Vance David E, Fazeli Pariya L, Azuero Andres, Wadley Virginia G, Jensen Michael, Raper James L
School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Res Nurs Health. 2018 Feb;41(1):11-18. doi: 10.1002/nur.21841. Epub 2017 Dec 20.
Nearly 50% of adults with HIV have some form of HIV-associated neurocognitive disorder (HAND), ranging from subtle to symptoms that interfere with everyday functioning and quality of life. HAND is diagnosed when a person performs more than 1 standard deviation below his or her normative mean on standardized measures in two or more cognitive domains (e.g., attention, speed of processing, verbal memory, executive functioning). As adults age with HIV, they are more likely to develop comorbidities such as cardiovascular disease, hypertension, and insulin resistance that may further contribute to poorer cognitive functioning and HAND. Certain computerized cognitive training programs may be able to improve specific cognitive domains in those with HIV. Such programs may be effective in changing the diagnosis of HAND in cognitively vulnerable adults. In this article, we describe the design and methods of TOPS-the Training On Purpose Study. In this on-going experimental study, 146 older adults (50+) with HAND are randomized to either: (i) an Individualized-Targeted Cognitive Training group, or (ii) a no-contact control group. This study targets those cognitive domains in which participants experience a deficit and trains participants with the corresponding computerized cognitive training program for that domain. An Individualized Targeted Cognitive Training approach using cognitive-domain-specific cognitive training programs may offer symptom relief to those individuals diagnosed with HAND, which may actually reverse this diagnosis. Given that these cognitive training programs are commercially available, this approach represents a potential paradigm shift in how HAND is considered and treated.
近50%的成年HIV感染者患有某种形式的HIV相关神经认知障碍（HAND），症状从轻微到干扰日常功能和生活质量不等。当一个人在两个或更多认知领域（如注意力、处理速度、言语记忆、执行功能）的标准化测量中表现低于其正常均值超过1个标准差时，即可诊断为HAND。随着成年HIV感染者年龄增长，他们更有可能出现心血管疾病、高血压和胰岛素抵抗等合并症，这些可能进一步导致认知功能下降和HAND。某些计算机化认知训练项目可能能够改善HIV感染者的特定认知领域。此类项目可能有效地改变认知脆弱的成年人中HAND的诊断。在本文中，我们描述了“有目的训练研究”（TOPS）的设计和方法。在这项正在进行的实验研究中，146名年龄在50岁及以上的HAND患者被随机分为两组：（i）个体化靶向认知训练组，或（ii）无接触对照组。本研究针对参与者存在缺陷的认知领域，并使用相应的计算机化认知训练项目对参与者进行训练。使用特定认知领域的认知训练项目的个体化靶向认知训练方法可能会缓解那些被诊断为HAND的个体的症状，实际上可能会扭转这一诊断。鉴于这些认知训练项目已商业化，这种方法代表了在HAND的认知和治疗方式上的潜在范式转变。
