1. Findings from the Ontario HIV Treatment Network (OHTN) Cohort Study
Examining the impact of CNS penetration effectiveness (CPE) of combination antiretroviral treatment (cART) on neuropsychological outcomes in persons living with HIV:
Findings from the Ontario HIV Treatment Network (OHTN) Cohort Study
Sean B. Rourke, Ph.D.
University of Toronto, Toronto, Canada
Ontario HIV Treatment Network
St. Michael’s Hospital

2. I have the following potential conflicts of interest:
CONFLICT OF INTEREST DISCLOSURE
I have the following potential conflicts of interest:
Advisory Board/ Publications/ Honoraria:
Abbott Laboratories
Research Funding:
Canadian Institute for Health Research
Public Health Agency of Canada
The Ontario HIV Treatment Network

3. Co-Principal Investigators:
INVESTIGATOR TEAM
Co-Principal Investigators:
Dr. Sean B. Rourke
OHTN, St. Michael’s Hospital, University of Toronto
Dr. Adriana Carvalhal
McMaster University, Psychiatry and Behavioral Neurosciences
Co-Investigators:
Amy R. Zipursky OHTN, St. Michael’s Hospital
Tsegaye Bekele OHTN
Dr. Jen McCombe Univ Alberta, Univ Calgary, Department of Medicine
Dr. Anita Rachlis University of Toronto, Sunnybrook Health Sciences Center
Dr. Evan Collins University of Toronto, Psychiatry
Dr. M. John Gill University of Calgary, Department of Medicine
Dr. Janet Raboud University Health Network, University of Toronto
Dr. Ann Burchell OHTN, McGill University, Oncology

4. BACKGROUND

5. HIV enters CNS shortly after infection
THE ISSUE
HIV enters CNS shortly after infection
HIV Associated Neurocognitive Disorder (HAND): Antinori et al.
Asymptomatic neurocognitive impairment (ANI)
HIV-associated mild neurocognitive disorder (MND)
HIV-associated dementia (HAD)
Introduction of cART has decreased incidence of HAD, but there is evidence of an increased prevalence of MND and ANI
Detrimental effect of mild neuropsychological deficits in HIV
Can affect job functioning and decreased performance in those working
Can affect ability to carry out complex tasks
Shown to affect medication adherence
Associated with increased mortality rates

6. cART can improve NP functioning (but not complete recovery)
THE ISSUE
cART can improve NP functioning (but not complete recovery)
Different ARVs have different abilities to penetrate the CNS
Letendre et al., (2006, 2010) developed a system to evaluate the CNS penetration of antiretroviral drugs with respect to neurological outcomes
What we know so far: (1) Increased CNS penetration of ARVs is associated with decreased CNS viral load (most consistent in prospective studies); (2) the relationship between CPE of ARVs and neuropsychological outcomes is more equivocal (potentially because further downstream in effect)
Please note: other presentation I saw labelled CPE 2006 as CPE 2008 because the paper was published in 2008 (but the scale was introduced in a presentation in 2006)

