Neuropsychological Benefits of Cognitive Training in Ugandan HIV Children

描述（由申请人提供）：研究主题：超过110，000名HIV乌干达儿童因CNS HIV感染的进行性脑病而有神经认知障碍的风险。即使临床稳定，这些儿童也可能有运动，注意力，记忆，视觉空间处理和其他执行功能障碍。乌干达卡永加区150名感染艾滋病毒的学龄儿童将参加我们的活动。其中50名儿童将被随机选择接受24个计算机认知康复治疗（CCRT）项目的培训，该项目名为“船长日志”，主要针对有注意力或学习问题的美国儿童。将对第二个“主动控制”组使用不以渐进方式指导儿童训练的锁定版本的船长日志;而第三组将是不接受任何计算机训练干预的被动控制组。研究目的1：比较8周内和3个月随访时24次Captain's Log CCRT训练与主动和被动对照组的神经心理学获益。研究目的2：比较8周内和3个月随访时，主动和被动对照组与Captain's Log CCRT的24次培训课程的精神益处。研究目的3：评估HIV亚型、ART治疗状态和儿童相应的临床稳定性如何改变CCRT神经心理学表现的改善和精神症状的减轻。结局评估：在8周培训期前后和3个月随访时，将进行儿童考夫曼成套评估（第2版）（KABC-2）、注意力变量测试（TOVA）视觉和听觉测试、CogState计算机神经心理学筛查测试、Bruininks-Oseretsky运动能力测试（BOT-2）和Achenbach儿童行为量表（CBCL）。我们以前曾对乌干达艾滋病毒感染儿童使用过所有这些评估，以有效评估神经心理和精神问题。船长的日志有一个内部评估功能，这将有助于我们监测具体的训练任务，孩子们最好的反应。根据我们之前对卡永加艾滋病毒感染儿童的研究，我们预计在研究入组时，约40%的样本将接受抗逆转录病毒治疗，约20%将为D亚型，60%将为A亚型。我们还观察到，艾滋病毒A亚型的儿童患神经认知障碍的风险更大。分析：我们将比较我们三个研究组在8周训练期间和3个月随访时的神经心理学和精神病学增益，预计CCRT干预儿童的增益将显著更大（研究目的1和2）。这些神经心理学的收获将与长期改善的学校表现有关。接受抗逆转录病毒治疗的干预儿童比未接受抗逆转录病毒治疗的儿童获益更大，D亚型艾滋病毒儿童的病毒载量更低，淋巴细胞活化水平更高，因此CCRT获益更大（研究目标3）。结论：CCRT将被证明是有效和可持续的增强艾滋病病毒儿童ART的神经认知益处。它将被证明是评估和治疗资源匮乏环境中的儿童的可行方法。 公共卫生相关性：除了儿童艾滋病毒感染对神经发育的直接影响外，考虑到艾滋病毒疾病如何进一步损害家庭环境质量和已经贫困的儿童的教育机会，全球数千万艾滋病毒儿童和孤儿的公共卫生负担是巨大的。如果计算机化认知训练被证明对增强艾滋病毒儿童的神经心理功能和精神健康是切实有效的，那么这将支持联合国千年发展目标的第二个目标，即确保所有儿童都有最好的机会完成小学教育。计算机化的认知培训和评估还可以在整个发展中世界资源贫乏的环境中采取成本效益高的干预措施，因为在这些环境中没有受过训练的专业人员提供特殊教育或医疗康复护理。

DESCRIPTION (provided by applicant): Research Topic: Over 110,000 HIV Ugandan children are at risk for neurocognitive disorders due to the progressive encephalopathy of CNS HIV infection. Even if clinically stable, these children can have motor, attention, memory, visual-spatial processing, and other executive function impairment. One-hundred and fifty school-age children with HIV in Kayunga District, Uganda, will serve as our participants. Fifty of these children will be randomly selected to receive 24 training sessions of a computerized cognitive rehabilitation therapy (CCRT) program called Captain's Log, marketed mostly for American children with attention or learning problems. A locked version of Captain's Log which does not direct the child's training in a progressive manner will be administered to a second "active control" group; while a third group will be a passive control group not receiving any computer training intervention. Study Aim 1: To compare the neuropsychological benefit of 24 training sessions of Captain's Log CCRT to the active and passive control groups over a 8-week period, and at 3-month follow-up. Study Aim 2: To compare the psychiatric benefit of 24 training sessions of Captain's Log CCRT to the active and passive control groups over an 8-week period, and at 3-month follow-up. Study Aim 3: To evaluate how HIV subtype, ART treatment status, and the corresponding clinical stability of the child modifies CCRT neuropsychological performance gains and psychiatric symptom reduction. Outcome Assessments: The Kaufman Assessment Battery for Children, 2nd ed. (KABC-2), Tests of Variables of Attention (TOVA) visual and auditory tests, CogState computerized neuropsychological screening test, Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and Achenbach Child Behavior Checklist (CBCL) will be administered before and after the 8-week training period and at 3-month follow-up. We have previously used all these assessments with Ugandan children with HIV to effectively evaluate neuropsychological and psychiatric problems. Captain's Log has an internal evaluator feature which will help us monitor the specific training tasks to which the children best respond. Based on our prior research with Kayunga children with HIV, we anticipate that about 40% of our sample will be on ART at study enrollment, and about 20% will be Subtype D while 60% will be subtype A. We also observed that children with HIV Subtype A are at greater risk for neurocognitive deficits. Analyses: We will compare neuropsychological and psychiatric gains over the 8-week training period and at 3-mo follow-up for our three study groups, anticipating that they will be significantly greater for the CCRT intervention children (Study Aims 1 & 2). These neuropsychological gains will be associated with improved school performance over the long-term. Intervention children on ART will have greater gains than those not on ART, and HIV subtype D children will have lower viral loads and higher lymphocyte activation levels, resulting in greater gains from CCRT (Study Aim 3). Conclusion: CCRT will prove effective and sustainable in potentiating the neurocognitive benefit of ART in HIV children. It will prove viable for assessing and treating children in resource-poor settings. PUBLIC HEALTH RELEVANCE: Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV children and orphans globally is monumental when considering how it further compromises quality of home environment and educational opportunity for children already impoverished. If computerized cognitive training proves practical and effective for enhancing neuropsychological function and psychiatric well-being in HIV children, then this would support the second of the UN Millennium Development Goals, which is to ensure that all children have the best opportunity to complete primary schooling. Computerized cognitive training and assessment might also allow for cost/effective interventions in resource poor settings throughout the developing world where special education or medical rehabilitative care by trained professionals are not available.