A Metacognition-based Approach to Improve HAND Among Methamphetamine Users

基于元认知的方法可改善甲基苯丙胺使用者的 HAND

• 批准号: 8699510
• 负责人: Kaitlin B Casaletto
• 金额: $ 3.53万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8699510
• 关键词: AIDS neuropathy; Address; Affect; Age; Awareness; Behavior Therapy; Brain Injuries; Brain region; Characteristics; Clinical; Cognition; Cognitive; Cognitive remediation; Dependence; Development; Disease; Economic Burden; Educational process of instructing; Ensure; Evaluation; Executive Dysfunction; Future; Goals; HIV; HIV Infections; Illicit Drugs; Impairment; Individual; Injury; Knowledge; Learning; Life; Major Depressive Disorder; Medication Management; Mentored Patient-Oriented Research Career Development Award; Mentors; Methamphetamine; Methamphetamine dependence; Modeling; Monitor; Neurocognitive; Neurorehabilitation; Occupational activity of managing finances; Outcome; Perception; Performance; Persons; Pharmaceutical Preparations; Plasma; Population; Predisposition; Prevalence; Problem Solving; Public Health; Quality of life; Rehabilitation therapy; Research; Research Design; Research Infrastructure; Research Project Grants; Risk Factors; Scientist; Substance Use Disorder; System; Task Performances; Techniques; Thinking; Training; Traumatic Brain Injury; Unemployment; Viral Load result; Writing; addiction; base; cognitive rehabilitation; daily functioning; disability; executive function; high risk; implementation research; improved; in vivo; insight; instrumental activity of daily living; learned behavior; medication compliance; neurobehavioral; neurotoxic; novel; pill; programs; public health relevance; relating to nervous system; remediation; response; success; transmission process

DESCRIPTION (provided by applicant): Methamphetamine (MA) is one of the most commonly used illicit drugs worldwide and is a major risk factor for the transmission of HIV infection. The neurotoxic effects of comorbid MA dependence and HIV infection (MA/HIV) preferentially impact the frontostriatal regions of the brain leading to increased prevalence of HIV-associated neurocognitive disorders (HAND) that affect up to 60% of the population, particularly disrupting higher-order executive functions (e.g., problem-solving abilities). In both HIV and MA, executive dysfunction is associated with dependence in instrumental activities of daily living (IADLs; e.g., medication or financial management). Despite the high risk for and economic burden of HAND-related disability (e.g., unemployment), there are currently no empirically validated techniques to treat HAND among MA users. One cognitive rehabilitation technique that has been effective for improving IADL functioning in other populations with executive dysfunction (e.g., traumatic brain injury) is metacognitive training. Metacognition involves the capacity for introspection including accurate perception and assessment of one's everyday performance and its consequences. Metacognition is commonly impaired following brain injury to the prefrontal systems and is associated with integrity of executive functions; in fact, up to 50% of HIV individuals show poor insight into their cognitive abilities, which is directly associated with poorer IADL outcomes in these individuals. Impaired metacognition may therefore represent an important mechanism by which executive dysfunction impacts successful IADL abilities in individuals with MA/HIV. Metacognitive training thus represents a potentially powerful technique to improve IADL functioning in MA/HIV. Metacognitive training is a cognitive rehabilitation technique that teaches individuals to self-regulate and monitor their thoughts and actions in order to gain control over their learning and behaviors. The proposed dissertation project aims to evaluate the efficacy of a brief metacognitive training module for neurocognitive rehabilitation in MA/HIV individuals with executive dysfunction. Due to the current absence of such techniques in this population, results from this study will inform future development of novel behavioral interventions to improve HAND among MA users. Through the implementation of this research project and the comprehensive training plan outlined in this F31 proposal including close interaction with expert mentors in a successful and collaborative research infrastructure (i.e., HIV Neurobehavioral Research Program), the applicant will enhance her scientific knowledge, research design techniques, and ability to further contribute to the fields of IADL functioning and neurocognitive rehabilitation in neuroAIDS and addictions. The opportunities afforded via this F31 mechanism will significantly contribute to the applicant's intermediate goal of attaining a K23 award focused on the development of empirically-based neurorehabilitation techniques and her long-term goal of becoming an independent neurorehabilitation scientist dedicated to improving the lives of persons living with substance use disorders and HIV infection.

描述（由申请人提供）：甲基苯丙胺（MA）是全球最常用的非法药物之一，是艾滋病毒感染传播的主要危险因素。合并症MA依赖性和HIV感染（MA/HIV）的神经毒性作用优先影响大脑的额叶区域，从而增加了与HIV相关的神经认知障碍（手）的患病率的增加，这些神经认知障碍（手）最大程度地影响了60％的人群，尤其破坏了高级执行功能，从而破坏了高级执行功能（例如，解决问题，可解决问题）。在HIV和MA中，执行功能障碍都与日常生活乐器活动的依赖有关（IADLS；例如，药物或财务管理）。尽管与手相关残疾的高风险和经济负担（例如失业），但目前尚无经验验证的技术 在MA用户中对手。元认知训练是一种有效改善其他行政功能障碍（例如创伤性脑损伤）的IADL功能的认知康复技术。元认知涉及内省的能力，包括对人的日常表现及其后果的准确看法和评估。脑损伤对前额叶系统损伤后通常会受到损害，并且与执行功能的完整性有关。实际上，多达50％的艾滋病毒个体对他们的认知能力表现出较差的见解，这与这些人的IADL结果直接相关。因此，元认知受损可能代表了一种重要机制，通过该机制，执行功能障碍会影响MA/HIV患者成功的IADL能力。因此，元认知训练代表了一种潜在的强大技术，可以改善MA/HIV中的IADL功能。元认知培训是一种认知康复技术，它教会个人自我调节和监控自己的思想和行动，以控制他们的学习和行为。拟议的论文项目旨在评估简短的元认知培训模块对具有执行功能障碍的MA/HIV患者神经认知康复的功效。由于目前在该人群中缺乏此类技术，因此这项研究的结果将为未来的新型行为干预措施开发，以改善MA使用者的手。 Through the implementation of this research project and the comprehensive training plan outlined in this F31 proposal including close interaction with expert mentors in a successful and collaborative research infrastructure (i.e., HIV Neurobehavioral Research Program), the applicant will enhance her scientific knowledge, research design techniques, and ability to further contribute to the fields of IADL functioning and neurocognitive rehabilitation in neuroAIDS and成瘾。通过这种F31机制提供的机会将极大地为申请人获得以K23奖励的中间目标做出贡献 关于基于经验的神经康复技术的发展以及她成为独立的神经康复科学家的长期目标，致力于改善患有药物使用障碍和艾滋病毒感染的人的生活。