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

HAND 的修复：初步功效、现实世界相关性和机制

• 批准号: 8848428
• 负责人: THOMAS D MARCOTTE
• 金额: $ 23.25万
• 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: 2013-06-03 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8848428
• 关键词: Address; Affect; Anti-Retroviral Agents; Attention; Automobile Driving; Behavior; Behavior Therapy; Cognition Disorders; Cognitive; Cognitive deficits; Computers; Control Groups; Data; Disease; Employment; Eye; Foundations; Future; Goals; HIV; HIV-associated neurocognitive disorder; Impaired cognition; Impairment; Individual; Information Systems; Intervention; Intervention Trial; Laboratories; Longevity; Measures; Medical; Memory; Neuropsychological Tests; Participant; Pattern; Performance; Persons; Pharmacologic Substance; Phase; Positioning Attribute; Protocols documentation; Quality of life; Randomized; Reaction Time; Research; Scanning; Societies; System; Technology; Testing; Thinking; Time; Training; Training Programs; Visual; Weight; arm; base; cognitive ability; computerized; disability; effectiveness trial; improved; insight; medication compliance; multitask; neuropsychological; performance tests; post intervention; prevent; primary outcome; processing speed; public health relevance; remediation; simulation; treatment effect; visual process; visual processing

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.

描述（由申请人提供）：尽管有效的抗逆转录病毒治疗，但与HIV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会影响日常功能。由于感染HIV的个体现在可以预期正常的寿命，因此出现了一个问题，即在与HIV相关认知缺陷的个体中是否可以通过行为干预措施改善现实世界的功能，目的是最大程度地减少残疾并增强生活质量。 降低的处理速度（PS）是与与HIV相关的神经认知障碍有关的标志性变化（手）。我们已经表明，这种缺陷与驾驶模拟器和公路驱动器期间评估的驾驶性能差有关，并且在有用的视野（UFOV）中预测了公路崩溃的损害，而不是标准神经心理学（NP）测试提供的信息。患有PS缺陷的人在多数方面也有更大的困难 任务与日常功能相关的各种活动。 该修订项目的具体目的是：1）为实施一个协议制定协议并确定可行性 基于计算机的视觉PS培训计划针对手和PS缺陷的人，2）确定视觉PS训练是否改善了相关认知措施（包括UFOV），驾驶模拟和多任务处理以及3）的性能，以检查通过眼神跟踪技术进行此类改进的可能机制。 用手和已建立的PS缺损的五十个HIV+驱动器将随机分为a）计算机化的视觉PS训练或b）控制条件。两组将每周两次完成培训或控制任务8周。然后，将对参与者进行评估评估PS和其他认知能力的认知措施，以前显示的模拟可以预测公路绩效，并对日常功能进行多任务测试。评估将在干预/控制阶段之后在基线进行，然后在治疗终止后6个月进行评估，以确定绩效是否持续存在。为了更好地了解任何改进的机制，我们将利用眼睛跟踪系统来评估视觉扫描模式，同时参与参与者进行车内信息系统模拟（干预前后）。然后将根据绝对性能和治疗效果进行分析。 该项目的结果将提供有关该项目的初步证据 在与HIV相关的认知障碍时，仅通过药物治疗似乎无法解决，可行性和可能改善PS相关缺陷的功效和机制，并为将来的研究奠定了基础，以更确定的方式研究这些问题。