Identifying adolescents at high risk of neurocognitive disorder: Development and validation of a composite risk index

Researchers at Michigan State University are developing and validating a composite risk index to identify children and adolescents at high risk of neurocognitive disorder, particularly focusing on those exposed to HIV. Supported by the National Institutes of Health, this interdisciplinary team aims to translate long-term observational insights into a practical, predictive tool that can be used to stratify risk and guide early interventions. This project builds on years of fieldwork in Uganda, where the team has been monitoring 750 children across three exposure categories: children unexposed to HIV, children living with HIV acquired perinatally, and children exposed to HIV perinatally but uninfected. This diverse cohort allows the investigators to examine how virologic, nutritional, psychosocial and environmental factors jointly shape cognitive trajectories during development.

The project recognizes that medical advances have improved survival for children affected by HIV, but social determinants—poverty, stigma, caregiver illness and loss, discrimination and stress—continue to influence long-term cognitive outcomes. To address this complexity, the research integrates biological variables such as viral genotype and the effects of maternal antiviral therapy, nutritional status and immune function with psychological and social measures including exposure to bullying, caregiver stability and community stigma. The resulting composite risk index will quantify the presence and extent of stressors that disrupt learning, behavior and functioning, with the goal of predicting which children are most likely to experience poor cognitive trajectories.

Developing the index in an international cohort underscores its potential generalizability: although the tool is being built in Uganda, the risk factors are applicable across settings and that the index could be adapted to proactively identify at-risk children in the United States and elsewhere.

Beyond prediction, the long-term aim is pragmatic: to connect identified at-risk children with existing support systems—health care, educational services and social work programs—to prevent or mitigate cognitive problems. The team has already observed protective, compensatory factors such as supportive adults and improved nutrition that can buffer risk. While intervention development will be a subject of future work, the current project lays the foundation for targeted prevention by elucidating which children are most in need and which modifiable factors most influence outcomes. Ultimately, the research aspires to ensure that children affected by HIV not only survive but thrive cognitively by providing tools to identify risk early and link children to resources that build resilience.