income countries where accurate diagnostic tools are limited. In Peru, the lack of locally validated neuropsychological (NP) normative data in Spanish poses a major barrier to diagnosing HIV-associated NCI, especially among PWH who develop NCI at younger ages. This study aimed to develop regression-based NP norms for young and middle-aged Spanish-speaking adults in Lima, Peru and validate the norms in demographically similar PWH to improve diagnostic precision of HIV-associated NCI. Methods: A total of 164 healthy adults without HIV from Lima completed a comprehensive NP battery assessing memory, attention, executive function, and language, which are commonly affected in HIV-associated NCI. Multiple regression models were used to consider the influence of age, years of education, and sex on raw scores, yielding standardized demographically-adjusted norms for the population. The resulting norms were then applied to 310 PWH from Lima and then compared with previously published norms for Spanish speaking adults to evaluate performance differences. Results: Age and education were the strongest predictors of performance across tests, while sex had minimal influence. Compared to people without HIV, PWH had significantly lower educational attainment (mean 12.6 vs. 13.7 years) and exhibited significantly worse performance on normed scores of Benson Figure Copy, Benson Figure Delayed Recall, Color Trails 1 and 2, Hopkins Verbal Learning Test - Revised, and WAIS-III Digit Symbol Coding, Digit Span, and Symbol Search. There were statistically significant differences between T-scores on nearly all tests between our population-specific norms and previously published norms in both directions, indicating potential over- and under-detection errors when applying norms from non-local samples. Discussion: Our findings highlight the utility of locally derived norms in detecting subtle cognitive changes among young and middle-aged PWH compared with previously published norms for Spanish-speakers. Application of these norms reveals significant between-group differences that may go undetected using non-local normative data or raw scores. Future efforts should focus on rural norm development and inclusion of individuals with lower educational backgrounds in Peru and other Latin American countries. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/1156 |
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| language | English |
| publishDate | 2026 |
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| spelling | oai:cris.upeu.edu.pe:20.500.15037/11562026-10-30T16:15:17ZDevelopment and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive ImpairmentMónica María DíazKimberly P. EndersSofía Tovar-RamirezYamile Rodriguez-AngelesValeria RoldánMarleny NolascoYating ZouJane ShePatricia SotolongoFernando MejiaVictor ValcourP. Mario GarcíaMaria MarquineElena TsoyNormativeNeurocognitivePsychologyNeuropsychologyDevelopmental psychologyNorm (philosophy)CognitionRaw dataNeuropsychological assessmentClinical psychologyRaw scoreLatin AmericansNeuropsychological testingFocus (optics)Psychological interventionPsychometricsCognitive developmentInclusion (mineral)Cognitive impairmentFocus groupItem response theoryLow and middle income countriesSocial norms approachYoung adultCognitive testNormativeNeurocognitiveNeuropsychologyNorm (philosophy)CognitionRaw dataNeuropsychological assessmentRaw scoreLatin AmericansLife Sciences Immunology and Microbiology Virology HIV Research and TreatmentHealth Sciences Medicine Psychiatry and Mental health Dementia and Cognitive Impairment ResearchSocial Sciences Psychology Experimental and Cognitive Psychology Cognitive Functions and MemoryIntroduction: Neurocognitive impairment (NCI) remains common among people living with HIV (PWH), particularly in low- and middle-income countries where accurate diagnostic tools are limited. In Peru, the lack of locally validated neuropsychological (NP) normative data in Spanish poses a major barrier to diagnosing HIV-associated NCI, especially among PWH who develop NCI at younger ages. This study aimed to develop regression-based NP norms for young and middle-aged Spanish-speaking adults in Lima, Peru and validate the norms in demographically similar PWH to improve diagnostic precision of HIV-associated NCI. Methods: A total of 164 healthy adults without HIV from Lima completed a comprehensive NP battery assessing memory, attention, executive function, and language, which are commonly affected in HIV-associated NCI. Multiple regression models were used to consider the influence of age, years of education, and sex on raw scores, yielding standardized demographically-adjusted norms for the population. The resulting norms were then applied to 310 PWH from Lima and then compared with previously published norms for Spanish speaking adults to evaluate performance differences. Results: Age and education were the strongest predictors of performance across tests, while sex had minimal influence. Compared to people without HIV, PWH had significantly lower educational attainment (mean 12.6 vs. 13.7 years) and exhibited significantly worse performance on normed scores of Benson