Towards Objective Metrics to Quantify the Role of HIV and Increasing Cognitive Demand on Instrumental ADLs in People Aging with HIV

项目总结 全球约有3700万人携带艾滋病毒(PLWH)。随着年龄的增长，他们的艾滋病毒状况变得更加严重 慢性，他们面临着与艾滋病毒慢性管理相关的新挑战，并经历了一系列 与身体、认知和心理健康相关的问题，这些问题会对他们的演奏能力产生不利影响 日常生活活动(IADL)，如管理财务和药物管理。研究表明， 80%的PLWH报告经历了至少一种功能障碍、活动受限或社交参与受限 而另一些人则认为50%-70%的人在日常生活中存在“全局性”功能障碍。虽然这些损伤可能 部分归因于与老龄化相关的传统风险因素，艾滋病毒本身优先影响 大脑的额纹状体区域，导致运动功能、注意力、信息处理、 执行功能和记忆力。大多数情况下，这些问题在艾滋病毒中被忽视了，很少有人尝试 来恢复他们的名誉。我们的长期目标是将基于机器人的神经康复策略扩展到PLWH。这个 这项建议的目的是首先客观地量化老龄化和艾滋病毒对现实世界IADL的影响。自.以来 在运动活动的执行过程中，IADL通常需要两个高水平的执行功能，我们还 寻求应用一种新的基于机器人的方法来研究如何系统地表征类IADL条件 执行功能中认知需求的增加影响艾滋病毒携带者的运动表现 反对他们的同龄人在没有艾滋病毒的情况下衰老。在目标1中，我们将评估一种新型机器人的并发有效性- 基于运动和认知任务，使用现有的临床工具来预测运动障碍，认知 艾滋病毒携带者老年人的功能障碍和IADL功能。42名老年艾滋病毒携带者和对照组 对于不同级别的IADL功能，将使用我们基于机器人的任务进行评估，该任务同时进行 运动和认知领域和标准临床测试组合。我们假设我们基于机器人的新任务 将是一个客观的方法，证明与临床量表，特别是有关的同时效度 以粗细上肢运动障碍、执行功能和IADL功能为主。在目标2中，我们将评估 老年HIV感染者认知需求增加与运动能力的相互作用 和没有艾滋病病毒的对照。59名艾滋病毒携带者和对照组将使用我们的新型机器人进行评估- 基于任务，而我们将改变认知难度。我们将作为一个函数来衡量运动性能的变化 不断增加的任务难度和艾滋病毒状况。我们假设艾滋病毒感染组将表现得更糟 与对照组相比，运动成绩随着任务难度的增加而增加。我们将确定这项新任务是否可以 客观地探讨复杂的IADL在HIV状态下的表现可能会受到影响。本项目支持使用 基于机器人的评估策略，用于快速和客观地评估认知运动性能和 IADL功能，并提供对艾滋病毒和年龄匹配的非艾滋病毒对照之间的差异的洞察。

PROJECT SUMMARY About 37 million people are living with HIV (PLWH) worldwide. As they age and their HIV status becomes more chronic, they face new challenges associated with the chronic management of HIV and experience a range of physical, cognitive, and mental health-related issues that detrimentally impact their ability to perform instrumental activities of daily living (IADLs) such as managing finances and medication management. Studies indicate that 80% of PLWH report experiencing at least one impairment, activity limitation, or social participation restriction while others suggest 50%-70% have a “global” impairment in everyday functioning. While these impairments can be partially attributed to traditional risks factors associated with aging, HIV itself preferentially impacts the frontostriatal regions of the brain, leading to deficits in motor function, attention, information processing, executive function, and memory. Most often these issues are overlooked in HIV and very little attempt is made to rehabilitate them. Our long-term goal is to expand robot-based neurorehabilitation strategies to PLWH. The objective of this proposal is to first objectively quantify the impact of aging with HIV on real-world IADLs. Since IADLs often require both high levels of executive functioning during the performance of motor activities, we also seek to apply a novel robot-based method to study how “IADL-like conditions” characterized by systematically increasing cognitive demand in the executive function affect motor performance in adults aging with HIV as oppose to their counterparts aging without HIV. In Aim 1, we will assess concurrent validity of a novel robot- based motor and cognitive task with existing clinical tools used to predict motor impairment, cognitive impairment and IADL function in older adults living with HIV. 42 participants aging with HIV and controls with varying levels of IADL function will be evaluated using our robot-based task that simultaneously engages motor and cognitive domains and standard clinical test battery. We hypothesize that our new robot-based task will be an objective method that demonstrates concurrent validity with the clinical scales, especially those related to gross and fine upper limb motor impairment, executive function and IADL function. In Aim 2, we will assess interactions between increasing cognitive demand and motor performance in older adults living with HIV and controls without HIV. 59 participants aging with HIV and controls will be evaluated using our novel robot- based task while we will vary cognitive difficulty. We will measure changes in motor performance as a function of increasing levels of task difficulty and HIV status. We hypothesize that the HIV group will demonstrate worse motor performance as the task difficulty increases compared to controls. We will determine if this new task can objectively probe how performance on complex IADLs may suffer with HIV status. This project supports the use of robot-based assessment strategies for fast and objective assessment of cognitive-motor performance and IADL function and provides insight into differences between HIV and age-matched non-HIV controls.