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: 9921453
• 负责人: JAY C BUCKEY
• 金额: $ 69.03万
• 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/9921453
• 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; 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; Hearing Tests; 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; ROC Curve; 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; comorbidity; 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 尽管有活跃的抗逆转录病毒治疗，但感染HIV的儿童仍处于神经认知疾病的风险和 神经发育延迟。这是艾滋病毒感染，终生影响和 残疾。检测初期的神经认知和神经发育问题是挑战的，尤其是在 大多数儿科HIV病例的发展中国家。神经认知和神经发育测试 电池需要大量时间进行管理（大约2小时），需要训练有素的人员，并依赖 在准确的正常数据上进行解释。这使他们难以在发展中国家使用 在临床时间有限的地方，很少有训练的人员可用，并且通常不存在正常数据。在我们的 在坦桑尼亚和中国的工作，我们已经表明，中央听觉测试可以为 中枢神经系统在艾滋病毒+个体中的功能。我们已经表现出牢固的负面关系 认知表现和在艾滋病毒+个人中理解背景噪音中语音的能力（尽管 否则，正常的听力是通过听觉阈值确定的）。中央听觉测试，例如差距检测， 响应之后的频率（FFR）和噪音中的解释语音要求中心神经任务 涉及多个大脑区域。使用中央听觉测试评估神经认知功能可能是 筛选的主要进步。对于大多数人来说，毫无疑问测试很容易理解，需要10 分钟，并具有现有的正常数据。我们已经在 儿童年仅6岁。 FFR特别有希望与儿童一起使用。该测试不需要 该主题的输入可以在任何年龄的主题中进行，并且可以预测未来的语言发展。 该项目的目的是将中央听觉测试的性能与已建立的措施联系起来 横断面研究中的神经认知表现，行为和识字率，然后跟随儿童 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选神经认知问题将是 通过分析接收器操作特征曲线的效果来建立 混杂因素。我们已经组建了一个国际团队，具有中央听觉测试的经验， HIV +个体中的神经认知和神经发育测试。 Nina Kraus博士和她的团队 西北航空是听觉FFR中国际公认的专家。达累斯萨拉姆的团队有 在执行中央听觉和神经认知测试方面的丰富经验。 Jonathan Lichtenstein博士 与Michael Boivin博士的合作是评估神经认知功能和发展延迟的专家 在儿童中。该团队将能够确定中央听觉测试在评估中所起的作用 患有艾滋病毒的发展中国家的孩子。这些测试可能会提供一种评估中央的新的和改进的方法 神经系统在资源有限的环境中艾滋病毒感染的合并性。