Executive Function Training to Reduce Cognitive Intra-Individual Variability in Adults with HIV

项目摘要 HIV感染者（PWH）患有认知障碍，称为HIV相关神经认知障碍 （手）。传统的神经心理学评估不能完全捕捉到PWH的认知障碍; 相反，更细致的评估需要检查个人在认知方面的表现， 个体内变异（IIV）。IIV预测认知障碍/下降，改变大脑 形态学和神经病理学。从概念上讲，IIV源于“执行失控”或效率， 哪些执行控制过程协调其他认知过程/域。行政部门支持 基于IIV的基本概念，PWH患者的认知功能可以得到改善 通过加强执行职能的干预措施，使其能够更好地协调其他部门的职能， 认知领域计算机化认知训练，广泛用于老年学文献和 研究小组先前的工作，已被证明是针对改善选定的认知领域，包括 执行功能因此，目前的建议是重要的和创新的，其重点是行政 PWH认知训练背景下的功能和IIV。该可行性研究将使用两组预- 成年HAND患者的后实验设计包括：1）20小时的执行功能训练组 （入组60例，n=48例有损耗），和2）无接触对照（入组60例，n=48例有损耗）。目标1 -可行性： 确定干预的可行性和可接受性（即，损耗、反馈）。探索目标1 - 认知：将接受执行功能训练的成年人与没有接受训练的成年人进行比较， 确定他们是否改善了整体认知能力和整体认知能力。这项高影响力的研究是 本研究在以下方面具有创新性：1）这是第一项旨在降低PWH认知IIV的研究。2)这是 第一项研究使用IIV作为指导，以执行功能训练为目标，以提高整体认知能力， 这可能会降低手的严重程度和患病率。3)在过去的十年里，艾滋病毒的中心已经 出现在这项研究将要进行的南方腹地。这项研究的大多数参与者将是年长的威尔斯亲王医院， 被鉴定为较低SES和/或非裔美国人，并经历HAND症状。

PROJECT ABSTRACT People with HIV (PWH) suffer from cognitive impairments known as HIV-Associated Neurocognitive Disorder (HAND). Cognitive impairments in PWH are not fully captured by traditional neuropsychological assessment; instead, more nuanced evaluation requires examining performance within individuals across cognitive domains, called Intra-Individual Variation (IIV). IIV predicts cognitive impairment/decline, altered brain morphology, and neuropathology. Conceptually, IIV results from “executive dyscontrol” or the efficiency with which executive control processes coordinate other cognitive processes/domains. Supported by the Executive Dyscontrol Hypothesis and based on the underlying concept of IIV, cognitive function in PWH can be improved through interventions that strengthen executive functioning so that it can better coordinate the function of other cognitive domains. Computerized cognitive training, widely used in the gerontological literature and in the study team’s prior work, has been demonstrated to target improvement in selected cognitive domains including executive functioning. The current proposal is therefore significant and innovative with its focus on Executive Functioning and IIV in the context of cognitive training in PWH. This feasibility study will use a two-group pre- post experimental design of adults with HAND including: 1) a 20-hours of Executive Functioning Training group (enroll 60, n=48 with attrition), and 2) a no-contact control (enroll 60, n=48 with attrition). Aim 1 – Feasibility: To determine feasibility and acceptability of the intervention (i.e., attrition, feedback). Exploratory Aim 1 – Cognition: Compare adults who receive Executive Functioning Training to those who receive no training to determine whether they improve in global cognitive ability and overall cognitive IIV. This high impact study is innovative in the following ways: 1) This is the first study aimed to reduce cognitive IIV in PWH. 2) This is the first study to use IIV as a guide to target solely executive functioning training to improve global cognitive ability, which may reduce the severity and prevalence of HAND. 3) Over the last decade, the epicenter of HIV has emerged in the Deep South where this study will occur. Most participants in this study will be older PWH who identify as lower SES and/or African Americans and experience HAND symptoms.