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展，但在HIV-1感染者的记忆评估的理论和临床意义方面仍然存在明显的局限性。这个修订后的多学科项目的总体目标是提供一个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、监测和执行未来意图的复杂过程。考虑ProM可以增强工具性日常生活活动（IADL）的预测和相关干预。因此，令人惊讶的是，ProM尚未在HIV-1中进行评估，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IADL的影响。因此，该修订的研究申请由以下具体目标指导：1）澄清HIV-1感染中ProM损伤的性质、程度和疾病相关性; 2）使用临床和实验测量两者描绘HIV-1中ProM损伤的认知机制;以及3）评估ProM在预测IADL（例如，药物依从性）在HIV-1中。我们将招募200名HIV+参与者和50名人口统计学上可比的对照，以评估以下主要假设：1）HIV-1感染与ProM内编码和检索的执行控制缺陷相关; 2）ProM损伤与晚期HIV-1疾病相关（例如，病毒载量）;和3）ProM在预测IADL（包括药物依从性）方面提供相对于传统认知测试的增量有效性。这项研究有望产生重要的概念和实践创新的性质和临床评估艾滋病毒相关的认知障碍，并可能最终促进发展的ProM为基础的干预措施，以尽量减少认知障碍的HIV-1感染者，照顾者和医疗保健系统的影响。

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.