David Vance - US grants

[unreadable] DESCRIPTION (provided by applicant): Highly Active Antiretroviral Therapy (HAART) has decreased HIV-related mortality, helping people aging with this disease. According to the Centers for Disease Control and Prevention, the number of adults with HIV/AIDS 50 years and older rose from 65,655 cases in 2001 to 104,260 cases in 2004, and this number is expected to increase along with the aging of the population in general. Given the synergistic effects of HIV and aging on cognition, the long term effects of having HIV may produce cognitive declines that impact everyday functioning and quality of life, resulting in poorer mental health and decreased autonomy. This research program consists of a cross-sectional study designed to determine how age and disease duration (chronicity) impact cognition and everyday function in this growing population. Specific aims include (1) examining differences in cognition between older and younger adults with and without HIV, (2) examining how impairments in speed of processing relate to everyday function, and (3) examining how disease chronicity and aging influence cognition and everyday function. These aims will be achieved by comparing the performance of 120 older and younger adults with and without HIV on a number of tests that measure functioning in different cognitive domains (e.g., memory, speed of processing) and everyday functioning (e.g., IADLs). Specifically, this study targets speed of processing given its implications as a cognitive resource for other cognitive abilities (e.g., diminished speed of processing theory) and its relationship to everyday functioning. This study will generate data necessary to design a clinical cognitive intervention. Such cognitive interventions may improve cognitive health, everyday functioning, vitality, and quality of life in adults aging with HIV. Many cognitive interventions, including speed of processing training (a cognitive remediation therapy), have already been developed and tested at the University of Alabama at Birmingham's Edward R. Roybal Center for Translational Research in Aging and Mobility for use in community-dwelling older adults who do not have HIV. Speed of processing training has been found to improve cognitive performance in this domain, as well as performance on laboratory measures of everyday functioning. If such speed of processing deficits are observed in adults with HIV compared to those younger with HIV or those older without HIV, speed of processing training may be warranted and efficacious in adults aging with HIV. [unreadable] [unreadable] PUBLIC HEALTH RELEVANCE Highly Active Antiretroviral Therapy (HAART) is facilitating aging with HIV, extending the duration in which neurons are being exposed to HIV. Yet, the interaction of age and HIV on cognition such as speed of processing and everyday functioning needs to be examined to determine what pitfalls may occur. This application proposes to examine this phenomenon and provides a possible intervention should speed of processing detrimentally impacts everyday functioning in this emerging population. [unreadable] [unreadable] [unreadable]

? DESCRIPTION (provided by applicant): As people age with HIV, the synergistic effects with normal age-related cognitive declines will accentuate and/or accelerate declines in cognitive functioning which can be detected as early as in one's 40s. Although interventions are needed to protect/improve cognitive functioning, one intervention already exists to improve speed of processing. NINR/NIA (January 14, 2014) announced that Speed of Processing Training used in the ACTIVE Study (N = 2,802 community-dwelling older adults) has the ability to enable older people to maintain their cognitive abilities as they age even 10 years after training. As shown in the ACTIVE Study, this intervention uniquely improves driving, instrumental activities of daily living (IADL), health-related quality of life, self-rated health, internal locus of control, and protects one from depression; these represent areas of needed intervention for adults with HIV as well. In adults with HIV, our pilot studies likewise indicate speed of processing declines are associated with poorer driving simulator performance and more self-reported at-fault automobile crashes; such speed of processing declines on driving alone represent a significant public health concern. We also demonstrated that Speed of Processing Training improved this cognitive ability and translated into improved performance on a timed measure of IADLs. Based on our prior research, this RCT proposal consists of a pre-post two-year longitudinal experimental design whereby 264 adults with HIV, 40+ years and diagnosed with HIV-Associated Neurocognitive Disorder, will be randomly assigned to one of three training conditions: 1) 10 hours of laboratory-based Speed of Processing Training, 2) 20 hours of laboratory- based Speed of Processing Training, or 3) 10 hours of a standardized computer-contact control (sham) condition. AIM 1: Determine whether 10 vs 20 hours of speed of processing training will improve this cognitive ability at post-test, year 1, and year 2 after baseline. AIM 2: Determine whether 10 vs 20 hours of speed of processing training will improve everyday functioning at post-test, year 1, and year 2 after baseline. Exploratory AIM: Determine whether improvement in speed of processing and/or everyday functioning over time mediate improvement in quality of life (e.g., depression).

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.