Novel pediatric neurocognitive screening using central auditory tests

使用中枢听觉测试进行新型儿科神经认知筛查

• 批准号: 9765362
• 负责人: JAY C BUCKEY
• 金额: $ 73.98万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-16 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9765362
• 关键词: 3 year old; 8 year old; Adult; Affect; Age; Area; Attenuated; Auditory; Auditory system; Behavior; Brain; Characteristics; Child; Childhood; China; Clinic; Collaborations; Comorbidity; Complement; Complex; Consequences of HIV; Consumption; Cross-Sectional Studies; Data; Data Analyses; Detection; Development; Developmental Delay Disorders; Diagnosis; Diffuse; Digit structure; Elements; Frequencies; Future; HIV; HIV Infections; Hour; Human Resources; Individual; Injury; International; Language; Language Development; Linguistics; Longitudinal Studies; Measures; Methods; Monitor; Nervous System Physiology; Neuraxis; Neurocognitive; Neurocognitive Deficit; Neurodevelopmental Problem; Neurological observations; Noise; Performance; Play; Quality of life; Receiver Operating Characteristics; Resources; Risk; Role; Running; Screening procedure; Standardization; Tanzania; Techniques; Test Result; Testing; Time; Training; Traumatic Brain Injury; United States National Institutes of Health; White Matter Disease; Wireless Technology; Work; antiretroviral therapy; auditory processing; base; clinical practice; cognitive ability; cognitive performance; cognitive process; disability; experience; improved; innovation; literacy; neurocognitive disorder; neurocognitive test; neurodevelopment; normal hearing; novel; pediatric human immunodeficiency virus; performance tests; recruit; response; screening; skills; sound; speech in noise; tool

Abstract Summary Despite active antiretroviral treatment, HIV-infected children are at risk for neurocognitive disorders and neurodevelopmental delay. This is a devastating consequence of HIV infection, with lifelong ramifications and disability. Detecting incipient neurocognitive and neurodevelopmental problems is challenging, particularly in the developing world where most pediatric HIV cases exist. Neurocognitive and neurodevelopmental test batteries take considerable time to administer (approximately 2 hours), require trained personnel, and depend on accurate normative data for interpretation. This makes them difficult to employ in the developing world where clinician time is limited, few trained personnel are available, and normative data often do not exist. In our work in both Tanzania and China, we have shown that central auditory tests can provide a “window” into central nervous system function in HIV+ individuals. We have shown a strong negative relationship between cognitive performance and the ability to understand speech in background noise in HIV+ individuals (despite otherwise normal hearing determined by audiometric thresholds). Central auditory tests such as gap detection, the frequency following response (FFR), and interpreting speech in noise are demanding central nervous tasks involving multiple brain areas. The use of central auditory tests to assess neurocognitive function could be a major advance for screening. Speech-in-noise testing is easy for most individuals to understand, takes 10 minutes, and has existing normative data. We have performed some types of speech-in-noise testing in children as young as 6 years. The FFR is particularly promising for use with children. This test requires no input from the subject, can be done in subjects of any age, and may predict future language development. The objective for this project is to relate performance on central auditory tests to established measures of neurocognitive performance, behavior, and literacy in a cross-sectional study, and then follow the children in a longitudinal study to assess the ability of the central auditory tests to predict future function—particularly language development. The appropriate use of these tests to screen for neurocognitive problems will be established through the analysis of the receiver operating characteristic curves taking into account the effects of confounders. We have assembled an international team with experience in central auditory testing and neurocognitive and neurodevelopmental testing in HIV + individuals. Dr. Nina Kraus and her team at Northwestern are internationally-recognized experts in the auditory FFR. The team in Dar es Salaam has extensive experience in performing both central auditory and neurocognitive tests. Dr. Jonathan Lichtenstein in collaboration with Dr. Michael Boivin are expert in assessing neurocognitive function and developmental delay in children. Together this team will be able to determine the role central auditory testing could play in assessing children in the developing world with HIV. These tests may offer a new and improved way to assess the central nervous system co-morbidities of HIV infection in resource-limited settings.

抽象概括 尽管进行了积极的抗逆转录病毒治疗，但感染艾滋病毒的儿童仍有患神经认知障碍的风险， 神经发育迟缓这是艾滋病毒感染的毁灭性后果，具有终身影响， 残疾。检测早期的神经认知和神经发育问题是具有挑战性的，特别是在 在发展中国家，大多数儿童艾滋病病例都存在。神经认知和神经发育测验 电池需要相当长的时间来管理（大约2小时），需要训练有素的人员， 准确的标准数据进行解释。这使得他们很难在发展中国家就业 在临床医生时间有限的情况下，很少有受过训练的人员可用，并且通常不存在标准数据。在我们 在坦桑尼亚和中国的工作中，我们已经证明，中枢听觉测试可以提供一个“窗口”， 中枢神经系统的功能在HIV+的人。我们已经证明了一个强烈的负面关系， 认知表现和理解HIV+个体在背景噪音中讲话的能力（尽管 否则由听力测定阈值确定的正常听力）。中央听觉测试，如间隙检测， 频率跟随反应（FFR）和在噪声中解释语音是要求中枢神经的任务 涉及多个大脑区域使用中枢听觉测试来评估神经认知功能可能是一种 筛选的重大进展。噪声中的语音测试对于大多数人来说很容易理解， 分钟，并具有现有的规范数据。我们已经进行了一些类型的语音噪声测试， 6岁的孩子。血流储备分数特别适用于儿童。该测试不需要 来自受试者的输入可以在任何年龄的受试者中进行，并且可以预测未来的语言发展。的 该项目的目标是将中央听觉测试的表现与既定的测量指标联系起来 神经认知表现，行为和读写能力的横断面研究，然后在一个 纵向研究，以评估中央听觉测试预测未来功能的能力，特别是 语言发展适当使用这些测试来筛查神经认知问题将是 通过分析受试者工作特性曲线，考虑到 混杂因素。我们已经组建了一个具有中央听觉测试经验的国际团队， 神经认知和神经发育测试在HIV +个体。尼娜·克劳斯博士和她的团队 Northwestern是国际公认的听觉FFR专家。达累斯萨拉姆的团队 在执行中枢听觉和神经认知测试方面具有丰富的经验。Jonathan Lichelin博士 与Michael Boivin博士合作，是评估神经认知功能和发育迟缓的专家 小儿这个团队将能够共同确定中央听觉测试在评估 发展中国家的儿童感染艾滋病毒。这些测试可能提供一种新的和改进的方法来评估中央 在资源有限的情况下，艾滋病毒感染的神经系统合并症。