Prospective Memory in HIV-1 Infection

描述（由申请人提供）：尽管在过去的15年中取得了相当大的科学进步，但在HIV-1感染者的记忆评估的理论和临床意义上仍然存在显着的局限性。这个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HIV-1感染对前瞻性记忆（ProM）的影响。ProM是情景记忆的一个独特方面，对额纹状体损伤敏感，包括形成、监测和执行与持续干扰相关的未来意图的复杂过程。考虑早破可以增强对日常生活工具活动（ladl）相关的预测和干预。因此，令人惊讶的是，ProM尚未在HIV-1中得到评估，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，本次修订的研究申请有以下具体目的：1)阐明HIV-1感染中胎膜早破损伤的性质、程度和疾病相关性；2)通过临床和实验方法描述HIV-1中早膜损伤的认知机制；3)评估ProM在预测HIV-1患者ladl（如药物依从性）方面的功效。我们将招募200名HIV阳性参与者和50名人口统计学上可比较的对照组来评估以下主要假设：1)HIV-1感染与ProM编码和检索的执行控制缺陷有关；2)早膜损伤与晚期HIV-1疾病（如病毒载量）有关；3)相对于传统的认知测试，ProM在预测ladl（包括药物依从性）方面提供了增量效度。这项研究有望在hiv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，并可能最终促进基于prom的干预措施的发展，以最大限度地减少认知障碍对HIV-1感染者、护理人员和卫生保健系统的影响。

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.