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 此应用是对NIA的战略方向目标D-3的回应，该目标要求更好地评估工具 诊所，初级保健环境和家庭环境中的认知功能，以区分处于风险的人 从没有危险的人开发阿尔茨海默氏病（AD）。艾滋病毒（PLHIV）的人现在活着 到他们的年龄人群中，他们正在增加开发AD的风险。因为多达50％ PLHIV经历艾滋病毒或经常包括记忆问题的相关因素的认知障碍，广告可能 在很大一部分旧的PLHIV中识别出不明身份。老年神经hiv迫切需要 能够准确识别和解散与艾滋病毒和广告相关的认知障碍并预测个体的能力 他们有进一步认知能力下降的风险。流行病学研究的证据表明，感觉（例如， 在PLHIV中，听觉处理）和电动机（例如，平衡）损伤比较频繁 对于类似年龄的一般人群，这些障碍可能会影响认知的发展 PLHIV和AD中的损害。基于大量证据，表明虚拟现实是广泛的 在老年人中被接受，我们建议使用一种新颖和便携式的3-D虚拟现实自动化工具，称为 检测，以准确衡量认知下降和姿势稳定随着时间的流逝而变化的老年人PLHIV 并且没有柔和的轻度认知障碍（AMCI），是AD的先驱。检测是为了快速开发 以及潜水员环境中的简短认知测试，例如繁忙的老年艾滋病毒诊所或家庭，可以准确 区分正常认知，MCI和痴呆症。此外，我们的飞行员工作表明检测 是一种敏感的筛查工具，用于区分正常认知和与HIV相关的神经认知 PLHIV中的障碍（手）。使用新技术，该系统对于诊断姿势不稳定性也很准确 这消除了站立和野蛮的需求。为了扩展这项工作，我们建议一个两个站点（UCSD和 Emory）对代表三种不同临床表型的120名老年人的前瞻性研究：PLHIV具有 手和AMCI（手+/amci+），手动plhiv，但没有AMCI（手+/amci）和HIV未染 患有AMCI的人（HIV-/AMCI+）。基于经验的神经心理学诊断方法将用于 在PLHIV中识别AMCI。我们将使用检测到：（目标1）比较确定性的确定性。 这些群体以及（目标2和3）了解非认知功能的变化，例如姿势不稳定， 听力损失和中央听觉处理动态影响这些群体的认知下降。我们的 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流逝而差异 一组个人。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 增加痴呆症进入临床实践的风险。事件采用此类工具 临床实践可以为患者和临床医生提供明确的信息，从而减轻没有 AMCI，提高效率，并指导个别患者的分类为特定的治疗途径。