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

南非(SA)，一个资源有限的国家，拥有世界上最大的艾滋病毒携带者人口， 数十万患有围产期获得性艾滋病毒(PHIV)的青年正在迅速成为 青少年和青壮年。携带艾滋病毒的青少年必须与终身病毒的负面影响作斗争 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， 终身坚持艺术的要求--使他们面临无法实现这些重要里程碑的风险。 在这些负面影响中，神经认知障碍(NCI)是最主要的。HIV感染者最多的青少年NCI 通常影响工作记忆、执行功能和处理速度的神经认知领域，以及 可能特别容易受到与前额叶皮质相关的NCI的影响，前额叶皮质在认知灵活性中发挥着关键作用， 反应抑制和注意控制(即执行功能)。NCI会影响年轻人的表现能力 完成学业，成功地与同龄人和成年人互动，找到工作，发起并维持长期的 术语关系，并独立发挥作用。NCI还会干扰坚持服药，这是 对艾滋病毒来说至关重要，并增加了糟糕的决策和更大的艾滋病毒传播风险行为(例如，无保护措施 性)。解决患有PHIV的NCI青少年的第一步是检测和诊断它，但在南方这样做 非洲正受到严重阻碍。在中国，对数十万感染艾滋病毒的青年进行的神经认知测试很少 莎拉。现有的考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 管理，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，因为 它们是为美国或欧洲的年轻人开发的，并以此为标准。鉴于SA医疗保健负担过重 系统及其对任务的依赖-将护理的各个组成部分转移到业馀卫生工作者(LHW)，而不是 准确的、临床上有用的、相对简单的神经认知测试，可以检测出NCI并满足 任务转移在资源有限的情况下，SA的艾滋病毒携带者青少年将不会得到评估，错过机会 检测NCI并进行干预。本附录将开发和增加两个新的执行功能测试 正在家长研究中进行评估的NeuroScreen应用程序(R01 HD095256；PI：Robbins)，并将 加强我们在SA关键神经认知中检测患有PHIV的青少年执行功能问题的能力 在感染艾滋病毒的青少年中可能特别脆弱并与学业高度相关的领域， 行为和健康后果。

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.