7. CURRENT LITERATURE REVIEW
Author, Year
Sample Size
Design
Neurocognitive Effects (green-direct association NP, grey- no association NP, blue- CSF viral load)
Garvey et al., 2011
N=22,356
Cross-Sectional
CNS disease more frequent with CPE ≤4 and less frequent with CPE ≥10
Smurzyinski et al., 2011
N=2,636
Better NPZ3 scores among individuals with higher CPE taking more than 3 drugs but not in participants with higher CPE taking 3 or fewer drugs
Starace et al., (Conference)
N=45
Higher CPE correlated with neurocognitive performance on measures of working memory, verbal fluency, and executive functions
Cysique et al., 2009
N=37
Longitudinal
Higher CPE rank (greater than or equal to 2) was associated with neuropsychological improvement
Patel et al., 2009
N=2,398
ARV regimens with higher CNS penetration were correlated with a 41% reduced incidence of HIV encephalopathy compared to regimens with lower CNS penetration
Tozzi et al., 2009
N=185
Higher CPE scores correlated with greater improvements in NPZ-4, NPZ-8, concentration, and speed of mental processing
Sacktor et al., 2001
N=73
Regimens with CSF penetrating drug improved psychomotor speed but no difference was found between single and multiple CSF penetrating drugs
Garvey et al., 2011 (Conference)
N=101
No association between neurocognitive performance and CPE in an asymptomatic sample
Ciccarelli, et al., 2011
N=146
No association between CPE rank and cognitive impairment in an asymptomatic sample
Picchi et al., 2011 (Conference)
N=219
Higher CPE 2010 associated with lower HIV-RNA in CSF in patients with supressed viral load but not in patients with detectable viral load
Letendre et al., (Conference)
N=1,221
Higher CPE (modified system) were correlated with lower CSF viral load
Marra et al., 2009
N=79
Odds of suppression of CSF HIV RNA were higher when CPE was 2 or greater
Letendre et al., 2008
N=467
Lower CPE rank (less than 2) correlated with higher CSF viral load
Letendre et al., 2006 (Conference)
N=374
Higher CNS penetration scores were correlated with lower CSF viral load, with and without adjusting for total number of ART

8. MAJOr Objective
To assess the association of CNS penetration of ARV regimen and neuropsychological functioning in people living with HIV in Ontario
Hypothesis:
Individuals on antiretroviral regimens with higher CPE rankings will perform better overall on measures of neuropsychological functioning (global, domains)

9. METHODS

10. Medical information retrieved by chart abstraction
Participants and testing
834 participants were recruited from two hospital-based clinics in Toronto, Canada that are part of the Ontario HIV Treatment Network Cohort Study (OCS), a longitudinal cohort of 5,000 people living with HIV collected at 10 sites across the province
Neuropsychological tests were administered as part of the annual data collection of the OCS
Medical information retrieved by chart abstraction
Sample is restricted to participants with both neuropsychological and medical information available. Frequency of neuropsychological assessments:
Time 1: 338
Time 2: 271
Time 3: 218
Time 4: 007

11. Completed Neuropsychological Tests
Sample
Completed Neuropsychological Tests
Sample Size=834
Observations=1,562
Excluded
ARV Naïve, N=211
Suboptimal ARV, N=94
Final Sample
Sample=529
Observations=864

12. Sample – Comparison included and excluded
Characteristics
On >=3 ARVs
(Included)
N=529
On suboptimal ARVs
N=94
Not on ARVs
N=211
P value
Age in years (mean, SD)
48.6 (10.1)
47.9 (9.9)
48.5 (10.2)
<0.001 b,c
Male (n,%)
439 (83%)
69 (73%)
156 (74%)
0.006 a,b
Caucasian (n,%)
323 (61%)
63 (67%)
113 (54%)
0.055
Born in Canada (n,%)
299 (57%)
59 (63%)
118 (56%)
0.491
Speak English at home (n,%)
445 (84%)
79 (84%)
176 (83%)
0.972
Years of education (mean, SD)
13.8 (2.7)
13.8 (2.3)
13.3 (3.0)
0.056
Currently employed (n,%)
248 (47%)
43 (46%)
84 (40%)
0.215
Personal annual income < $30K (n,%)
280 (53%)
57 (61%)
146 (69%)
<0.001 b
Recent CD4 count < 500 cells/ml (n,%)
242 (46%)
45 (48%)
111 (53%)
0.241
Nadir CD4 < 200 cells/ml (n,%)
353 (67%)
65 (69%)
67 (32%)
Log viral load (mean, SD)
4.1 (1.0)
4.3 (1.3)
2.6 (1.2)
<0.001 c
Diagnosed with HCV (n,%)
49 (9%)
10 (11%)
28 (13%)
0.273
Years since HIV diagnosis (mean, SD)
13.1 (6.8)
14.0 (6.7)
9.2 (7.4)
Used substances in the past 6 months (n,%)
68 (13%)
9 (10%)
43 (20%)
0.012 b,c
Depressive symptoms - CES-D score (Mean, SD)
12.0 ( 11.7)
11.4 (11.1)
14.2 (12.5)
0.049 b
Alcohol use - AUDIT-10 score (Mean, SD)
3.4 (4.3)
3.7 (4.8)
7.0 (2.8)
Indicate which ones are different
Check significance for age
a – difference between those on >=3 ARVs and on suboptimal ARVs is significant (p<0.05)
b - difference between those on >=3 ARVs and Not on ARVs is significant (p<0.05)
c - difference between those on suboptimal ARVs and Not on ARVs is significant (p<0.05)

