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、艾滋病毒感染者数量世界上最多的国家， 数十万感染围产期艾滋病毒 (PHIV) 的青少年正迅速成为感染者 青少年和年轻人。感染 PHIV 的青少年必须应对终生病毒的负面影响 感染和慢性炎症对其神经发育、医疗状况、心理健康以及对许多人来说 终生坚持 ART 的要求——使他们面临无法实现这些重要里程碑的风险。 神经认知障碍（NCI）是这些负面影响中最主要的。感染 PHIV 的青少年中 NCI 最多 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皮质相关的 NCI 影响，前额皮质在认知灵活性中发挥着关键作用， 反应抑制和注意力控制（即执行功能）。 NCI 可以影响青少年的表现能力 完成学业，与同龄人和成年人成功互动，找到工作，启动并维持长期 术语关系，并独立运作。 NCI 还会干扰药物依从性，即 对艾滋病毒至关重要，并增加糟糕的决策和更大的艾滋病毒传播风险行为（例如，无保护的行为） 性别）。解决 NCI 青少年感染 PHIV 问题的第一步是检测和诊断，但在南方这样做 非洲受到严重阻碍。对于数十万感染艾滋病毒的青少年来说，几乎没有进行任何神经认知测试。 SA。确实存在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 管理，缺乏预测现实世界结果的生态有效性，并且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并规范的。鉴于南澳医疗保健负担过重 该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 (LHW)，而无需 准确、临床有用且相对简短的神经认知测试，可以检测 NCI 并满足以下需求： 在资源有限的环境中进行任务转移，南澳感染艾滋病毒的青少年将不会接受评估，从而错失机会 检测 NCI 并进行干预。本增刊将开发并添加两项新的执行功能测试 NeuroScreen 应用程序正在母研究（R01 HD095256；PI：Robbins）中进行评估，并将 加强我们发现南澳州感染艾滋病病毒的青少年执行功能问题的能力——关键的神经认知 感染艾滋病毒的青少年可能特别容易受到影响的领域，并且与学术、 行为和健康结果。