Detect: A novel device to assess how HIV affects neurocognitive decline and postural instability in older adults at risk for Alzheimer's Disease

检测：一种新型装置，用于评估艾滋病毒如何影响有阿尔茨海默病风险的老年人的神经认知衰退和姿势不稳定

• 批准号: 10321221
• 负责人: Albert Anderson
• 金额: $ 78.37万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-15 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10321221
• 关键词: 3D virtual reality; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adoption; Adult; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease risk; Assessment tool; California; Classification; Clinic; Clinical; Cognition; Cognitive; Data; Dementia; Detection; Devices; Diagnosis; Elderly; Environment; Epidemic; Equilibrium; Evaluation; Foundations; Frequencies; Fright; Future; General Population; Geriatric Assessment; Goals; HIV; HIV-associated neurocognitive disorder; Hearing problem; Home; Home environment; Impaired cognition; Impairment; Individual; Institution; Investigation; Literature; Longitudinal Studies; Measures; Memory; Methods; Monitor; Motor; Musculoskeletal Equilibrium; Neurocognitive Deficit; Neuropsychology; Participant; Pathway interactions; Patients; Pattern; Performance; Persons; Population; Posture; Prospective Studies; Reaction Time; Research; Research Design; Resources; Risk; Risk Factors; Screening procedure; Self Administration; Sensory; Signal Transduction; Site; System; Techniques; Testing; Time; Traumatic Brain Injury; Triage; Universities; Work; accurate diagnosis; amnestic mild cognitive impairment; auditory processing; base; clinical care; clinical phenotype; clinical practice; cognitive change; cognitive function; cognitive testing; cohort; design; diagnostic strategy; digital health; epidemiology study; experience; frailty; geriatric neuroHIV; healthy aging; hearing impairment; improved; individual patient; memory recall; memory recognition; mild cognitive impairment; motor deficit; multimodality; neuroAIDS; neurobehavioral; novel; portability; posture instability; primary care setting; programs; response; screening; sensory integration; tool; virtual; virtual reality

Project Summary/Abstract This application is in response to the NIA’s Strategic Directions Goal D-3, which calls for better tools to assess cognitive function in the clinic, primary care setting, and home environment in order to distinguish persons at risk for developing Alzheimer’s disease (AD) from persons not at risk. Persons living with HIV (PLHIV) are now living well into the age demographic in which they are at increasing risk for developing AD. Because up to 50% of PLHIV experience cognitive impairment from HIV or related factors that often include memory problems, AD may go unidentified in a significant proportion of older PLHIV. There is a pressing need in geriatric neuroHIV for the ability to accurately identify and disentangle HIV- and AD-associated cognitive impairment and predict individuals who are at risk for further cognitive decline. Evidence from epidemiological studies suggests that sensory (e.g., auditory processing) and motor (e.g., balance) impairments are observed more frequently in PLHIV compared to the general population of a similar age and that these impairment may impact the progression of cognitive impairment in PLHIV and in AD. Building on substantial evidence demonstrating that virtual reality is widely accepted among older adults, we propose to use a novel and portable 3-D virtual reality automated tool, called DETECT, to accurately measure cognition decline and changes in postural stability over time in older PLHIV with and without amnestic mild cognitive impairment (aMCI), a precursor to AD. DETECT was developed for rapid and brief cognitive testing in diverse settings, such as busy geriatric HIV clinics or the home, and can accurately discriminate between normal cognition, MCI, and dementia. Additionally, our pilot work indicates that DETECT is a sensitive screening tool for differentiating between normal cognition and HIV-associated neurocognitive disorder (HAND) in PLHIV. The system is also accurate for diagnosing postural instability using a novel technique that obviates the need for standing and ambulation. To expand on this work, we propose a two site (UCSD and Emory) prospective study of 120 older individuals representing three different clinical phenotypes: PLHIV with HAND and aMCI (HAND+/aMCI+), PLHIV with HAND but without aMCI (HAND+/aMCI-), and HIV-uninfected persons with aMCI (HIV-/aMCI+). An empirically-based neuropsychological diagnostic approach will be used to identify aMCI among PLHIV. We will use DETECT to: (Aim 1) compare the determinants of cognitive decline in these groups, and (Aims 2 and 3) understand how non-cognitive functional changes such as postural instability, hearing loss, and central auditory processing dynamically influence cognitive decline in these groups. Our longitudinal study design will allow us to better understand how cognitive change differs over time between these groups of individuals. The long-term goal of this work is to bring rapid, accurate tools that can identify those at increased risk for progression to AD dementia into clinical practice. The eventual adoption of such tools into clinical practice could provide clarity to patients and clinicians, alleviate fears among PLHIV who do not have aMCI, improve efficiency, and guide the triage of individual patients into specific treatment pathways.

项目摘要/摘要 该应用程序响应了NIA的战略方向目标D-3，该目标要求使用更好的工具来评估 在诊所、初级保健环境和家庭环境中的认知功能，以区分处于危险中的人 用于从没有风险的人身上患上阿尔茨海默氏症(AD)。艾滋病毒携带者(PLHIV)现在生活在 很好地进入了他们患AD风险增加的年龄段。因为高达50%的 PLHIV经历艾滋病毒或相关因素造成的认知障碍，通常包括记忆问题，AD可能 在相当大比例的老年PLHIV中，患者的身份不明。在老年神经艾滋病毒中迫切需要 能够准确识别和理清艾滋病毒和AD相关的认知障碍，并预测个人 他们面临着进一步认知能力下降的风险。来自流行病学研究的证据表明，感官(例如， 与PLHIV相比，听觉加工)和运动(例如，平衡)障碍更常见 这些损害可能会影响认知能力的发展 PLHIV和AD的损害。建立在大量证据的基础上，证明虚拟现实广泛存在 在老年人中被接受，我们建议使用一种新颖的便携式3D虚拟现实自动化工具，名为 检测，准确测量老年PLHIV患者随着时间的推移认知能力下降和姿势稳定性的变化 并且没有遗忘性轻度认知障碍(AMCI)，这是AD的前兆。Detect是为快速开发的 并在不同的环境下进行简短的认知测试，如繁忙的老年艾滋病诊所或家中，并可以准确地 辨别正常认知、MCI和痴呆症。此外，我们的试点工作表明，检测到 是区分正常认知和HIV相关神经认知的敏感筛查工具 PLHIV中的障碍(手)。该系统还使用一种新技术准确地诊断姿势不稳定 这就消除了站立和行走的需要。为了扩展这项工作，我们提出了两个站点(UCSD和 Emory)对代表三种不同临床表型的120名老年人进行了前瞻性研究： Hand和aMCI(Hand+/aMCI+)，有手部但没有aMCI的PLHIV(Hand+/aMCI-)，以及未感染HIV AMCI(艾滋病毒-/aMCI+)患者。一种基于经验的神经心理诊断方法将用于 在PLHIV中确定一种MCI。我们将使用检测来：(目标1)比较认知能力下降的决定因素 这些小组，以及(目标2和3)了解非认知功能变化，如姿势不稳定， 听力损失和中枢听觉处理会动态地影响这些群体的认知能力下降。我们的 纵向研究设计将使我们更好地了解认知变化如何随着时间的推移而不同于 个体的群体。这项工作的长期目标是带来快速、准确的工具，能够在 增加进展为阿尔茨海默病的风险进入临床实践。这些工具最终将被采用到 临床实践可以为患者和临床医生提供澄清，缓解没有艾滋病病毒携带者的恐惧 AMCI，提高效率，并引导对个别患者的分诊进入特定的治疗路径。