13. Neuropsychological Test Impairment Descriptor
Computation of neuropsychological scores
Neuropsychological Test
Measurement
Domain Evaluated
Digit Symbol
Digit Symbol Score
Motor Efficiency
Grooved Pegboard
Dominant Hand Score
Non-dominant Hand Score
Spatial Span
Spatial Span Score
Spatial Working Memory
Hopkins Verbal Learning
Total Learning Score
Delayed Recall Score
Memory
Raw scores were converted into demographically corrected T-scores (corrected for Age, gender, education, race/ethnicity). 6 NP tests were categorized into 3 domains
T-scores were converted below into deficit scores for each test using Carey et al (2004) algorithm
NP Deficit Scores: 5 Impairment levels were collapsed into 2 categories (i.e., NP normal v NP impaired)
T scores
Deficit Scores
Impairment Descriptor
≥40
Normal
39-35 1
Mild
34-30 2
Mild-to-Moderate
29-25 3
Moderate
24-20 4
Moderate-to-Severe
≤19 5
Severe
Carey, C.L., Woods, S.P., Gonzalez, R., Conover, E., Marcotte, T.D., Grant, I., Heaton, R.K., & the HNRC Group (2004). Predictive Validity of Global Deficit Scores in Detecting Neuropsychological Impairment in HIV Infection. Journal of Clinical and Experiment Neuropsychology, 26,

14. Two major ways to evaluate neurocognitive impairment:
Methods to calculate Impairment
Two major ways to evaluate neurocognitive impairment:
Global Neuropsychological (NP) Impairment Rating, Heaton et al (1991): at least mild neuropsychological impairment on 2 or more ability domains
Global NP Deficit Score, Carey et al (2004): total sum of deficits scores for all tests were ≥0.50 cut-off
Does the 2a 2b thing look ok

15. Letendre S, et al. 13th CROI, Denver 2006, Abstract #74
CPE Ranking System 2006
Letendre S, et al. 13th CROI, Denver 2006, Abstract #74 1
0.5
NRTIs
Abacavir
Zidovudine
Emtricitabine
Lamivudine
Stavudine
Didanosine
Tenofovir
Zalcitabine
NNRTIs
Delavirdine
Nevirapine
Efavirenz
PIs
Amprenavir-r
Indinavir-r
Lopinavir-r
Amprenavir
Atazanavir
Atanzanavir-r
Indinavir
Nelfinavir
Ritonavir
Saquinavir
Saquinavir-r
Tipranavir-r
Fusion
Enfuvirtide
Some have fosamprenavir instead of amprenavir - fyi

16. Letendre S, et al. 17th CROI, San Francisco CA 2010, Oral #172
CPE Ranking System 2010
Letendre S, et al. 17th CROI, San Francisco CA 2010, Oral #172 4 3 2 1
NRTIs
Zidovudine
Abacavir
Emtricitabine
Lamavudine
Stadudine
Didanosine
Tenofovir
Zalcitabine
NNRTIs
Nevirapine
Delavirdine
Efavirenz
Etravirine
PIs
Indinavir-r
Duranavir-r
Fosamprenivir-r
Indinavir
Lopinavir-r
Atazanavir-r
Atazanavir
Fosamprenavir
Nelfinavir
Ritonavir
Saquinavir-r
Tipranavir-r
Entry Inhs
Maraviroc
Enfuvirtide
Integrase Inhs
Raltegravir

