Cognitive Training to Reduce Impulsivity in HIV-infected Cocaine Users

认知训练可减少感染艾滋病毒的可卡因使用者的冲动

• 批准号: 9198077
• 负责人: CHRISTINA S MEADE
• 金额: $ 22.66万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198077
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Aging; American; Area; Attention; Automobile Driving; Behavioral; Biological Models; Brain; Clinical; Cocaine; Cocaine Users; Cognitive deficits; Communities; Complication; Data; Decision Making; Disease; Drug user; Educational Intervention; Effectiveness; Employment; Evidence based treatment; Funding; Gambling; Goals; HIV; HIV Infections; HIV risk; Health; Impulsivity; Incidence; Individual; Informal Social Control; Intervention; Lead; Life; Major Depressive Disorder; Memory impairment; Morbidity - disease rate; Neurocognitive Deficit; Neurologic; Neuropsychology; Outcome; Participant; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention approach; Process; Research; Research Support; Resources; Rewards; Risk Behaviors; Risk Reduction; Schizophrenia; Short-Term Memory; Specialist; Substance abuse problem; System; Testing; Training; Training Activity; Training Programs; Translations; Vulnerable Populations; Work; addiction; clinical practice; cocaine use; cognitive function; cognitive training; computerized; daily functioning; design; discount; discounting; effective therapy; executive function; experience; follow-up; high risk; improved; innovation; intervention effect; medication compliance; mortality; neurobehavioral; neuroimaging; novel; pilot trial; preference; primary outcome; programs; public health relevance; randomized trial; secondary outcome; sex; substance misuse; theories; transmission process; trial design

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.

项目摘要 在120万美国艾滋病毒感染者中，超过一半的人患有神经认知障碍（NCI）， 不利地影响日常生活，并预示发病率和死亡率增加。hiv感染者 那些对可卡因等兴奋剂上瘾的人患NCI的风险更高，这有助于冲动 决策，并从事高风险行为，这与不良的临床 艾滋病毒传播给其他人。延迟折扣，冲动的一个关键方面，描述了 随着延迟时间的增加，奖励的价值会降低。吸毒成瘾的人倾向于 更小的、即时的奖励，而不是更大的、延迟的奖励。过度贴现与广泛的 一系列其他健康风险行为，包括危险性行为。竞争的神经行为决策系统 模型假定，过度贴现的结果，更大的相对强度的脉冲系统超过 执行控制系统。我们自己的工作表明，艾滋病毒感染调节可卡因对大脑的影响 在延迟折扣期间在执行控制网络中起作用。先前的研究支持一个强大的 过度折扣和工作记忆损伤之间的联系。作为一个核心执行功能， 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， 它尚未在感染艾滋病毒的吸毒者中进行过测试。拟议的R21研究将测试初步疗效 一个计算机化的认知训练计划，以改善工作记忆和减少延迟折扣艾滋病毒- 可卡因使用者使用随机试验设计，我们将50名参与者分配到 实验认知训练条件或注意力匹配控制条件。参与者将完成 8周内进行16次培训，包括基线、培训后和1个月随访评估 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。我们还将研究艾滋病毒的变化 危险行为（可卡因使用，危险性行为和药物依从性）。结果将支持R 01申请， 一项更大规模的试验，严格测试认知训练对艾滋病毒相关行为和临床的影响， 结果。这项创新的研究对艾滋病毒临床实践具有重要的转化意义， 包括在缺乏神经心理学专家的资源有限的环境中传播。这项建议 通过测试一种新的艾滋病毒治疗方法，直接推动了艾滋病指定资金的高度优先主题， 与NCI相关的药物。通过重点关注继续推动艾滋病毒传播的高危人群， 这项研究有很大的潜力，以改善艾滋病毒感染者的神经行为功能， 最终减少新的艾滋病毒感染的发生率。