Figure Copy, Benson Figure Delayed Recall, Color Trails 1 and 2, Hopkins Verbal Learning Test - Revised, and WAIS-III Digit Symbol Coding, Digit Span, and Symbol Search. There were statistically significant differences between T-scores on nearly all tests between our population-specific norms and previously published norms in both directions, indicating potential over- and under-detection errors when applying norms from non-local samples. Discussion: Our findings highlight the utility of locally derived norms in detecting subtle cognitive changes among young and middle-aged PWH compared with previously published norms for Spanish-speakers. Application of these norms reveals significant between-group differences that may go undetected using non-local normative data or raw scores. Future efforts should focus on rural norm development and inclusion of individuals with lower educational backgrounds in Peru and other Latin American countries.Articlehttps://pubmed.ncbi.nlm.nih.gov/41728318https://www.medrxiv.org/content/medrxiv/early/2026/02/11/2026.02.09.26345550.full.pdfhttps://doi.org/10.64898/2026.02.09.2634555010.64898/2026.02.09.26345550https://hdl.handle.net/20.500.15037/1156W7128619021en2026-02-112026-06-13T09:47:56Z2026-06-13T09:47:56Z |
| spellingShingle | Normative Neurocognitive Psychology Neuropsychology Developmental psychology Norm (philosophy) Cognition Raw data Neuropsychological assessment Clinical psychology Raw score Latin Americans Neuropsychological testing Focus (optics) Psychological intervention Psychometrics Cognitive development Inclusion (mineral) Cognitive impairment Focus group Item response theory Low and middle income countries Social norms approach Young adult Cognitive test Normative Neurocognitive Neuropsychology Norm (philosophy) Cognition Raw data Neuropsychological assessment Raw score Latin Americans Life Sciences Immunology and Microbiology Virology HIV Research and Treatment Health Sciences Medicine Psychiatry and Mental health Dementia and Cognitive Impairment Research Social Sciences Psychology Experimental and Cognitive Psychology Cognitive Functions and Memory Mónica María Díaz Kimberly P. Enders Sofía Tovar-Ramirez Yamile Rodriguez-Angeles Valeria Roldán Marleny Nolasco Yating Zou Jane She Patricia Sotolongo Fernando Mejia Victor Valcour P. Mario García Maria Marquine Elena Tsoy Development and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive Impairment |
| title | Development and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive Impairment |
| title_full | Development and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive Impairment |
| title_fullStr | Development and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive Impairment |
| title_full_unstemmed | Development and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive Impairment |
| title_short | Development and Validation of Regression-based Neuropsychological Testing Norms for Peruvian adults to detect HIV-associated Neurocognitive Impairment |
| title_sort | development and validation of regression based neuropsychological testing norms for peruvian adults to detect hiv associated neurocognitive impairment |
| topic | Normative Neurocognitive Psychology Neuropsychology Developmental psychology Norm (philosophy) Cognition Raw data Neuropsychological assessment Clinical psychology Raw score Latin Americans Neuropsychological testing Focus (optics) Psychological intervention Psychometrics Cognitive development Inclusion (mineral) Cognitive impairment Focus group Item response theory Low and middle income countries Social norms approach Young adult Cognitive test Normative Neurocognitive Neuropsychology Norm (philosophy) Cognition Raw data Neuropsychological assessment Raw score Latin Americans Life Sciences Immunology and Microbiology Virology HIV Research and Treatment Health Sciences Medicine Psychiatry and Mental health Dementia and Cognitive Impairment Research Social Sciences Psychology Experimental and Cognitive Psychology Cognitive Functions and Memory |
| topic_facet | Normative Neurocognitive Psychology Neuropsychology Developmental psychology Norm (philosophy) Cognition Raw data Neuropsychological assessment Clinical psychology Raw score Latin Americans Neuropsychological testing Focus (optics) Psychological intervention Psychometrics Cognitive development Inclusion (mineral) Cognitive impairment Focus group Item response theory Low and middle income countries Social norms approach Young adult Cognitive test Normative Neurocognitive Neuropsychology Norm (philosophy) Cognition Raw data Neuropsychological assessment Raw score Latin Americans Life Sciences Immunology and Microbiology Virology HIV Research and Treatment Health Sciences Medicine Psychiatry and Mental health Dementia and Cognitive Impairment Research Social Sciences Psychology Experimental and Cognitive Psychology Cognitive Functions and Memory |
| url | https://pubmed.ncbi.nlm.nih.gov/41728318 https://www.medrxiv.org/content/medrxiv/early/2026/02/11/2026.02.09.26345550.full.pdf https://doi.org/10.64898/2026.02.09.26345550 https://hdl.handle.net/20.500.15037/1156 |
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