Non-pathological cognitive declines occur with aging, which negatively affects everyday functioning and reduces quality of life. Many elders, aware of such cognitive changes, seek ways to bolster their cognitive functioning. Evidence based on the cognitive aging literature supports a number of factors associated with cognitive functioning. These factors include physical exercise, intellectual exercise, nutrition, sleep hygiene, social interaction, and mood and emotional state. These factors can be manipulated and woven together by nurses and other medical professionals to develop an easy to use, non-invasive cognitive prescription for improving the cognitive health of their patients. An example and directions for developing and implementing cognitive prescriptions are described.
BackgroundHIV-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.ObjectiveThis 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.MethodsThe 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.ResultsThe project was funded in April 2016 and enrolment is on-going. The first results are expected to be submitted for publication in 2020.ConclusionsSimilar 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 RegistrationClinicalTrials.gov NCT02758093; https://clinicaltrials.gov/ct2/show/NCT02758093 (Archived by Webcite at http://www.webcitation.org/6p8C5fBCX)
Half of the people living with HIV have cognitive deficits indicative of HIV-associated neurocognitive disorders (HANDs). With few treatment options, informing patients about a HAND diagnosis is a questionable practice. A sample of 139 people living with HIV were administered gold-standard cognitive tests; scores were used to determine whether they met cognitive criteria for HAND. Participants were informed that they met the criteria for HAND and asked 2 open-ended questions about their reactions to learning this information. Participant responses were recorded verbatim and coded into 3 overarching themes: positive, indifferent, and negative. Positive responses contained subthemes of confirmation, gratitude, desire for improvement, and curiosity. Indifferent responses contained nonreactive responses, apathy, and confusion. Negative responses contained surprise, discontentment, fear, and denial. Although most participants responded positively to feedback about HANDs, others experienced distress. Nurse clinicians should be mindful about informing patients if they have HAND while also educating them about brain health.
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