17. Letendre S, et al. 17th CROI, San Francisco CA 2010, Oral #172
Comparison of CPE Ranking Systems 2006 and 2010
Letendre S, et al. 17th CROI, San Francisco CA 2010, Oral #172

18. Dichotomized CPE Scores 2006
Letendre, S., Marquie-Beck, J., Capparelli, E., Best, B., Clifford, D., Collier, A. C. et al. (2008). Validation of the CNS Penetration-Effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Arch.Neurol., 65,

19. For the Present Investigation:
Dichotomized CPE Scores - PRESENT
For the Present Investigation:
Breakdown of sample:
1) CPE rank 2006
2) CPE rank 2010
Mean CPE= 7.08, Median=7.00
Mean CPE= 1.57, Median=1.50
Group 1 (CPE <=7:40.0%)
Group 1 (CPE <=1.5:52.9%)
Group 2 (CPE>7:60.0%)
Group 2 (CPE>1.5:47.1%)
* Same as Letendre et al., 2008 dichotomized scores

20. RESULTS

21. Global Deficit Scores: < 0.5 (n=364) Global Deficit Scores:
Baseline characteristics of participants (N=834)
Characteristics
Global Deficit Scores: < 0.5 (n=364)
Global Deficit Scores:
≥ 0.5 (n=470) p
Age in years (mean, SD)
46.6 (9.8)
47.2 (10.9)
0.395
Male (n,%)
356 (85%)
308 (76%)
0.002
Caucasian (n,%)
231 (64%)
268 (57%)
0.060
Years of education (mean, SD)
13.5 (2.7)
13.8 (2.7)
0.153
Born in Canada (n,%)
232 (64%)
244 (52%)
0.006
Speak English at home (n,%)
317 (87%)
383 (81%)
0.029
Currently employed (n,%)
193 (53%)
182 (39%)
<0.001
Personal Annual income < $30K (n,%)
197 (54%)
286 (61%)
0.051
Recent CD4 count < 500 cells/ml (n,%)
169 (46%)
229 (49%)
0.511
Nadir CD4 < 200 cells/ml (n,%)
291 (53%)
194 (62%)
0.012
Recent viral load (Log 10) (mean, SD)
4.9 (2.1)
4.8 (2.0)
0.673
Diagnosed with HCV
829 (%)
58 (12%)
0.040
Years since HIV diagnosis (mean, SD)
12.3 (7.3)
12.2 (7.0)
0.935
Used substances in the past 6 months (n,%)
55 (15%)
65 (14%)
0.601
Alcohol use - AUDIT-10 score (Mean, SD)
4.3 (5.1)
3.3 (4.8)
0.004
Depressive symptoms - CES-D score (Mean, SD)
11.8 (11.6)
13.0 (12.0)
0.134
Global deficit score is computed as the average of Spatial Span, Digit Symbol, Grooved Pegboard, and HVLT tests deficit scores following Carey et al’s (2004) algorithm

22. Global Deficit Score ≥ 0.5 by CPE 2006 (N=834, p=0.06)
Spearman correlation coefficient (non-parametric) r=
Pearson correlation coefficient (parametric) r= -0.07
CPE 2006 Median (IQR) 1.5 (1-2)
Black squares are proportions
Green bars are 95% CI intervals

23. Global Deficit Score ≥ 0.5 by CPE 2010 (N=834, p=0.41)
Spearman correlation coefficient (non-parametric) r= -0.03
Pearson correlation coefficient (parametric) r=
CPE 2010 Median (IQR) 7 (6-8)
Black squares are proportions
Green bars are 95% CI intervals

24. Neuropsychological Impairment by CPE 2006 (n=529)
No statistical significance
Note: Sample for graphs is limited to Individuals with 3 or more ARVs

