Neurobehavioral and Functional Consequences of HIV in African Americans

描述(由申请人提供)：这项研究提案旨在提高对非裔美国人“现实生活”功能结果(例如，药物管理)中与艾滋病毒相关的神经认知障碍的理解。这个K23应用程序的目标是开发一个模型，用于使用神经成像、神经认知评估和基于实验室的功能评估方法预测功能结果，同时控制潜在的混杂社会文化因素(例如，教育经历)。下面的研究方案首先确定了解释非裔美国人和高加索人之间神经认知表现差异的社会文化因素。接下来，我们将使用结构神经成像作为大脑组织的客观标志，在潜在解释变量中建模的同时，检查两个民族的神经认知评估和神经成像之间的关系。预计白种人的神经认知表现和神经成像之间的关系将很强，但非裔美国人的关系相对较弱(因为这一群体最常受到不利社会条件的影响)。我们预计，考虑潜在混杂变量的模型将提高神经认知测试的有效性，以衡量非裔美国人的大脑功能和功能结果。应聘者具有临床神经心理学背景，并从该奖项寻求两个主要培训目标：1)学习结构神经成像技术，2)成为神经艾滋病方面的专家，重点是少数民族人群。应聘者在加州大学洛杉矶分校认知神经科学中心和塞梅尔研究所的工作环境为神经成像和神经艾滋病的培训提供了极好的基础设施。这些实验室有几项资助的、正在进行的研究，与大脑测绘中心和分子神经成像实验室(LONI)有很强的联系。作为培训的一部分，候选人将参加基础神经成像主题(编程、统计、图像获取、神经解剖学)和更高级神经成像主题(例如DTI解释)的课程和研讨会，以及艾滋病毒感染的生物和神经心理学后遗症课程。跨文化心理学培训将通过心理学系内的多样性科学司提供的课程作业、与文化、创伤和心理健康中心的每周会议和文化神经心理学倡议，以及与Hector Myers博士的每周会议来获得。她还将出席艾滋病毒(例如，国际神经病毒学学会)和神经成像(例如，人脑成像)的年度会议，并定期与导师会面。候选人计划在获奖期结束时申请R01奖助金。从长远来看，她计划在健康差异方面建立一个独立的研究生涯，专注于大脑-行为关系、文化神经心理学和“现实世界”功能结果。 公共卫生相关性：神经认知评估通常用于做出诊断决定和对功能能力的推断；然而，人们对用于非裔美国人的神经认知测试的有效性提出了担忧。利用结构神经成像作为“黄金标准”，目前的项目寻求通过检查影响神经认知测试成绩的社会文化变量(例如，教育质量)来改善对非裔美国人中与艾滋病毒感染相关的认知和功能缺陷的评估。提高非裔美国人神经认知评估的准确性将降低患者被误诊为认知障碍的可能性。

DESCRIPTION (provided by applicant): This research proposal seeks to improve the understanding of HIV-associated neurocognitive impairment on "real-life" functional outcomes in African Americans (e.g., managing medications). The objective of this K23 application is to develop a model for predicting functional outcomes using methods of neuroimaging, neurocognitive assessment, and laboratory-based functional assessments, while controlling for potentially confounding sociocultural factors (e.g., educational experience). The following research proposal begins by first identifying sociocultural factors that explain differences in neurocognitive performance between African Americans and Caucasians. Next, we will use structural neuroimaging as an objective marker of brain organization to examine relationships between neurocognitive assessment and neuroimaging in both ethnic groups while modeling in potential explanatory variables. It is expected that the relationship between neurocognitive performance and neuroimaging will be strong for Caucasians, but relatively weak for African Americans (as this group is most often affected by disadvantaged social conditions). We expect that a model that factors in potential confounding variables will increase the validity of neurocognitive testing for measuring brain function and functional outcomes among African Americans. The candidate has a background in clinical neuropsychology and seeks two primary training goals from this award: 1) learn structural neuroimaging techniques, and 2) become an expert in NeuroAIDS, within emphasis on ethnic minority populations. The candidate's work environment at the UCLA Center for Cognitive Neuroscience and Semel Institute provides an excellent infrastructure for training in neuroimaging and NeuroAIDS. These labs have several funded, ongoing studies with strong ties to the Brain Mapping Center and the Laboratory of Molecular Neuroimaging (LONI). As part of this training, the candidate will attend courses and workshops in foundational neuroimaging topics (programming, statistics, image acquisition, neuroanatomy) and more advanced neuroimaging topics (e.g., DTI interpretation), as well as courses in the biological and neuropsychological sequelae of HIV infection. Training in cross-cultural psychology will be obtained through coursework offered through the Diversity Science Division within the Department of Psychology, weekly meetings with the Center for Culture, Trauma, and Mental Health and the Cultural Neuropsychology Initiative, in addition to weekly meetings with Dr. Hector Myers. She will also attend annual conferences in HIV (e.g., International Society of Neurovirology) and neuroimaging (e.g., Human Brain Mapping), and meet with mentors regularly. The candidate plans to apply for a R01 grant toward the end of the award period. Long term, she plans to establish an independent research career in health disparities focusing on brain-behavior relationships, cultural neuropsychology, and "real-world" functional outcomes. PUBLIC HEALTH RELEVANCE: Neurocognitive assessment is commonly used to make diagnostic decisions and inferences about functional capacity; however, concerns have been raised about the validity of neurocognitive testing for use with African Americans. Using structural neuroimaging as the "gold standard," the current project seeks to improve the assessment of cognitive and functional deficits associated with HIV infection among African Americans through examination of sociocultural variables (e.g., quality of education) that influence neurocognitive test performance. Improving the accuracy of neurocognitive assessment for use with African Americans will reduce the likelihood that patients are misdiagnosed with cognitive impairment.