Building Resources to Assess Impaired Neurocognition for Care and Research among Adults Aging with HIV (BRAIN Care HIV)

建立资源来评估神经认知受损，以促进老年艾滋病毒感染者的护理和研究（BRAIN Care HIV）

• 批准号: 10756384
• 负责人: Reuben N Robbins
• 金额: $ 22.97万
• 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: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10756384
• 关键词: Adolescent; Adult; Affect; Age; Aging; Behavioral; Big Data; Brain; Caring; Chronic; Clinical; Clinical Research; Computer Literacy; Country; Data; Data Set; Decision Making; Detection; Development; Disease; Elderly; Evaluation; Face; General Population; HIV; HIV Infections; HIV-associated neurocognitive disorder; Human immunodeficiency virus test; Immune response; Impairment; Income; Inflammation; Inflammatory; Institution; Interdisciplinary Study; Internet; Intervention; Knowledge; Language; Machine Learning; Malaysia; Malaysian; Measures; Medical; Multilingualism; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychology; Participant; Pathogenesis; Patients; Persons; Phenotype; Population; Prevalence; Prevention; Provider; Psychometrics; Psychosocial Stress; Research; Research Project Grants; Resources; Risk; Risk Factors; Socioeconomic Factors; South Africa; Statistical Data Interpretation; Tablets; Techniques; Testing; Thailand; Time; Translations; Visit; clinical care; cohort; comorbidity; cost; dementia risk; design; epidemiology study; ethnic diversity; experience; instrument; longitudinal dataset; low and middle-income countries; medication compliance; meetings; mortality; multimodal data; multimodality; neuroAIDS; neurocognitive test; research in practice; sociodemographics; socioeconomics; timeline; tool; usability

Neurocognitive impairment (NCI) is highly prevalent in older (≥50 years) people with HIV (PWH). Older PWH have higher rates of NCI than the general population of the same age; prevalence rates are as high as 50% – even among the virologically controlled. Having NCI is associated with increased mortality, decline in independence, lower medication adherence, poor decision making, and possibly greater dementia risk. The pathogenesis of NCI in HIV is likely multifactorial due to extensive diversity of PWH and factors that affect the brain (e.g., HIV, demographic, socioeconomic, chronic inflammation, comorbidities, and psychosocial stress). This knowledge, however, comes mostly from high-income countries (HICs). Yet, the burden of HIV is greatest in low- and middle- income countries (LMICs) where our understanding of NCI (e.g., prevalence; risk; patient/provider needs) in aging PWH is only just emerging and risk may differ than in HICs. Multimodal phenotypes of NCI risk can help elucidate NCI’s mechanisms and assist in developing more targeted interventions for it. Critical aspects of HIV disease differ between HICs and LMICs (e.g., immune responses, age of patients, duration of HIV infection, type of treatment, and socio-economic factors), but most phenotyping studies have been done with PWH in HICs. We propose to leverage multimodal data (e.g., demographic, medical, inflammation) from a cohort of diverse, aging, and treated PWH in Malaysia from two time points across 4-6 years and add one more time point to develop longitudinal phenotypes of NCI risk – a first for PWH in Malaysia. A pre-requisite, however, is high quality, accurate, unbiased, and valid neurocognitive test data that can be easily collected in any setting and is suitable for cross-study/-country comparisons and Big Data applications. Because few tests meeting these requirements exist in Malaysia, we propose to adapt and preliminarily norm a battery of tests (NeuroScreen) that do. NeuroScreen is brief (~25 minutes), highly automated, easy-to-administer by all levels of staff, disseminated via the internet, designed for adaptation across countries/languages and in harmonized cross-study data sets. It assesses six neurocognitive domains most affected by HIV, and has a growing body of evidence demonstrating that it is unbiased, culturally fair, and psychometrically valid in adolescent and adult populations with HIV and varying levels of computer literacy in multiple countries and languages (US, South Africa, and neighboring Thailand). No testing apps have been adapted and normed for ethnically diverse Malaysians, where the most commonly spoken languages are Bahasa Malaysia, Mandarin, Tamil, and English. Using NeuroScreen’s data will enhance our phenotyping. Moreover, having an easy-to-use and valid tool to measure neurocognition and screen for NCI can enhance research and clinical care for PWH in Malaysia. We will build neuropsychological expertise in Malaysia (where there is little); promote multidisciplinary research into the causes, risks, and detection of NCI in HIV; and expand capacity to use state-of-the-art statistical analyses (i.e., machine learning).

神经认知障碍 (NCI) 在老年（≥50 岁）艾滋病毒感染者 (PWH) 中非常普遍。年长的 PWH 有 NCI 发生率高于同龄一般人群；患病率高达 50%——甚至 属于病毒学控制范围内。患有 NCI 与死亡率增加、独立性下降、 药物依从性较低，决策不佳，并且可能存在较高的痴呆风险。 NCI的发病机制 由于艾滋病毒感染者和影响大脑的因素（例如艾滋病毒、 人口、社会经济、慢性炎症、合并症和社会心理压力）。这些知识， 然而，大部分来自高收入国家（HIC）。然而，艾滋病毒负担在低收入和中收入人群中最为严重。 我们对老龄化中的 NCI（例如患病率、风险、患者/提供者需求）的了解的收入国家 (LMIC) 艾滋病毒/艾滋病患者刚刚兴起，风险可能与高收入国家不同。 NCI 风险的多模式表型有助于阐明 NCI 的机制并协助制定更有针对性的干预措施。 HIV 疾病的关键方面有所不同 HIC 和 LMIC 之间的差异（例如免疫反应、患者年龄、HIV 感染持续时间、治疗类型、 和社会经济因素），但大多数表型研究都是针对高收入国家的感染者进行的。我们建议 利用来自多样化、老龄化和接受治疗的队列的多模式数据（例如人口统计、医疗、炎症） 马来西亚的 PWH 从 4-6 年的两个时间点开始，并增加一个时间点来制定纵向 NCI 风险的表型——这是马来西亚 PWH 的首次研究。然而，先决条件是高质量、准确、公正、 以及有效的神经认知测试数据，可以在任何环境下轻松收集，适合跨国家/地区研究 比较和大数据应用。由于马来西亚很少有符合这些要求的测试，我们 建议调整并初步规范一系列测试（NeuroScreen）。 NeuroScreen 很简短（~25 分钟），高度自动化，易于各级员工管理，通过互联网传播，专为 跨国家/语言和统一的交叉研究数据集的适应。它评估六种神经认知 受艾滋病毒影响最严重的领域，并且有越来越多的证据表明它是公正的、文化上的 对于感染艾滋病毒和不同计算机水平的青少年和成人群体来说，公平且在心理测量上有效 多种国家和语言的读写能力（美国、南非和邻国泰国）。没有测试应用程序有 针对不同种族的马来西亚人进行了调整和规范，其中最常用的语言是 马来语、华语、淡米尔语和英语。使用 NeuroScreen 的数据将增强我们的表型分析。 此外，拥有一个易于使用且有效的工具来测量神经认知和筛查 NCI 可以增强 马来西亚 PWH 的研究和临床护理。我们将在马来西亚建立神经心理学专业知识（其中 很少）；促进对 HIV 中 NCI 的原因、风险和检测的多学科研究；并扩展 使用最先进的统计分析（即机器学习）的能力。