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

描述（由申请人提供）：尽管进行了有效的抗逆转录病毒治疗，但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的寿命，因此出现了一个问题，即是否可以通过行为干预来改善患有艾滋病毒相关认知缺陷的个体的真实世界功能，以最大限度地减少残疾并提高生活质量。 降低的处理速度（PS）是与HIV相关的神经认知障碍（HAND）相关的标志性变化。我们已经证明，这种缺陷与驾驶模拟器和道路驾驶过程中评估的驾驶性能差有关，并且有用视野（UFOV）中的损伤预测道路碰撞超出了标准神经心理学（NP）测试提供的信息。PS缺陷的个体在多方面也有更大的困难， 安排与日常功能相关的各种活动。 这一修订项目的具体目标是：1）制定一项议定书，并确定实施一项 基于计算机的视觉PS训练计划，用于HAND和PS缺陷的个体，2）确定视觉PS训练是否改善相关认知测量（包括UFOV），驾驶模拟和多任务处理的表现，以及3）通过眼动跟踪技术检查这种改善的可能机制。 将50名患有HAND和确定PS缺陷的HIV+驾驶员随机分配至a）计算机化视觉PS训练或B）对照条件。两组均每周完成两次训练或对照任务，持续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，驾驶模拟先前显示可预测道路性能，以及日常功能的多任务测试。将在基线、干预/对照期后和治疗终止后6个月进行评估，以确定性能是否持续改善。为了更好地理解任何改进背后的机制，我们将利用眼动跟踪系统来评估视觉扫描模式，同时参与者参与车载信息系统模拟（干预前后）。然后将分析这些与绝对性能和治疗效果的关系。 该项目的结果将提供有关 在HIV相关的认知障碍似乎无法单独通过药物治疗解决的时候，改善PS相关缺陷的可行性和可能的疗效和机制，并为未来的研究奠定基础，以更明确的方式检查这些问题。

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.