25. Neuropsychological Impairment by Domain (n=529) – CPE 2006
No significant differences

26. Neuropsychological Impairment Classifications (n=529) – CPE 2006
Which global impairment score to use?

27. Dependent Variable Covariates Generalized estimating equation (gee)
Neuropsychological Outcomes
Covariates
Age at interview (Years)
Race (White / Black/ Other)
Gender (Male / Female)
Education (Years)
HCV Diagnosis (Yes/No)
Current CD4 count (< 500 / >= 500)
Dichotomized ARV CPE (High/Low)
Time HIV positive (Years)
Closest viral load value from interview date (log)
CD4 nadir (< 200/ >=200)
Drug Use Last Six Months (Yes/No)
Depressive Symptoms (CES-D total score)

28. Neuropsychological Impairment Measure (Impaired or Not)
Generalized estimating equation RESULTS
Neuropsychological Impairment Measure (Impaired or Not)
CPE 2010*
CPE 2006**
Global Impairment Rating
1.08 (0.78, 1.50)
1.05 (0.77, 1.43)
Global Deficit Score (>0.5)
1.08 (0.77, 1.52)
1.32 (0.96,1.80)
Global Deficit Score (>1.0)
1.07 (0.76, 1.52)
1.15 (0.83, 1.60)
Red=statistically significant
Changes need to be made here
NOTE: Numbers reported are Odds Ratio (95% CI) from GEE models
* CPE > 7 vs. CPE <=7
** CPE > 1.5 vs. CPE <= 1.5

29. Generalized estimating equation Neuropsychological Test (T-Scores)
CPE 2010*
CPE 2006**
Spatial Span
1.60
1.66
Pegboard Dominant Hand
-0.72
-1.15
Pegboard ND Hand
-0.77
-1.01
Hopkins Recall
0.17
-0.99
Hopkins Delayed Recall
0.54
-0.74
Digit Symbol
-1.47
-1.77
Motor Efficiency Domain
-1.46
-1.61
Working Memory Domain
Memory Domain
0.33
-0.89
Red=statistically significant
Changes need to be made here
Observations=864
NOTE: Numbers reported are unstandardized regression coefficients from linear GEE models
* CPE > 7 vs. CPE <=7
** CPE > 1.5 vs. CPE <= 1.5

30. Significant covariates – Full Sample (obs=864)
CPE ranking
Spatial Span
Peg DH
Peg NDH
HVLT Recall
HVLT DRecall
Digit Symbol
MEFF
SWM
MEM
Age
2006 X
2010
Race
Gender
Education
History of HCV Diagnosis
CD4 Nadir
Time since HIV Diagnosis
Current Viral Load
Current CD4 Count
Drug use in the Past 6 Months
Depressive Symptoms
Significant variables are from GEE models for each NP measure using T scores

31. Neuropsychological Impairment among participants
who completed two NP evaluations (N=218)
Participants included are those who completed 3 NP evaluations. Difference are not statistically significant CPE ranking was used.

32. Neuropsychological Impairment among participants who completed two
NP evaluations and were on >=3 ARVs at baseline (N=127)
This sample includes those who completed 2 NP evaluations and were on >=3 ARVs at baseline. Differences are not statistically significant CPE ranking was used.
NOTE: 2006 CPE ranking was used.

33. CONCLUSIONS

34. CONCLUSIONS
No effect of CPE scores on overall neuropsychological (NP) outcomes but specific effect were seen on individual domains using Letendre 2006 criteria (but not using the 2010 criteria): (1) negative effect on motor functioning (2) positive effect on spatial working memory
Our results are consistent with other neuropsychological studies of CPE (Smurzyinski et al., 2011; Starace et al., 2010, Cysique et al., 2009; and Tozzi et al., 2009; however, our results need to be replicated prospectively, and we need to identify why our results were not consistent across both criteria
NP outcomes are downstream effects – we will need to explore other ARV effects (timing / length), methodological issues (better matching) and confounding comorbidities (e.g., HCV)

