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

 描述(申请人提供)：随着艾滋病毒携带者年龄的增长，与正常年龄相关的认知功能下降的协同效应将加剧和/或加速认知功能的下降，早在一个人40多岁的时候就可以检测到。虽然需要干预措施来保护/改善认知功能，但已经有一种干预措施可以提高处理速度。NINR/NIA(2014年1月14日)宣布，这项积极研究中使用的处理速度培训(N=2,802名居住在社区的老年人)即使在培训10年后也能够使“老年人在变老时保持他们的认知能力”。如中所示 这项积极的研究，这种干预措施独特地改善了驾驶、日常生活工具活动(IADL)、与健康相关的生活质量、自我评估的健康、内部控制点，并保护一个人免受抑郁；这些也是成年人艾滋病毒携带者需要干预的领域。在感染艾滋病毒的成年人中，我们的初步研究同样表明，处理速度的下降与较差的驾驶模拟器性能和更多自我报告的故障车祸有关；仅驾驶时处理速度的下降就代表了一个重大的公共卫生问题。我们还证明，处理速度训练提高了这种认知能力，并转化为对IADL的定时测量的改善。基于我们之前的研究，这项随机对照试验方案包括一项前后两年的纵向实验设计，将264名40岁以上被诊断为HIV相关神经认知障碍的HIV患者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训练，2)20小时基于实验室的处理速度训练，或3)10小时标准化计算机接触控制(SHAM)条件。目标1：确定10小时和20小时的加工速度训练是否会在测试后、基线后的第一年和第二年提高这种认知能力。目标2：确定10小时和20小时的处理速度训练是否会在测试后、基线后的第一年和第二年改善日常功能。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会促进生活质量的改善(例如，抑郁)。

 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).