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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要在艾滋病毒感染艾滋病毒的120万美国人中，超过一半的神经认知障碍（NCI）不利地影响日常生活，并可以预测发病率和死亡率的增加。艾滋病毒感染者对可卡因等兴奋剂的上瘾的人对NCI的风险更高，这有助于冲动决策，并参与与临床不佳相关的高风险行为率结果和艾滋病毒传播给他人。延迟打折是冲动性的关键方面，描述了随着收据的延迟增加而贬低奖励的趋势。沉迷于毒品的人往往更喜欢较小，立即获得较大的延迟奖励。过度折扣与宽其他健康风险行为的范围，包括风险性行为。竞争的神经行为决策系统模型认为，过度折现是由于冲动系统比相对的相对强度更大执行控制系统。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打折期间在执行控制网络中运行。先前的研究支持强大的过度折扣与工作记忆障碍之间的关联。作为核心执行功能支持自我调节，工作记忆在理论上是降低艾滋病毒风险的干预目标。已经显示，计算机化的工作记忆训练可以减少刺激用户的延迟打折，但尚未在感染HIV的吸毒者中对其进行测试。拟议的R21研究将测试初步功效一项计算机化认知培训计划，以改善工作记忆并减少艾滋病毒的延迟折现 - 感染可卡因用户。使用随机试验设计，我们将分配50名参与者实验认知训练条件或注意力匹配的控制条件。参与者将完成在8周内进行16次课程，并在基线，训练后和1个月的随访中进行评估以评估干预效果。我们假设认知训练将相对于控制条件，导致更大改进工作记忆和减少折扣的减少。我们还将检查艾滋病毒的变化风险行为（可卡因使用，危险性和药物依从性）。结果将支持R01应用一项更大的试验，严格测试认知训练对HIV相关行为和临床的影响结果。这种创新的研究线对HIV临床实践具有重要的翻译意义，包括在资源有限的环境中传播，很少有神经心理学专家。这个建议直接通过测试用于HIV的新型治疗方法来直接提高艾滋病指定资金的高优先级主题。与吸毒者相关的NCI。通过关注继续推动艾滋病毒传播的高风险人群这项研究具有改善艾滋病毒感染者的神经行为功能的强大潜力，以及最终减少新的HIV感染的发生率。