Prospective Memory in HIV-1 Infection

描述(由申请人提供)：尽管在过去15年中取得了相当大的科学进步，但在HIV-1感染者记忆评估的理论和临床意义上仍然存在显著的局限性。这一修订的多学科项目的总体目标是提供一种概念驱动的方法来描述艾滋病毒-1感染对前瞻记忆(PROM)的影响。胎膜早破是情节记忆的一个独特方面，它对额纹状体损伤敏感，包括针对持续分心的未来意图的形成、监测和执行的复杂过程。考虑胎膜早破可以加强对日常生活工具活动(LADL)的预测和相关干预。因此，令人惊讶的是，胎膜早破没有在HIV-1中被评估，特别是考虑到HIV-1相关记忆缺陷的额纹状体神经发病机制及其对lADL的影响。因此，这项修订的研究应用以以下具体目标为指导：1)澄清艾滋病毒-1感染中胎膜早破损害的性质、程度和疾病相关性；2)使用临床和实验措施描述艾滋病毒-1胎膜早破损害的认知机制；以及3)评估胎膜早破在预测艾滋病毒-1的lADLS(例如，用药依从性)方面的有效性。我们将招募200名HIV+参与者和50名人口统计学上具有可比性的对照来评估以下主要假设：1)艾滋病毒-1感染与胎膜早破中编码和检索的执行控制缺陷有关；2)胎膜早破损害与晚期艾滋病毒-1疾病(如病毒负荷)有关；以及3)胎膜早破在预测lADL方面提供了相对于传统认知测试的递增有效性，包括用药依从性。这项研究承诺在艾滋病毒相关认知障碍的性质和临床评估方面产生重要的概念和实践创新，并最终可能促进基于胎膜早破的干预措施的开发，以将认知障碍对艾滋病毒-1感染者、照顾者和医疗保健系统的影响降至最低。

DESCRIPTION (provided by applicant): Despite considerable scientific progress over the past 15 years, notable limitations persist in the theoretical and clinical significance of memory assessment in persons with HIV-1 infection. The overarching aim of this revised multidisciplinary project is to provide a conceptually-driven approach to delineating the impact of HIV-1 infection on prospective memory (ProM). ProM is a unique aspect of episodic memory sensitive to fronto-striatal damage that encompasses the complex processes of forming, monitoring, and executing future intentions vis-a-vis ongoing distractions. Consideration of ProM can enhance prediction of- and interventions related to - instrumental activities of daily living (lADLs). It is therefore surprising that ProM has not been evaluated in HIV-1, especially given the fronto-striatal neuropathogenesis of HIV-1-associated memory deficits and their impact on lADLs. Accordingly, this revised research application is guided by the following specific aims: 1) to clarify the nature, extent, and disease correlates of ProM impairment in HIV-1 infection; 2) to delineate the cognitive mechanisms of ProM impairment in HIV-1 using both clinical and experimental measures; and 3) to assess the efficacy of ProM in predicting lADLs (e.g., medication adherence) in HIV-1. We will recruit 200 HIV+ participants and 50 demographically comparable controls to evaluate the following primary hypotheses: 1) HIV-1 infection is associated with deficient executive control of encoding and retrieval within ProM; 2) ProM impairment is associated with advanced HIV-1 disease (e.g., viral load); and 3) ProM provides incremental validity relative to traditional cognitive tests in predicting lADLs, including medication adherence. This study promises to produce important conceptual and practical innovations regarding the nature and clinical assessment of HIV-associated cognitive disorders, and may ultimately facilitate the development of ProM-based interventions to minimize the impact of cognitive disorders on persons with HIV-1 infection, caregivers, and the health care system.