Remediation of HAND: Initial efficacy, real-world relevance, and mechanisms

描述(由申请人提供)：尽管有效的抗逆转录病毒治疗，艾滋病毒相关的神经认知障碍仍然普遍存在，许多研究表明，这些认知障碍影响日常功能。由于艾滋病毒感染者现在可以预期正常寿命，因此出现了一个问题，即是否可以通过行为干预来改善艾滋病毒相关认知缺陷患者的现实世界功能，以最大限度地减少残疾和提高生活质量。处理速度降低(PS)是与HIV相关的神经认知障碍(HAND)相关的一个标志性变化。我们已经证明，这些缺陷与驾驶模拟器和道路驾驶过程中评估的糟糕驾驶性能有关，有用视野(UFOV)的损害可以预测道路上的撞车事故，而不是标准的神经心理学(NP)测试所提供的信息。有PS缺陷的个体在多项运动中也有更大的困难 负责与日常运作相关的各种活动。这一订正项目的具体目标是：1)制定一项议定书，并确定执行一项 基于计算机的视觉PS训练计划，适用于手部和PS缺陷的个体，2)确定视觉PS训练是否改善了相关认知测量(包括UFOV)、驾驶模拟和多任务处理的表现，以及3)通过眼球跟踪技术研究这种改善的可能机制。50名手部有PS缺陷的HIV司机将被随机分成a)计算机化视觉PS训练或b)对照条件。两组都将每周两次完成训练或控制任务，为期8周。然后，参与者将接受评估PS和其他认知能力的认知测量，之前被证明可以预测道路表现的驾驶模拟，以及对日常功能的多任务测试。评估将在干预/控制阶段之后的基线上进行，然后在治疗结束后6个月进行，以确定绩效是否持续改善。为了更好地了解任何改进背后的机制，我们将利用眼球跟踪系统在参与者进行车载信息系统模拟(干预前和干预后)时评估视觉扫描模式。然后将分析这些指标与绝对表现和治疗效果的关系。该项目的结果将提供关于 在HIV相关认知障碍似乎无法仅通过药物治疗解决的情况下，改善PS相关缺陷的可行性和可能的有效性和机制，并为未来以更明确的方式检查这些问题的研究奠定了基础。

DESCRIPTION (provided by applicant): HIV-associated neurocognitive disorders remain prevalent despite effective anti-retroviral treatments, and numerous studies indicate that these cognitive impairments impact everyday functioning. Since HIV-infected individuals can now anticipate a normal lifespan, the question arises as to whether real-world functioning in individuals with HIV-related cognitive deficits can be improved via behavioral interventions, with the goal of minimizing disability and enhancing quality of life. Reduced processing speed (PS) is a hallmark change associated with HIV-associated neurocognitive disorders (HAND). We have shown that such deficits are associated with poor driving performance as assessed on driving simulators and during on-road drives, and that impairments in the Useful Field of View (UFOV) predict on-road crashes beyond the information provided by standard neuropsychological (NP) testing. Individuals with PS deficits also have greater difficulty in multi tasking various activities associated with everyday functioning. The specific aims for this revised project are: 1) to develop a protocol for, and determine the feasibility of, implementing a computer-based visual PS training program for individuals with HAND and PS deficits, 2) to determine whether visual PS training improves performance on related cognitive measures (including UFOV), driving simulations, and multi-tasking, and 3) to examine the possible mechanisms of such improvements via eye tracking technology. Fifty HIV+ drivers with HAND and established PS deficits will be randomized to either a) computerized visual PS training or b) a control condition. Both groups will complete the training or control task twice weekly for 8 weeks. Participants will then be evaluated on cognitive measures assessing PS and other cognitive abilities, driving simulations previously shown to be predictive of on-road performance, and a multi-tasking test of everyday functioning. Assessments will take place at baseline, following the intervention/control phase, and then 6 months following treatment termination to determine whether any improvements in performance persist. To better understand the mechanisms behind any improvement, we will utilize an eye-tracking system to assess visual scanning patterns while participants are engaged in an in-vehicle information system simulation (pre- and post-intervention). These will then be analyzed in relation to absolute performance and treatment effects. The results of this project will provide preliminary evidence regarding the feasibility and possible efficacy and mechanisms of improving PS-related deficits at a time when HIV-associated cognitive disorders appear unresolvable via pharmaceutical treatments alone, and lay the foundation for future studies to examine these issues in a more definitive manner.