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和 神经发育迟缓。这是艾滋病毒感染的毁灭性后果，具有终身影响和 残疾。检测早期的神经认知和神经发育问题具有挑战性，尤其是在 大多数儿童艾滋病毒病例存在的发展中国家。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)，需要经过培训的人员，并且依赖于 关于准确的规范性数据以供解释。这使得它们很难在发展中国家使用。 在临床医生时间有限的地方，受过培训的人员很少，而且标准数据往往不存在。在我们的 在坦桑尼亚和中国的研究中，我们已经表明，中枢听觉测试可以提供一扇进入 HIV阳性个体的中枢神经系统功能。我们已经表现出强烈的负相关关系 HIV+个体在背景噪声中的认知表现和理解语音的能力(尽管 否则由听力阈值确定为正常听力)。中枢听觉测试，如间隙检测， 频率跟随反应(FFR)和在噪声中翻译语音是要求中枢神经功能的任务 涉及多个脑区。使用中枢听觉测试来评估神经认知功能可能是一种 筛查方面的重大进展。噪音中的语音测试对大多数人来说很容易理解，需要10 会议纪要，并有现有的规范数据。我们已经执行了一些类型的噪声中语音测试 年仅6岁的儿童。FFR特别适合儿童使用。这项测试不需要 来自受试者的输入，可以在任何年龄的受试者中完成，并可以预测未来的语言发展。这个 这个项目的目标是将中枢听觉测试的表现与既定的措施联系起来 一项横断面研究中的神经认知表现、行为和识字能力，然后在一项 评估中枢听觉测试预测未来功能能力的纵向研究--特别是 语言发展。适当地使用这些测试来筛查神经认知问题将是 通过分析建立了考虑影响的接收器工作特性曲线 混血儿。我们已经组建了一支在中央听觉测试和 HIV阳性个体的神经认知和神经发育测试。Nina Kraus博士和她的团队在 西北大学是国际公认的听觉FFR专家。达累斯萨拉姆的团队已经 具有进行中枢听觉和神经认知测试的丰富经验。乔纳森·利希滕斯坦博士 与Michael Boivin博士的合作是评估神经认知功能和发育延迟的专家 在孩子们身上。这个团队将能够共同确定中枢听觉测试在评估 发展中国家的艾滋病毒携带者儿童。这些测试可能会提供一种新的、改进的方法来评估中央 在资源有限的情况下，艾滋病毒感染的神经系统共病。