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

描述（由申请人提供）：尽管有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。既然艾滋病毒感染者现在可以预期正常寿命，那么问题来了，是否可以通过行为干预来改善与艾滋病毒相关的认知缺陷患者的现实功能，以尽量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较差的驾驶表现有关，而且有用视场（UFOV）的缺陷预测了标准神经心理学（NP）测试提供的信息之外的道路碰撞。有PS缺陷的个体在多种活动中也有较大的困难

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.