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      Testing a Computerized Cognitive Training Protocol in Adults Aging With HIV-Associated Neurocognitive Disorders: Randomized Controlled Trial Rationale and Protocol

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          Abstract

          Background

          HIV-associated neurocognitive disorders occur in nearly 50% of adults with HIV. Such disorders can interfere with everyday functioning such as driving and medication adherence. Therefore, cognitive interventions are needed to address such neurocognitive disorders as well as improve everyday functioning, especially as people age with HIV.

          Objective

          This article reports and discusses the overall rationale and development of speed of processing training, a computerized Internet cognitive training program, to improve this specific neurocognitive ability as well as everyday functioning and quality of life in adults aging with HIV. Although this protocol has been shown to improve speed of processing, everyday functioning, and quality of life in healthy, community-dwelling older adults in the advanced cognitive training in vital elderly (ACTIVE) study, its efficacy in adults aging with HIV has not been established. Nevertheless, such a cognitive intervention is particularly germane as 52%-59% of adults with HIV experience HIV-associated neurocognitive disorders (HAND), and both the frequency and severity of such disorders may increase with advancing age.

          Methods

          The description of this longitudinal randomized controlled trial covers the following: (1) rationale for speed of processing training in this clinical population, (2) overview of overall study design, (3) eligibility criteria and HAND, (4) intervention dosage, (5) assessment battery, and (6) examination of biomarkers.

          Results

          The project was funded in April 2016 and enrolment is on-going. The first results are expected to be submitted for publication in 2020.

          Conclusions

          Similar novel cognitive intervention approaches are suggested as they may be of value to those with HAND and may utilize similar features of this current randomized controlled trial (RCT) protocol to examine their therapeutic efficacy.

          Trial Registration

          ClinicalTrials.gov NCT02758093; https://clinicaltrials.gov/ct2/show/NCT02758093 (Archived by Webcite at http://www.webcitation.org/6p8C5fBCX)

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          Long-term effects of cognitive training on everyday functional outcomes in older adults.

          Sherry L. Willis, Sharon L Tennstedt, Michael Marsiske … (2006)
          Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated. To determine the effects of cognitive training on daily function and durability of training on cognitive abilities. Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample. Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training. Self-reported and performance-based measures of daily function and cognitive abilities. The reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; 99% CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing (effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years (memory: effect size, 0.23 [99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance (effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance (effect size, 0.85; 99% CI, 0.61-1.09). Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention. clinicaltrials.gov Identifier: NCT00298558.
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            Effects of cognitive training interventions with older adults: a randomized controlled trial.

            Karlene Ball, Daniel Berch, Karin Helmers … (2002)
            Cognitive function in older adults is related to independent living and need for care. However, few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently. To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older, independent-living adults. Randomized, controlled, single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001. Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing, community centers, and hospital/clinics in 6 metropolitan areas in the United States. Participants were randomly assigned to 1 of 4 groups: 10-session group training for memory (verbal episodic memory; n = 711), or reasoning (ability to solve problems that follow a serial pattern; n = 705), or speed of processing (visual search and identification; n = 712); or a no-contact control group (n = 704). For the 3 treatment groups, 4-session booster training was offered to a 60% random sample 11 months later. Cognitive function and cognitively demanding everyday functioning. Thirty participants were incorrectly randomized and were excluded from the analysis. Each intervention improved the targeted cognitive ability compared with baseline, durable to 2 years (P<.001 for all). Eighty-seven percent of speed-, 74% of reasoning-, and 26% of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period. Booster training enhanced training gains in speed (P<.001) and reasoning (P<.001) interventions (speed booster, 92%; no booster, 68%; reasoning booster, 72%; no booster, 49%), which were maintained at 2-year follow-up (P<.001 for both). No training effects on everyday functioning were detected at 2 years. Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities. Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals. Because of minimal functional decline across all groups, longer follow-up is likely required to observe training effects on everyday function.
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              Cognitive Neuropsychology of HIV-Associated Neurocognitive Disorders

              Steven Paul Woods, David Moore, Erica Weber … (2009)
              Advances in the treatment of the human immunodeficiency virus (HIV) have dramatically improved survival rates over the past 10 years, but HIV-associated neurocognitive disorders (HAND) remain highly prevalent and continue to represent a significant public health problem. This review provides an update on the nature, extent, and diagnosis of HAND. Particular emphasis is placed on critically evaluating research within the realm of cognitive neuropsychology that aims to elucidate the component processes of HAND across the domains of executive functions, motor skills, speeded information processing, episodic memory, attention/working memory, language, and visuoperception. In addition to clarifying the cognitive mechanisms of HAND (e.g., impaired cognitive control), the cognitive neuropsychology approach may enhance the ecological validity of neuroAIDS research and inform the development of much needed novel, targeted cognitive and behavioral therapies.
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                Author and article information

                Contributors
                David Vance:
                School of NursingUniversity of Alabama at Birmingham1701 University BoulevardBirmingham, AL, 35294United States1 20593475891 2059967183devance@uab.edu
                ORCID: http://orcid.org/0000-0002-0498-6263
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: April 2017
                Publication date (Electronic): 26 April 2017
                Volume: 6
                Issue: 4
                Electronic Location Identifier: e68
                Affiliations
                [1] 1School of Nursing University of Alabama at Birmingham Birmingham, ALUnited States
                [2] 2Department of Pharmacology & Toxicology University of Alabama at Birmingham Birmingham, ALUnited States
                [3] 3School of Medicine University of Alabama at Birmingham Birmingham, ALUnited States
                [4] 4Department of Psychology University of Alabama at Birmingham Birmingham, ALUnited States
                Author notes
                Corresponding Author: David Vance devance@ 123456uab.edu
                Author information
                http://orcid.org/0000-0002-0498-6263
                http://orcid.org/0000-0001-6629-0010
                http://orcid.org/0000-0002-4361-7962
                http://orcid.org/0000-0003-0601-6540
                http://orcid.org/0000-0001-8744-0313
                http://orcid.org/0000-0002-3242-4911
                http://orcid.org/0000-0001-9883-1424
                http://orcid.org/0000-0003-4524-8395
                http://orcid.org/0000-0003-1811-9870
                Article
                Publisher ID: v6i4e68
                DOI: 10.2196/resprot.6625
                PMC ID: 5422019
                PubMed ID: 28446421
                SO-VID: e48c85e5-b3cd-42cf-abad-764d31f73749
                Copyright © ©David Vance, Pariya Fazeli, John Shacka, William Nicholson, Peggy McKie, James Raper, Andres Azuero, Virginia Wadley, Karlene Ball. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.04.2017.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                Date received : 7 September 2016
                Date revision requested : 28 September 2016
                Date revision received : 20 October 2016
                Date accepted : 22 October 2016
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: cognitive aging,cognitive remediation therapy,cognition therapy,hiv associated cognitive motor complex
                Data availability:
                Keywords: cognitive aging, cognitive remediation therapy, cognition therapy, hiv associated cognitive motor complex

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