International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI 48824–1315, USA.
Neuropsychology. 2010 Sep;24(5):667-73. doi: 10.1037/a0019312.
Because antiretroviral treatment (ART) fails to improve neurocognitive impairment in children with HIV, we completed a pilot study evaluating the feasibility and cognitive benefit of computerized cognitive rehabilitation therapy (CCRT) in Ugandan children with HIV.
Sixty Ugandan children with HIV (23 on ART) were randomly assigned to 10 sessions of Captain's Log CCRT (Sandford, 2007) training configured for attention and memory skills or no intervention. Kaufman Assessment Battery for Children (2nd ed., KABC-2; Kaufman & Kaufman, 2004) performance at baseline indicated pervasive neurocognitive impairment. Cognitive ability was assessed before and after training using the Cogstate computerized neuropsychological test (Darby, Maruff, Collie, & McStephen, 2002). Viral load along with CD4 and CD8 absolute and activation levels also were measured posttest.
CCRT was well received with a 95% adherence rate to scheduled training sessions. CCRT intervention children showed greater improvement on a Cogstate card detection task of simple attention (p = .02), and speed of correct moves on a Groton Maze Learning Task (p < .001). These analyses were completed using an analysis of covariance model that adjusted Cogstate performance for the child's age, standardized weight for age, gender, socioeconomic status, school grade level, and baseline KABC-2 performance. ART treatment was not related to Cogstate performance or improvement as a result of CCRT. CD4 and CD8 activation levels were correlated with Cogstate improvement specifically for the CCRT group.
CCRT was feasible with our study population and improved maze learning and attention on a detection task. This supports previous findings by our group with cerebral malaria survivors (Bangirana, Giordani, et al., 2009).
由于抗逆转录病毒治疗（ART）未能改善 HIV 儿童的神经认知障碍，我们完成了一项试点研究，评估计算机认知康复治疗（CCRT）在乌干达 HIV 儿童中的可行性和认知益处。
60 名乌干达 HIV 儿童（23 名接受 ART 治疗）被随机分配到 10 次船长日志 CCRT（Sandford，2007）训练，针对注意力和记忆技能进行配置，或不进行干预。基线时 Kaufman 儿童评估成套测验（第二版，KABC-2；Kaufman 和 Kaufman，2004）的表现表明存在普遍的神经认知障碍。在训练前后使用 Cogstate 计算机神经心理测试（Darby、Maruff、Collie 和 McStephen，2002）评估认知能力。在测试后还测量了病毒载量以及 CD4 和 CD8 的绝对和激活水平。
CCRT 得到了很好的接受，计划的训练课程的依从率达到 95%。CCRT 干预组在 Cogstate 卡片检测任务中的简单注意力（p =.02）和格罗顿迷宫学习任务中的正确移动速度（p <.001）方面表现出更大的改善。这些分析使用协方差分析模型完成，该模型根据儿童的年龄、标准化体重与年龄、性别、社会经济地位、年级和基线 KABC-2 表现调整了 Cogstate 表现。ART 治疗与 Cogstate 表现或 CCRT 后的改善无关。CD4 和 CD8 的激活水平与 Cogstate 改善有关，特别是对 CCRT 组。
CCRT 在我们的研究人群中是可行的，并改善了迷宫学习和检测任务中的注意力。这支持了我们小组以前对脑疟疾幸存者的研究结果（Bangirana、Giordani 等人，2009 年）。
