Individualized-Targeted Cognitive Training in Older Adults with HAND

摘要 超过50%的艾滋病毒携带者患有某种形式的艾滋病毒相关神经认知障碍(手)，这种疾病 代表一种严重的症状，干扰日常功能和生活质量。随着成年人年龄的增长 携带艾滋病毒，他们更有可能患上心血管疾病、高血压和 胰岛素抵抗，这将进一步导致认知功能和手部功能较差。基于 Frascati标准，当一个人的得分低于正常均值1到2个标准差时，就被诊断为手部 (教育和年龄)关于两个或更多认知域的测量(例如，注意力、处理速度、言语 记忆、执行功能)。然而，从认知文献和我们之前的研究来看，我们知道我们可以 管理某些计算机化的认知训练计划，以改善老年人的特定认知领域 成年人和艾滋病毒携带者。这样的认知训练计划可能对感染艾滋病毒的老年人和 因此，我们也许能够改变对这些认知脆弱的成年人手部的诊断。在这个预案中- 在实验研究后，146名有手的老年人(50+)将被随机分为以下两组：1) 个体化-针对性认知训练，或2)非接触性对照组。我们将重点关注这些认知 参与者表达损伤的领域，并对他们进行相应的认知训练。 这种使用标准认知训练计划的个性化目标认知训练方法可以 为那些用手诊断的人提供希望和症状缓解。此外，我们断言，这些 改变将导致改善日常功能(例如，IADL)和生活质量。这种方法代表了 一种可能改变我们看待手的方式的范式转变。具体目标1：比较这样做的成年人 对那些没有接受个体化的有针对性的认知培训，以确定是否有变化 在手中，患病率和严重程度发生在不同的组之间。探索性目标1：比较确实收到 对那些没有这样做的人进行个性化的有针对性的认知培训，以确定这是否有所改善 日常运作(例如，IADL)。探索性目标2：确定手部和/或手部的改进 随着时间的推移，每天的功能都会促进生活质量的提高。

ABSTRACT Over 50% of adults with HIV have some form of HIV-Associated Neurocognitive Disorder (HAND) which represents a significant symptom that interferes with everyday functioning and quality of life. As adults age with HIV, they are more likely to develop comorbidities such as cardiovascular disease, hypertension, and insulin resistance which will further contribute to poorer cognitive functioning and HAND. Based upon the Frascati criteria, HAND is diagnosed when a person performs less than 1 to 2 SD below their normative mean (education & age) on measures of two or more cognitive domains (e.g., attention, speed of processing, verbal memory, executive functioning). Yet, from the cognitive literature and our prior studies, we know we can administer certain computerized cognitive training programs to improve specific cognitive domains in older adults and those with HIV. Such cognitive training programs may be effective in older adults with HIV and therefore we may be able to change the diagnosis of HAND in such cognitively vulnerable adults. In this pre- post experimental study, 146 older adults (50+) with HAND will be randomized to be in either: 1) the Individualized-Targeted Cognitive Training, or 2) a no-contact control group. We will focus on those cognitive domains in which participants express an impairment and train them with the corresponding cognitive program. Such an Individualized-Targeted Cognitive Training approach using standard cognitive training programs may offer hope and symptom relief to those individuals diagnosed with HAND. Furthermore, we assert that these changes will result in improved everyday functioning (e.g., IADLs) and quality of life. This approach represents a paradigm shift in possibly changing the way we look at HAND. Specific Aim 1: Compare adults who do receive Individualized-Targeted Cognitive Training to those who do not in order to determine whether a change in HAND prevalence and severity occurs between groups. Exploratory Aim 1: Compare adults who do receive individualized-targeted cognitive training to those who do not in order to determine whether this improves everyday functioning (e.g., IADLs). Exploratory Aim 2: Determine whether improvements in HAND and/or everyday functioning over time mediate improvements in quality of life.