Executive Function Training to Reduce Cognitive Intra-Individual Variability in Adults with HIV

项目摘要 艾滋病毒携带者(PWH)患有被称为艾滋病毒相关性神经认知障碍的认知障碍 (手)。传统的神经心理学评估不能完全反映PWH患者的认知障碍； 相反，更细致入微的评估需要检查个体在认知方面的表现 区域，称为个体内变异(IIV)。IIV预测认知障碍/下降，大脑改变 形态学和神经病理学。从概念上讲，IIV的结果是“执行失控”，或者是 哪些执行控制过程协调其他认知过程/领域。由执行人员提供支持 疾病控制假说和基于IIV的基本概念可以改善PWH的认知功能 通过加强执行功能的干预，使其能够更好地协调其他 认知域。计算机化认知训练，广泛应用于老年学文献和 研究小组之前的工作，已经被证明在选定的认知领域有针对性的改进，包括 执行功能。因此，当前的提案具有重大意义和创新性，其重点是执行 在威尔斯亲王医院的认知训练背景下的功能和IIV。这项可行性研究将使用两个小组的预 成人手功能后实验设计包括：1)20小时执行功能训练组 (登记60人，n=48人，有自然减员)；2)非接触对照(登记60人，n=48人，有自然减员)。目标1--可行性： 确定干预措施(即自然减员、反馈)的可行性和可接受性。探索性目标1- 认知：将接受过执行功能培训的成年人与没有接受培训的成年人进行比较 确定他们在整体认知能力和整体认知IIV方面是否有所改善。这项高影响力的研究是 在以下方面具有创新性：1)这是第一项旨在减少PWH患者认知IIV的研究。2)这是 第一项研究使用IIV作为指导，只针对执行功能训练，以提高全球认知能力， 这可能会降低手部疾病的严重程度和患病率。3)在过去的十年里，艾滋病毒的中心已经 出现在南方腹地，这项研究将在那里进行。这项研究的大多数参与者将是年长的威尔斯亲王 确定为较低SES和/或非裔美国人，并出现手部症状。

PROJECT ABSTRACT People with HIV (PWH) suffer from cognitive impairments known as HIV-Associated Neurocognitive Disorder (HAND). Cognitive impairments in PWH are not fully captured by traditional neuropsychological assessment; instead, more nuanced evaluation requires examining performance within individuals across cognitive domains, called Intra-Individual Variation (IIV). IIV predicts cognitive impairment/decline, altered brain morphology, and neuropathology. Conceptually, IIV results from “executive dyscontrol” or the efficiency with which executive control processes coordinate other cognitive processes/domains. Supported by the Executive Dyscontrol Hypothesis and based on the underlying concept of IIV, cognitive function in PWH can be improved through interventions that strengthen executive functioning so that it can better coordinate the function of other cognitive domains. Computerized cognitive training, widely used in the gerontological literature and in the study team’s prior work, has been demonstrated to target improvement in selected cognitive domains including executive functioning. The current proposal is therefore significant and innovative with its focus on Executive Functioning and IIV in the context of cognitive training in PWH. This feasibility study will use a two-group pre- post experimental design of adults with HAND including: 1) a 20-hours of Executive Functioning Training group (enroll 60, n=48 with attrition), and 2) a no-contact control (enroll 60, n=48 with attrition). Aim 1 – Feasibility: To determine feasibility and acceptability of the intervention (i.e., attrition, feedback). Exploratory Aim 1 – Cognition: Compare adults who receive Executive Functioning Training to those who receive no training to determine whether they improve in global cognitive ability and overall cognitive IIV. This high impact study is innovative in the following ways: 1) This is the first study aimed to reduce cognitive IIV in PWH. 2) This is the first study to use IIV as a guide to target solely executive functioning training to improve global cognitive ability, which may reduce the severity and prevalence of HAND. 3) Over the last decade, the epicenter of HIV has emerged in the Deep South where this study will occur. Most participants in this study will be older PWH who identify as lower SES and/or African Americans and experience HAND symptoms.