Ezeamama Amara E, Sikorskii Alla, Sankar Parvathy R, Nakasujja Noeline, Ssonko Michael, Kaminski Norbert E, Guwatudde David, Boivin Michael J, Giordani Bruno
Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
Department of Psychiatry, Makerere University College of Health Sciences, Kampala P.O. Box 7062, Uganda.
J Clin Med. 2020 Jul 7;9(7):2137. doi: 10.3390/jcm9072137.
The feasibility, acceptability and preliminary efficacy of computerized cognitive rehabilitation therapy (CCRT) for mitigating neurocognitive decline was evaluated in African adults ≥50 years old. Eighty-one Ugandans with ( = 40) and without ( = 41) chronic human immunodeficiency viruses (HIV) were allocated CCRT-i.e., 20-45-min cognitive training sessions with culturally adapted video games delivered via Captain's Log Software, or standard of care (SOC). Pre and post (i.e., 8-weeks later) intervention performance based neurocognitive tests, quality of life (QOL) and frailty related phenotype (FRP) were determined in all respondents. Multivariable linear regression estimated CCRT- vs. SOC-related differences (β) in neurocognitive batteries, QOL and FRP. Effect sizes (ES) for estimated β were calculated. CCRT protocol was completed by 92.8% of persons allocated to it. Regardless of HIV status, CCRT was associated with higher performance in learning tests than SOC-interference list (β = 1.00, 95%CI: (0.02, 1.98); ES = 0.43) and delayed recall (β = 1.04, 95%CI: (0.06, 2.02); ES = 0.47). CCRT effect on verbal fluency was clinically important (ES = 0.38), but statistical significance was not reached (β = 1.25, 95%CI: (-0.09, 2.58)). Among HIV-positive adults, clinically important post-CCRT improvements were noted for immediate recall (ES = 0.69), working memory (ES = 0.51), verbal fluency (ES = 0.51), and timed gait (ES = -0.44) tasks. Among HIV-negative adults, CCRT resulted in moderate post-intervention improvement in learning tests (ES = 0.45) and large decline in FRP (ES = -0.71), without a positive effect on simple attention and visuomotor coordination tasks. CCRT intervention is feasible among older Ugandan adults with potential benefit for learning and verbal fluency tests regardless of HIV status and lowering FRP in HIV-negative older adults.
对50岁及以上的非洲成年人进行了计算机化认知康复治疗（CCRT）减轻神经认知衰退的可行性、可接受性和初步疗效评估。81名乌干达人，其中40名患有慢性人类免疫缺陷病毒（HIV），41名未患HIV，被分配接受CCRT（即通过Captain's Log软件提供的经过文化适应的电子游戏进行20 - 45分钟的认知训练课程）或标准护理（SOC）。在所有受访者中确定了干预前后（即8周后）基于神经认知测试的表现、生活质量（QOL）和衰弱相关表型（FRP）。多变量线性回归估计了CCRT与SOC在神经认知测试组、QOL和FRP方面的差异（β）。计算了估计β的效应大小（ES）。分配接受CCRT的人中92.8%完成了CCRT方案。无论HIV状态如何，CCRT与学习测试中的更高表现相关，高于SOC干扰列表（β = 1.00，95%CI：（0.02，1.98）；ES = 0.43）和延迟回忆（β = 1.04，95%CI：（0.06，2.02）；ES = 0.47）。CCRT对言语流畅性的影响具有临床重要性（ES = 0.38），但未达到统计学显著性（β = 1.25，95%CI：（-0.09，2.58））。在HIV阳性成年人中，CCRT后在即时回忆（ES = 0.69）、工作记忆（ES = 0.51）、言语流畅性（ES = 0.51）和定时步态（ES = -0.44）任务方面有临床重要改善。在HIV阴性成年人中，CCRT导致学习测试干预后有中度改善（ES = 0.45），FRP大幅下降（ES = -0.71），对简单注意力和视觉运动协调任务没有积极影响。CCRT干预在乌干达老年成年人中是可行 的，无论HIV状态如何，对学习和言语流畅性测试有潜在益处，并且能降低HIV阴性老年成年人的FRP。
