School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
Curr Top Behav Neurosci. 2021;50:503-515. doi: 10.1007/7854_2018_80.
Approximately 50% of older adults with HIV meet the Frascati diagnostic criteria of HIV-associated neurocognitive disorders (HAND) which can interfere with everyday function such as medication adherence, employment, and driving ability, thus reducing quality of life. As the number of older adults with HIV continues to grow, many will become vulnerable to cognitive frailty, especially as they experience multimorbidities, polypharmacy, and geriatric syndromes. Healthcare professionals need strategies to prevent, remediate, and compensate for cognitive losses observed in memory, language, executive functioning, and speed of processing. Sadly, there are no standard protocols or accepted treatment/intervention guidelines to address HAND at this time. Fortunately, evidence from the cognitive aging literature indicates that cognitive training can protect and improve cognition in normal older adults and may even reduce the incidence of dementia/MCI. This article provides the scientific context in which computerized cognitive training approaches have been successfully used in older adults and provides examples of how these approaches have been translated to adults with HIV. Evidence from ongoing clinical trials are also presented that suggest that reversing a diagnosis of HAND may be possible. Recommendations for clinical practice and research are provided.
约 50%的老年 HIV 感染者符合与 HIV 相关的神经认知障碍 (HAND) 的 Frascati 诊断标准，这可能会干扰日常功能，如药物依从性、就业和驾驶能力，从而降低生活质量。随着 HIV 感染者中老年人数量的不断增加，许多人将容易受到认知脆弱的影响，尤其是当他们患有多种疾病、多种药物治疗和老年综合征时。医疗保健专业人员需要策略来预防、纠正和补偿记忆力、语言、执行功能和处理速度方面观察到的认知损失。可悲的是，目前尚无针对 HAND 的标准方案或公认的治疗/干预指南。幸运的是，认知老化文献中的证据表明，认知训练可以保护和改善正常老年人的认知能力，甚至可以降低痴呆症/MCI 的发病率。本文提供了计算机化认知训练方法在老年人中成功应用的科学背景，并提供了这些方法如何转化为 HIV 成年人的例子。还介绍了正在进行的临床试验的证据，表明逆转 HAND 的诊断可能是可能的。提供了临床实践和研究的建议。
