Using Ecological Momentary Assessment to Improve Self-Reported Cognitive Functioning among Adults with Comorbid HIV/AIDS and Heavy Alcohol Use

项目总结/摘要 艾滋病毒/艾滋病和大量饮酒是高度共病的，这种结合大大增加了 不良健康后果。共病HIV和大量饮酒的神经毒性作用优先影响 胼胝体和额叶白色物质，导致神经认知障碍的患病率增加 以运动技能、言语工作记忆、视觉空间技能和执行功能的缺陷为特征。 虽然严重程度通常是轻微的，但这些神经认知障碍随后会导致更大的风险， 日常生活活动的依赖，艾滋病毒疾病管理不善，艾滋病毒疾病加速 进展尽管在这一人群中神经认知障碍的严重后果， 普遍缺乏可靠和有效的工具来识别那些可能面临这些障碍风险的人。自我报告 认知功能的评估通常用于在许多情况下简要评估神经认知损害。 临床人群;然而，目前所有自我报告的认知测量的回顾性性质 由于回忆错误、社会期望效应、认知缺陷或状态，功能降低准确性 依赖偏倚例如，国际上推荐的欧洲艾滋病临床学会（EACS） 神经认知筛查问题是回顾性的，可以通过以下途径重复给药来改善： 生态瞬时评价（EMA）。EMA是一种创新的移动的评估方法， 生态有效性，并通过收集实时，真实世界的数据减少回顾性回忆错误。因此， 代表了一种潜在的强大技术，以改善自我报告的认知功能的测量， 检测高危临床人群（如饮酒的HIV感染者）的神经认知障碍风险 很重。因此，建议的F31论文项目旨在：1）评估心理测量特性的 EMA管理的EACS筛选问题; 2）检查EMA自我报告的 酒精使用，情绪和认知投诉;和3）检查人口统计学，HIV疾病的潜在影响 特征和日常活动的认知复杂性对自我报告的认知主诉的影响。鉴于 目前缺乏这种评估技术在这一人群中，从这项研究的结果将告知未来 开发新的移动的评估方法，以检测HIV和重型 饮酒通过F31机制提供的机会将大大有助于申请人的 长期目标是成为一名独立的学术神经心理学家，致力于早期发现 神经认知功能障碍与艾滋病毒感染和大量饮酒共病个体。

PROJECT SUMMARY/ABSTRACT HIV/AIDS and heavy alcohol use are highly comorbid, and the combination greatly increases the likelihood of adverse health outcomes. The neurotoxic effects of comorbid HIV and heavy alcohol use preferentially impact the corpus callosum and frontal white matter, leading to increased prevalence of neurocognitive disorders characterized by deficits in motor skills, verbal working memory, visuospatial skills, and executive functioning. Although often mild in severity, these neurocognitive impairments subsequently lead to greater risk for dependence in activities of daily living, poor HIV disease management, and accelerated HIV disease progression. Despite the significant consequences of neurocognitive impairment in this population, there is a general lack of reliable and valid tools to identify those who may be at risk for these impairments. Self-report assessments of cognitive functioning are often used to briefly assess for neurocognitive impairment in many clinical populations; however, the retrospective nature of all current measures of self-reported cognitive functioning reduces accuracy due to recall errors, social desirability effects, cognitive deficits, or state dependent bias. For example, the internationally recommended European AIDS Clinical Society (EACS) neurocognitive screening questions are retrospective and may be improved by repeated administration via ecological momentary assessment (EMA). EMA is an innovative mobile assessment method that increases ecological validity and reduces retrospective recall errors by collecting real-time, real-world data. EMA thus represents a potentially powerful technique to improve measurement of self-reported cognitive functioning and detect risk for neurocognitive impairment in high-risk clinical populations such as people with HIV who drink heavily. Accordingly, the proposed F31 dissertation project aims to: 1) evaluate psychometric properties of the EMA-administered EACS screening questions; 2) examine temporal relationships among EMA self-reported alcohol use, mood, and cognitive complaints; and 3) examine potential effects of demographics, HIV disease characteristics, and cognitive complexity of daily activities on self-reported cognitive complaints. Given the current absence of such assessment techniques in this population, results from this study will inform future development of novel mobile assessment methods to detect neurocognitive impairment in HIV and heavy alcohol use. The opportunities afforded via this F31 mechanism will significantly contribute to the applicant’s long-term goal of becoming an independent academic neuropsychologist dedicated to early detection of neurocognitive impairment among individuals with comorbid HIV infection and heavy alcohol use.