Computerized Cognitive Rehabilitation Training for Ugandan Seniors Living with HIV: A Validation Study

Abstract

<jats:p>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 (n = 40) and without (n = 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.</jats:p>

Evaluation of Computerized Cognitive Training and Cognitive and Daily Function in Patients Living With HIV

“…Of those, 1019 records were excluded based on titles and abstracts, and 24 full-text articles were assessed for eligibility. After exclusions, 12 eligible RCTs [40][41][42][44][45][46][47][48][49][54][55][56] were selected for inclusion in the meta-analysis.…”

“…Studies included data from the US, 40,41,44,[46][47][48][49][54][55][56] Uganda, 42 and Italy, 45 comprising 596 total participants (320 participants in the CCT group and 276 participants in the control group).…”

“…Participant ages ranged from a mean of 47.5 years 45 to 59.7 years 42 in the CCT group and 44.2 years 46 to 60.0 years 42 in the control group. The proportion of women ranged from 0% 54 to 94% 40 in the CCT group and 19% 45 to 90% 40 in the control group.…”

“…34 Furthermore, physiological parameters, including brain metabolism 35 and inflammatory, 36 hormonal, 37 and sleep-related factors, 38 may also be transformed through brain plasticity. 25 In addition, many studies involving people living with HIV have reported that CCT may reduce the risk of cognitive deterioration in several domains, 39 such as working memory, [40][41][42][43] processing, 40,44 executive function and attention, [45][46][47] and memory (learning and recall). 42 However, the benefits reported in original articles using the same CCT program (Posit Science software) have been inconsistent.…”

“…25 In addition, many studies involving people living with HIV have reported that CCT may reduce the risk of cognitive deterioration in several domains, 39 such as working memory, [40][41][42][43] processing, 40,44 executive function and attention, [45][46][47] and memory (learning and recall). 42 However, the benefits reported in original articles using the same CCT program (Posit Science software) have been inconsistent. Pope et al 48 found that this software could improve abstraction/executive function, whereas Fazeli et al 49 reported that the software could not only enhance abstraction/ executive function but also improve attention, working memory, and speed of information processing among people living with HIV.…”