Cognitive Training to Reduce Impulsivity in HIV-infected Cocaine Users

项目摘要 在120万艾滋病毒携带者中，超过一半的人经历了神经认知障碍(NCI) 对日常生活造成不利影响，并预示着发病率和死亡率的增加。感染艾滋病毒的个人 对可卡因等刺激性药物上瘾的人患NCI的风险更高，这会导致冲动 决策，并从事与糟糕的临床相关的高风险行为 结果和艾滋病毒传播给其他人。延迟折扣是冲动性的一个关键方面，它描述了 随着收到报酬的延迟时间的增加而贬值的倾向。吸毒成瘾的人往往更喜欢 较小的即时奖励胜过较大的延迟奖励。过多的折扣与较大的 其他危害健康的行为，包括危险的性行为。相互竞争的神经行为决策系统 模型假设，过度贴现是由于脉冲系统相对于 执行控制系统。我们自己的工作表明，艾滋病毒感染调节了可卡因对大脑的影响 在延迟折扣期间在执行控制网络中运行。先前的研究支持稳健的 过度打折与工作记忆受损之间的关系。作为一项核心执行职能， 支持自我调节，工作记忆理论上是降低艾滋病毒风险的干预目标。 计算机化的工作记忆训练已被证明可以减少兴奋剂使用者的延迟折扣，但 它还没有在感染艾滋病毒的吸毒者身上进行测试。拟议的R21研究将测试初步疗效 一项计算机化的认知训练计划，以改善工作记忆，减少HIV病毒的延迟折扣- 受感染的可卡因使用者。采用随机试验设计，我们将50名参与者分配到 实验认知训练条件或注意匹配控制条件。参赛者将完成 在8周内进行16次会议，在基线、培训后和1个月的跟踪评估中进行评估 干预效果。我们假设，相对于控制条件，认知训练将导致更大的 工作记忆的改善和延迟折扣的减少。我们还将检查艾滋病毒的变化 危险行为(可卡因使用、危险性行为和服药依从性)。结果将支持R01应用程序 严格测试认知训练对HIV相关行为和临床的影响的更大规模的试验 结果。这一创新的研究路线对艾滋病毒临床实践具有重要的翻译意义， 包括在资源有限的情况下传播，而神经心理学专家寥寥无几。这项建议 通过测试一种新的艾滋病毒治疗方法，直接推动艾滋病指定资金的高度优先主题- 与吸毒者相关的NCI。通过将重点放在继续推动艾滋病毒传播的高危人群上， 这项研究对改善艾滋病毒感染者的神经行为功能具有很大的潜力， 最终减少新的艾滋病毒感染的发生率。

Project Summary Of the 1.2 million Americans living with HIV, over half experience neurocognitive impairments (NCI) that adversely affect daily living and are predictive of increased morbidity and mortality. HIV-infected individuals who are addicted to stimulant drugs like cocaine are at even higher risk for NCI, which contributes to impulsive decision making, and engage in high rates of risky behaviors that are associated with both poor clinical outcomes and HIV transmission to others. Delay discounting, a key aspect of impulsivity, describes the tendency to devalue a reward as the delay to its receipt increases. Individuals addicted to drugs tend to prefer smaller, immediate rewards over larger, delayed rewards. Excessive discounting is associated with a wide range of other health risk behaviors, including risky sex. The Competing Neurobehavioral Decision Systems model posits that excessive discounting results from greater relative strength of the impulsive system over the executive control system. Our own work suggests that HIV infection modulates the effect of cocaine on brain functioning in the executive control network during delay discounting. Prior research supports a robust association between excessive discounting and working memory impairment. As a core executive function that supports self-regulation, working memory is theoretically an intervention target for HIV risk reduction. Computerized working memory training has been shown to decrease delay discounting in stimulant users, but it has not yet been tested in HIV-infected drug users. The proposed R21 study will test the preliminary efficacy of a computerized cognitive training program to improve working memory and reduce delay discounting in HIV- infected cocaine users. Using a randomized trial design, we will assign 50 participants to either the experimental cognitive training condition or an attention-matched control condition. Participants will complete 16 sessions in 8 weeks, with assessments at baseline, post-training, and 1-month follow-up to evaluate intervention effects. We hypothesize that cognitive training will, relative to the control condition, lead to greater improvements in working memory and reductions in delay discounting. We will also examine change in HIV risk behaviors (cocaine use, risky sex, and medication adherence). Results will support an R01 application for a larger scale trial to rigorously test the impact of cognitive training on HIV-related behavioral and clinical outcomes. This innovative line of research has important translational implications for HIV clinical practice, including dissemination in resource-limited settings with few neuropsychology specialists. This proposal directly advances a high priority topic for AIDS-designated funding by testing a novel treatment for HIV- associated NCI in drug users. By focusing on a high-risk population that continues to drive HIV transmission, this research has strong potential to improve neurobehavioral functioning in HIV-infected persons, and ultimately to reduce the incidence of new HIV infections.