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

项目概要/摘要 此应用程序是为了响应NIA的战略方向目标D-3，该目标要求更好的工具来评估 在临床、初级保健环境和家庭环境中的认知功能，以区分风险人群 从没有风险的人发展阿尔茨海默病（AD）。艾滋病毒感染者目前生活在 进入他们患AD的风险越来越高的年龄段。因为高达50%的 艾滋病毒感染者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 在老年艾滋病毒感染者中有很大一部分未被发现。老年神经HIV迫切需要 准确识别和区分HIV和AD相关认知障碍并预测个体的能力 有进一步认知能力下降的风险。流行病学研究的证据表明，感官（例如， 听觉处理）和运动（例如，平衡）受损在PLHIV中更常见， 这些损害可能会影响认知功能障碍的进展， 在艾滋病病毒感染者和AD中的损伤。基于大量证据表明，虚拟现实广泛应用于 我们建议使用一种新颖的便携式3D虚拟现实自动化工具，称为 DETECT，以准确测量认知能力下降和姿势稳定性随时间的变化，在老年PLHIV患者中， 并且没有遗忘型轻度认知障碍（aMCI），这是AD的前兆。DETECT是为快速 在不同的环境中，如忙碌的老年艾滋病诊所或家庭， 区分正常认知MCI和痴呆此外，我们的试点工作表明， 是区分正常认知和HIV相关神经认知的敏感筛查工具 艾滋病病毒感染者的手（HAND）该系统也是准确的诊断姿势不稳定使用一种新技术 这样就不需要站着和蹲着了。为了扩大这项工作，我们提出了两个网站（UCSD和 Emory）前瞻性研究，120名老年人代表三种不同的临床表型： HAND和aMCI（HAND +/aMCI+）、伴HAND但不伴aMCI的PLHIV（HAND +/aMCI-）和HIV未感染者 aMCI患者（HIV-/aMCI+）。一种基于神经心理学的诊断方法将被用于 在艾滋病毒感染者中识别aMCI。我们将使用DETECT来：（目的1）比较认知能力下降的决定因素， 这些群体，和（目标2和3）了解如何非认知功能的变化，如姿势不稳定， 听力损失和中枢听觉处理动态地影响这些群体的认知能力下降。我们 纵向研究设计将使我们能够更好地了解认知变化如何随着时间的推移而变化， 个人群体。这项工作的长期目标是带来快速，准确的工具，可以识别那些在 临床实践中进展为AD痴呆的风险增加。这些工具的最终应用， 临床实践可以为患者和临床医生提供清晰的信息，减轻那些没有感染艾滋病毒的人的恐惧。 aMCI，提高效率，并指导个体患者的分诊进入特定的治疗途径。

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.