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.

摘要摘要 尽管积极进行抗逆转录病毒治疗，感染艾滋病毒的儿童仍面临神经认知障碍和 神经发育迟缓。这是艾滋病毒感染的毁灭性后果，会产生终生影响， 残疾。检测早期的神经认知和神经发育问题具有挑战性，特别是在 存在大多数儿科艾滋病毒病例的发展中国家。神经认知和神经发育测试 电池需要相当长的时间来管理（大约 2 小时），需要经过培训的人员，并且依赖 准确的规范数据进行解释。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，训练有素的人员很少，而且往往不存在规范数据。在我们的 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” HIV+个体的中枢神经系统功能。我们已经证明两者之间存在很强的负相关关系 HIV+ 个体的认知表现和在背景噪音中理解言语的能力（尽管 否则正常听力由听力阈值确定）。中枢听觉测试，例如间隙检测、 频率跟随响应（FFR）和在噪声中解释语音是要求中枢神经任务 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 筛选方面的重大进展。噪声中语音测试对于大多数人来说很容易理解，需要 10 分钟，并有现有的规范数据。我们已经进行了一些类型的噪声中语音测试 年仅 6 岁的儿童。 FFR 尤其适合儿童使用。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完成，并且可以预测未来的语言发展。这 该项目的目标是将中央听觉测试的表现与既定的衡量标准联系起来 横断面研究中的神经认知表现、行为和读写能力，然后跟踪孩子们 纵向研究评估中枢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 通过分析接收者操作特性曲线建立并考虑到影响 的混杂因素。我们组建了一支具有中枢听觉测试经验的国际团队 HIV + 个体的神经认知和神经发育测试。 Nina Kraus 博士和她的团队 西北大学是国际公认的听觉 FFR 专家。达累斯萨拉姆的团队有 在进行中枢听觉和神经认知测试方面拥有丰富的经验。乔纳森·利希滕斯坦博士 与评估神经认知功能和发育迟缓方面的专家 Michael Boivin 博士合作 在儿童中。该团队将共同确定中央听觉测试在评估中可以发挥的作用 发展中国家感染艾滋病毒的儿童。这些测试可能会提供一种新的、改进的方法来评估中央 资源有限环境中艾滋病毒感染的神经系统并发症。