35. Igor G, Canada Presentation, 2011, http://hnrc.hivresearch.ucsd.edu/
NEUROTOXICITY
Igor G, Canada Presentation, 2011,
cART that cross the blood brain barrier are both helpful in terms of neurocognitive functioning and toxic at the cerebral metabolism level (Brew, 2010)

36. Thank You
Examining the impact of CNS penetration effectiveness (CPE) of combination antiretroviral treatment (cART) on neuropsychological outcomes in persons living with HIV: Findings from the Ontario HIV Treatment Network (OHTN) Cohort Study
Sean B. Rourke, Ph.D.
University of Toronto, Toronto, Canada
St. Michael’s Hospital
Ontario HIV Treatment Network

37. Geographic region of birth of Foreign-born participants (N=358)
EXTRA: Sample Info
Geographic region of birth of Foreign-born participants (N=358)
Region of Birth N
(%)
Africa
131
(37%)
Caribbean 65
(18%)
South Asia 10
(3%)
Asia 21
(6%)
Europe 56
(16%)
North America 28
(8%)
South America 31
(9%)
Central America 8
(2%)
Other 9
Total
358
100%

38. Born in other countries
Baseline characteristics of participants
by place of birth (N=834)
Characteristics
Born in
Canada
(n=476)
Born in other countries
(n=358) p
Age in years (mean, SD)
48.2 (10.1)
45.3 (10.7)
<0.001
Male (n,%)
423 (88%)
241 (67%)
Caucasian (n,%)
421 (88%)
78 (22%)
Years of education (mean, SD)
13.7 (2.7)
13.5 (2.8)
0.395
Speak English at home (n,%)
460 (97%)
240 (67%)
Currently employed (n,%)
213 (45%)
162 (45%)
0.885
Personal annual income < $30K (n,%)
246 (52%)
237 (66%)
Recent CD4 count < 500 cells/ml (n,%)
222 (47%)
176 (49%)
0.470
Nadir CD4 < 200 cells/ml (n,%)
281 (59%)
204 (57%)
0.552
Recent viral load (Log 10) (mean, SD)
4.8 (2.0)
4.9 (2.1)
0.383
Diagnosed with HCV (n,%)
63 (13%)
24 (7%)
Years since HIV diagnosis (mean, SD)
13.8 (7.3)
10.1 (6.3)
Used substances in the past 6 months (n,%)
94 (20%)
26 (7%)
Alcohol use - AUDIT-10 score (Mean, SD)
4.5 (5.3)
2.6 (4.2)
Depressive symptoms - CES-D score (Mean, SD)
13.1 (12.4)
12.0 (11.4)
0.195
Np impariment by Heaton definition

39. Born in other countries
Baseline characteristics of NP Impaired (GDS > 0.5)
participants by place of birth (N=470)
Characteristics
Born in
Canada
(n=244)
Born in other countries
(n=226) p
Age in years (mean, SD)
49.4 (10.6)
44.8 (10.8)
<0.001
Male (n,%)
208 (85%)
148 (65%)
Caucasian (n,%)
214 (88%)
54 (24%)
Years of education (mean, SD)
13.9 (2.6)
13.6 (2.9)
0.279
Speak English at home (n,%)
236 (97%)
147 (65%)
Currently employed (n,%)
89 (36%)
93(41%)
0.299
Personal annual income < $30K (n,%)
137 (56%)
149 (66%)
<0.030
Recent CD4 count < 500 cells/ml (n,%)
119 (49%)
110 (49%)
0.983
Nadir CD4 < 200 cells/ml (n,%)
158(65%)
133 (59%)
0.188
Recent viral load (Log 10) (mean, SD)
4.7 (2.0)
4.9 (2.1)
0.189
Diagnosed with HCV (n,%)
38 (16%)
20 (9%)
<0.027
Years since HIV diagnosis (mean, SD)
14.3 (7.1)
10.0 (6.3)
Used substances in the past 6 months (n,%)
47 (19%)
18 (8%)
Alcohol use - AUDIT-10 score (Mean, SD)
4.0 (5.2)
2.5 (4.3)
Depressive symptoms - CES-D score (Mean, SD)
12.7 (11.5)
13.3 (12.5)
0.573

