Improving Assessment for Neurocognitive Impairment Among Older Adults with Alzheimer's Disease and Related Dementias

改进对患有阿尔茨海默病和相关痴呆症的老年人的神经认知损伤的评估

• 批准号: 10094688
• 负责人: Reuben N Robbins
• 金额: $ 35.36万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-17 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10094688
• 关键词: 15 year old; Academic Medical Centers; Academic achievement; Address; Adherence; Administrative Supplement; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Alzheimer' s disease related dementia; Behavior; Behavioral; Biological; Brain; Brain imaging; CD4 Positive T Lymphocytes; Caring; Cells; Child; Chronic; Clinical; Cognitive; Collaborations; Collection; Computer software; Congenital neurologic anomalies; Decision Making; Development; Diagnosis; Elderly; Employment; Europe; Evaluation; Exposure to; Gold; HIV; HIV Encephalopathy; Health; Health behavior; Healthcare Systems; Hour; Human Resources; Immune; Impairment; Infection; Inflammation; Institutes; Instruction; Language; Letters; Life; Link; Medical; Mental Health; Mentors; Neuraxis; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; New York; Outcome; Paper; Parents; Performance; Perinatal; Pharmaceutical Preparations; Play; Population; Postdoctoral Fellow; Prefrontal Cortex; Psychometrics; Psychosocial Assessment and Care; Puberty; Research; Research Infrastructure; Research Personnel; Resources; Risk; Risk Behaviors; Risk-Taking; Schools; Science; Short-Term Memory; South Africa; South African; Tablet Computer; Tablets; Testing; Training; Translating; Unsafe Sex; Viral Load result; Viral reservoir; Virus Diseases; Youth; attentional control; base; behavioral health; biobehavior; computerized; design; executive function; flexibility; imaging study; improved; low and middle-income countries; mHealth; macrophage; medication compliance; neurocognitive test; neurodevelopment; neuroimaging; peer; performance tests; processing speed; response; stressor; touchscreen; transmission process

South Africa (SA), a resource limited setting with the world’s largest population of people living with HIV, has hundreds of thousands of youth living with perinatally acquired HIV (PHIV) who are rapidly becoming adolescents and young adults. Adolescents with PHIV must contend with the negative effects of life-long viral infection and chronic inflammation on their neurodevelopment, medical status, mental health, and, for many, the demands of lifelong ART adherence – placing them at risk for not achieving these important milestones. Neurocognitive impairment (NCI) is chief among these negative effects. NCI in adolescents with PHIV most commonly affects the neurocognitive domains of working memory, executive function and processing speed, and may be particularly vulnerable to NCI related to the prefrontal cortex, which plays a key role in cognitive flexibility, response inhibition and attentional control (i.e., executive functioning). NCI can affect youth’s ability to perform in and complete school, interact successfully with peers and adults, find employment, initiate and maintain long- term relationships, and function independently. NCI can also interfere with adherence to medication, which is critical in HIV, and increase poor decision-making and greater HIV transmission risk behaviors (e.g., unprotected sex). The first step in addressing NCI adolescents with PHIV is detecting and diagnosing it, but doing so in South Africa is seriously hampered. Few neurocognitive tests exist for the hundreds of thousands of youth with PHIV in SA. The tests that do exist require highly trained personnel to administer and score, take several hours to administer, lack ecological validity to predict real-world outcomes, and many suffer from cultural biases because they were developed for and normed on youth in the US or Europe. Given how overburdened the SA healthcare system is and its reliance on task-shifting various components of care to lay health workers (LHWs), without accurate, clinically useful, and relatively brief neurocognitive tests that can detect NCI and meet the demands of task-shifting in resource-limited settings, adolescents with PHIV in SA will not be assessed, missing opportunities to detect NCI and intervene. This supplement will develop and add two new tests of executive functioning to the NeuroScreen app that is being evaluated in the parent study (R01 HD095256; PI: Robbins), and will strengthen our ability to detect executive functioning problems in youth with PHIV in SA – key neurocognitive domains that may be particularly vulnerable in adolescents with PHIV and are highly related to academic, behavioral and health outcomes.

南非（SA）是一个资源有限的环境，拥有世界上最多的艾滋病毒感染者， 数十万患有围产期获得性艾滋病毒（PHIV）的年轻人正在迅速成为 青少年和年轻人。患有PHIV的青少年必须与终身病毒感染的负面影响作斗争 感染和慢性炎症对他们的神经发育，医疗状况，心理健康，以及对许多人来说， 终身坚持抗逆转录病毒治疗的要求-使他们面临无法实现这些重要里程碑的风险。 神经认知功能障碍（NCI）是这些负面影响中最主要的。NCI在PHIV感染青少年中最常见 通常影响工作记忆、执行功能和处理速度等神经认知领域， 可能特别容易受到与前额叶皮层相关的NCI的影响，前额叶皮层在认知灵活性中起着关键作用， 反应抑制和注意力控制（即，执行功能）。NCI可以影响青年的能力， 完成学业，成功地与同龄人和成年人互动，找到工作，开始并保持长期的- 术语关系，并独立运行。NCI也会干扰药物的依从性， 艾滋病毒的关键，并增加不良决策和更大的艾滋病毒传播风险行为（例如，无保护 性别）。解决NCI青少年PHIV感染问题的第一步是检测和诊断，但在南 非洲受到严重阻碍。在美国，对成千上万的PHIV感染者进行的神经认知测试很少。 SA.现有的测试需要训练有素的人员来管理和评分，需要几个小时才能完成。 缺乏生态有效性来预测现实世界的结果，许多人遭受文化偏见， 它们是为美国或欧洲的年轻人开发和规范的。鉴于南加州的医疗负担过重 系统及其依赖于将护理的各个组成部分的任务转移给非专业卫生工作者， 准确，临床有用，相对简短的神经认知测试，可以检测NCI，并满足 在资源有限的环境中进行任务转移，将不会对SA中的PHIV青少年进行评估，错失机会 检测NCI并进行干预这一补充将发展和增加两个新的测试执行功能的 在母研究（R 01 HD 095256; PI：Robbins）中评价的NeuroScreen应用程序，将 加强我们在SA中检测PHIV青年执行功能问题的能力-关键神经认知 这些领域可能在患有PHIV的青少年中特别脆弱，并且与学术， 行为和健康结果。