An RCT of Speed of Processing Training in Middle-Aged and Older Adults with HIV

 描述（由申请人提供）：随着艾滋病毒感染者年龄的增长，与正常年龄相关的认知能力下降的协同效应将加重和/或加速认知功能的下降，这可以在40多岁时检测到。虽然需要干预措施来保护/改善认知功能，但已经存在一种干预措施来提高处理速度。NINR/NIA（2014年1月14日）宣布，在ACTIVE研究（N = 2，802社区居住的老年人）中使用的处理速度训练有能力使“老年人在训练后10年内保持他们的认知能力”。所示 在ACTIVE研究中，这种干预措施独特地改善了驾驶，工具性日常生活活动（IADL），健康相关的生活质量，自我评价的健康，内部控制点，并保护一个人免受抑郁症的影响;这些也代表了成年艾滋病毒感染者需要干预的领域。在成年艾滋病毒感染者中，我们的初步研究同样表明，处理速度下降与驾驶模拟器性能较差和更多自我报告的故障汽车碰撞有关;这种处理速度下降仅代表了一个重大的公共卫生问题。我们还证明，处理速度训练改善了这种认知能力，并转化为IADL定时测量的改善表现。根据我们之前的研究，这项RCT提案包括一个前后两年的纵向实验设计，其中264名40岁以上并被诊断患有HIV相关神经认知障碍的HIV成年人将被随机分配到三种训练条件之一：1）10小时基于实验室的处理速度培训，2）20小时基于实验室的处理速度培训，或3）10小时的标准化计算机接触控制（假）条件。目标1：确定10小时与20小时的处理速度训练是否会在测试后、基线后第1年和第2年改善这种认知能力。目标2：确定10小时与20小时的处理速度训练是否会改善测试后、基线后第1年和第2年的日常功能。探索性目的：确定随着时间的推移，处理速度和/或日常功能的改善是否介导生活质量的改善（例如，抑郁症）。

 DESCRIPTION (provided by applicant): As people age with HIV, the synergistic effects with normal age-related cognitive declines will accentuate and/or accelerate declines in cognitive functioning which can be detected as early as in one's 40s. Although interventions are needed to protect/improve cognitive functioning, one intervention already exists to improve speed of processing. NINR/NIA (January 14, 2014) announced that Speed of Processing Training used in the ACTIVE Study (N = 2,802 community-dwelling older adults) has the ability to enable "older people to maintain their cognitive abilities as they age" even 10 years after training. As shown in the ACTIVE Study, this intervention uniquely improves driving, instrumental activities of daily living (IADL), health-related quality of life, self-rated health, internal locus of control, and protects one from depression; these represent areas of needed intervention for adults with HIV as well. In adults with HIV, our pilot studies likewise indicate speed of processing declines are associated with poorer driving simulator performance and more self-reported at-fault automobile crashes; such speed of processing declines on driving alone represent a significant public health concern. We also demonstrated that Speed of Processing Training improved this cognitive ability and translated into improved performance on a timed measure of IADLs. Based on our prior research, this RCT proposal consists of a pre-post two-year longitudinal experimental design whereby 264 adults with HIV, 40+ years and diagnosed with HIV-Associated Neurocognitive Disorder, will be randomly assigned to one of three training conditions: 1) 10 hours of laboratory-based Speed of Processing Training, 2) 20 hours of laboratory- based Speed of Processing Training, or 3) 10 hours of a standardized computer-contact control (sham) condition. AIM 1: Determine whether 10 vs 20 hours of speed of processing training will improve this cognitive ability at post-test, year 1, and year 2 after baseline. AIM 2: Determine whether 10 vs 20 hours of speed of processing training will improve everyday functioning at post-test, year 1, and year 2 after baseline. Exploratory AIM: Determine whether improvement in speed of processing and/or everyday functioning over time mediate improvement in quality of life (e.g., depression).