A brief iPad-based screening measure for HIV-associated neurocognitive disorders

描述（由申请人提供）：尽管有有效的抗逆转录病毒治疗，但HIV相关的神经认知障碍（HAND）仍然普遍存在。在当前的治疗时代，认知障碍通常是轻微的，并且不容易检测到，因为当前的筛查措施（例如，HIV痴呆量表）缺乏检测认知功能中细微损伤的灵敏度。虽然可能存在更敏感的测试，但与其管理和解释相关的时间和成本限制了其在检测中广泛使用的可行性 在常规门诊访视期间用手。因此，需要能够在忙碌的诊所环境中常规实施的敏感措施。平板电脑计算工具，如苹果iPad，越来越普遍，并提供了一个机会，潜在地实现一个直观的界面，主要是自我导向的简短认知评估与自动评分， 数据汇总，实时初步确定认知障碍，从而最大限度地减少临床医生和工作人员的负担。在第一阶段，我们将开发一个简短的，基于iPad的认知筛查，使其适用于功能诊所，并验证其在检测HIV+患者队列中的认知障碍方面的效用。本研究的目的是：1）开发一种简短的、基于iPad的多领域认知筛查，能够检测艾滋病毒感染者的细微神经认知障碍，2）检查将新措施纳入艾滋病毒诊所的可行性，以及3）进行初步研究，检查筛查的（a）可靠性和（B）有效性。 为了实现这些目标，我们将调整现有的Brainbaseline措施套件，该措施基于对使用更多时间密集型测试的HIV+参与者的初步工作，以将评估时间缩短到10分钟以下。然后将在当地艾滋病毒诊所部署筛查措施，以收集认知性能数据以及关于其可用性和患者和护理提供者的可接受性的信息。80名艾滋病毒阳性患者将在诊所环境中完成基于iPad的评估。40名HIV+参与者也将在HIV神经行为研究计划中接受评估，在那里他们将接受全面评估，以确定HIV相关神经认知障碍（HAND）的诊断。还将在iPad和完整的神经心理学测试组合上对20名HIV血清阴性对照进行评估，以便为在HIV+参与者中收集的数据提供比较点，并检查iPad测试与无脑功能障碍的个体中的常见神经心理学测试之间的关系。所有参与者（n = 100）也将在大约3个月后在iPad上完成重新测试，以评估重测信度和与该措施相关的可能的实践效果。 这将是第一项开发基于iPad的针对HAND的认知筛查测试的研究，并将为我们提供有关这种措施可行性的关键信息。如果整个项目成功，它将为临床医生提供一种新颖且高度可实施的工具，用于评估患者认知，并将Digital Artefacts定位为开发HAND和其他神经系统疾病的用户和临床医生友好筛查措施的关键领导角色。

DESCRIPTION (provided by applicant): HIV-associated neurocognitive disorders (HAND) remain prevalent despite effective anti-retroviral treatments. Cognitive impairments in the current treatment era are often mild and not readily detectable because current screening measures (e.g., the HIV Dementia Scale) lack sensitivity to detect subtle impairments in cognitive function. Although more sensitive tests may exist, the time and cost associated with their administration and interpretation limits the feasibility of their widespread use in detecting HAND during routine clinic visits. Thus, there is a need for sensitive measures that can be routinely implemented within a busy clinic environment. Tablet computing tools, such as the Apple iPad, are increasingly ubiquitous, and offer an opportunity to potentially implement an intuitive interface for primarily self-directed brief cognitive assessments with automated scoring, data aggregation, preliminary determination of cognitive impairment in real-time, thus minimizing clinician and staff burden. In Phase I we will develop a brief, iPad-based cognitive screening, adapt it for use in functioning clinics, and validate its utility in detecting cognitive impairment within an HIV+ patient cohort. The aims of this study are to: 1) develop a brief, iPad-based multi-domain cognitive screen capable of detecting subtle neurocognitive impairments in individuals with HIV infection, 2) examine the feasibility of incorporating the new measure in HIV clinics, and 3) conduct a preliminary study examining the (a) reliability and (b) validity of the screen. To accomplish these aims, we will adapt the existing Brainbaseline suite of measures, based upon preliminary work with HIV+ participants using more time-intensive tests, in order to reduce assessment time to less than 10 minutes. The screening measure will then be deployed in local HIV clinics in order to gather both cognitive performance data, as well as information on its usability and acceptability with patients and care providers. Eighty HIV+ patients will complete the iPad-based assessment in a clinic setting. A subset of 40 HIV+ participants will also be assessed at the HIV Neurobehavioral Research Program, where they will receive a comprehensive evaluation to determine a diagnosis of HIV-associated neurocognitive disorder (HAND). Twenty HIV seronegatives controls will also be evaluated on both the iPad and full neuropsychological test battery, in order to provide a point of comparison for the data collected in the HIV+ participants, as well as examine the relationship between the iPad tests and common neuropsychological tests in individuals without brain dysfunction. All participants (n = 100) will also complete a retesting on the iPad approximately 3 months later, in order to assess the test-retest reliability and possible practice effects associated with the measure. This would be the first study to develop an iPad-based cognitive screening test targeting HAND, and would provide us with critical information regarding the feasibility of such a measure. Should the overall project be successful, it would provide clinicians with a novel and highly-implementable tool for evaluating patient cognition, and position Digital Artefacts in a key leadership role in te development of user- and clinician- friendly screening measures for HAND and other neurologic conditions.