Towards Objective Metrics to Quantify the Role of HIV and Increasing Cognitive Demand on Instrumental ADLs in People Aging with HIV

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PROJECT SUMMARY About 37 million people are living with HIV (PLWH) worldwide. As they age and their HIV status becomes more chronic, they face new challenges associated with the chronic management of HIV and experience a range of physical, cognitive, and mental health-related issues that detrimentally impact their ability to perform instrumental activities of daily living (IADLs) such as managing finances and medication management. Studies indicate that 80% of PLWH report experiencing at least one impairment, activity limitation, or social participation restriction while others suggest 50%-70% have a “global” impairment in everyday functioning. While these impairments can be partially attributed to traditional risks factors associated with aging, HIV itself preferentially impacts the frontostriatal regions of the brain, leading to deficits in motor function, attention, information processing, executive function, and memory. Most often these issues are overlooked in HIV and very little attempt is made to rehabilitate them. Our long-term goal is to expand robot-based neurorehabilitation strategies to PLWH. The objective of this proposal is to first objectively quantify the impact of aging with HIV on real-world IADLs. Since IADLs often require both high levels of executive functioning during the performance of motor activities, we also seek to apply a novel robot-based method to study how “IADL-like conditions” characterized by systematically increasing cognitive demand in the executive function affect motor performance in adults aging with HIV as oppose to their counterparts aging without HIV. In Aim 1, we will assess concurrent validity of a novel robot- based motor and cognitive task with existing clinical tools used to predict motor impairment, cognitive impairment and IADL function in older adults living with HIV. 42 participants aging with HIV and controls with varying levels of IADL function will be evaluated using our robot-based task that simultaneously engages motor and cognitive domains and standard clinical test battery. We hypothesize that our new robot-based task will be an objective method that demonstrates concurrent validity with the clinical scales, especially those related to gross and fine upper limb motor impairment, executive function and IADL function. In Aim 2, we will assess interactions between increasing cognitive demand and motor performance in older adults living with HIV and controls without HIV. 59 participants aging with HIV and controls will be evaluated using our novel robot- based task while we will vary cognitive difficulty. We will measure changes in motor performance as a function of increasing levels of task difficulty and HIV status. We hypothesize that the HIV group will demonstrate worse motor performance as the task difficulty increases compared to controls. We will determine if this new task can objectively probe how performance on complex IADLs may suffer with HIV status. This project supports the use of robot-based assessment strategies for fast and objective assessment of cognitive-motor performance and IADL function and provides insight into differences between HIV and age-matched non-HIV controls.