40. Generalized estimating equation- GDS >=0.5 only
Neuropsychological Test
(T-Scores)
CPE 2010
CPE 2006
Spatial Span
1.76
3.07
Pegboard Dominant Hand
5.53
0.59
Pegboard Non-dominant Hand
-6.02
0.09
Hopkins Recall
0.32
0.58
Hopkins Delayed Recall
0.45
0.23
Digit Symbol
-2.23
-2.05
Motor Efficiency Domain
-0.84
-2.21
Spatial Working Memory Domain
Memory Domain
0.38
0.40
Red=statistically significant
Changes need to be made here
Observations=483
NOTE: Numbers reported are unstandardized regression coefficients from linear GEE models
* CPE > 7 vs. CPE <=7
** CPE > 1.5 vs. CPE <= 1.5

41. Generalized estimating equation
Neuropsychological Test
(T-Scores)
CPE 2010
CPE 2006
Foreign-Born
(obs=349)
Canadian-Born
(obs=515)
Canadian-Born (obs=515)
Spatial Span
1.99
1.59
2.76
0.85
Pegboard Dominant Hand
-1.40
-0.07
-2.21
-0.35
Pegboard Non-dominant Hand
-2.22
0.33
-2.56
0.20
Hopkins Recall
-0.38
0.86
-0.04
1.73
Hopkins Delayed Recall
-0.79
1.56
-1.36
-0.45
Digit Symbol
-1.44
-1.03
-2.65
Motor Efficiency Domain
-1.77
-0.78
-1.78
-1.30
Spatial Working Memory Domain
-0.67
Memory Domain
1.20
-1.13
Red=statistically significant
Changes need to be made here
NOTE: Numbers reported are unstandardized regression coefficients from linear GEE models
* CPE > 7 vs. CPE <=7
** CPE > 1.5 vs. CPE <= 1.5

42. Generalized estimating equation
Neuropsychological Impairment Measure (Impaired or Not)
CPE 2010
CPE 2006
Foreign-Born
(obs=349)
Canadian-Born (obs=515)*
Canadian-Born (obs=515)**
Global Impairment Rating
1.38
(0.84, 2.26)
0.86
(0.55, 1.35)
1.04
(0.64, 1.70)
1.07 (0.70,1.63)
Global Deficit Score (>0.5)
1.50
(0.91, 2.49)
0.91 (0.57,1.46)
1.42
(0.88, 2.32)
1.40
(0.90, 2.17)
Global Deficit Score (>1.0)
0.98
(0.58, 1.67)
1.11
(0.69, 1.79)
0.78
(0.46, 1.32)
1.70 (1.07,2.67)
Red=statistically significant
Changes need to be made here
NOTE: Numbers reported are Odds Ratio (95% CI) from GEE models
* CPE > 7 vs. CPE <=7
** CPE > 1.5 vs. CPE <= 1.5

43. Generalized estimating equation
Neuropsychological Impairment Measure (Impaired or Not)
CPE 2010
CPE 2006
Foreign-Born
(obs=349)
Canadian-Born (obs=515)*
Canadian-Born (obs=515)**
Global Impairment Rating
1.38
(0.84, 2.26)
0.86
(0.55, 1.35)
1.04
(0.64, 1.70)
1.07
(0.70,1.63)
Global Deficit Score (>0.5)
1.50
(0.91, 2.49)
0.91 (0.57,1.46)
1.42
(0.88, 2.32)
1.40
(0.90, 2.17)
Global Deficit Score (>1.0)
0.98
(0.58, 1.67)
1.11
(0.69, 1.79)
0.78
(0.46, 1.32)
1.70
(1.07,2.67)
Red=statistically significant
Changes need to be made here
NOTE: Numbers reported are Odds Ratio (95% CI) from GEE models
* CPE > 7 vs. CPE <=7
** CPE > 1.5 vs. CPE <= 1.5