Individualized-Targeted Computerized Cognitive Training to Treat HIV-Associated Neurocognitive Disorder: An Interim Descriptive Analysis

Vance, David E.; Jensen, M.A.; Tende, Frida; Raper, James L.; Allison, David; Fazeli, Pariya L

doi:10.1016/j.jana.2018.04.005

Cited by 17 publications

(17 citation statements)

References 11 publications

(19 reference statements)

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“…Study results show that regardless of HIV status, older adults who participated in CCRT showed improvements of at least modest clinical importance in tests of executive function (verbal fluency) and verbal learning/memory (interference list and delayed recall) relative to the control group. These preliminary findings of neurocognitive benefits of modest clinical importance in some cognitive domains are consistent with previous reports of CCRT-related neurocognitive benefit in healthy older individuals [34], older adults with HIV infection [35][36][37][38], and older individuals with mild cognitive impairment [39]. Specifically, among healthy older Americans (mean age = 69, SD = 6.9), CCRT targeting auditory perception and visuomotor/working memory domains of cognition was associated with post-training improvements in tests of everyday problem solving, working memory and matrix reasoning [34].…”

Section: Discussionsupporting

confidence: 91%

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

Ezeamama

Sikorskii

Sankar

et al. 2020

JCM

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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.

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Section: Discussionsupporting

confidence: 91%

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

Ezeamama

Sikorskii

Sankar

et al. 2020

JCM

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“…To address this, a cognitive training algorithm was created that theoretically would best target the cognitive domains needed to reverse a HAND diagnosis. Thus, the three-step Individualized-Targeted Cognitive Training Framework (Vance et al, 2018b) was created. In Step one, if cognitive impairments were detected in either SOP and/or attention, participants were automatically assigned cognitive training in these domains.…”

Section: Procedures/treatment Design and Rationalementioning

confidence: 99%

A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States

Vance¹,

Pope²,

Fazeli³

et al. 2021

J Assoc Nurses AIDS Care

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HIV-associated neurocognitive disorder (HAND) is experienced by 30% to 50% of people living with HIV (PLWH), potentially affecting their quality of life (QoL). In the Training on Purpose Study, we investigated whether targeted cognitive training can improve QoL in PLWH with HAND. Using a two-group experimental design, we randomized 109 adults with HAND to either (a) the Individualized-Targeted Cognitive Training group or (b) a no-contact control group. Those in the training group were assigned 10 hr of cognitive training per two selected cognitive domains (20 hr total) for which impairment was observed. Overall, two patterns emerged. First, significant improvements in measures of everyday cognitive complaints, depression, and mental health were consistently observed after the completion of many cognitive training protocols. Second, immediate and delayed spatial learning and memory training resulted in more significant indicators of QoL improvements compared with the other cognitive domain trainings. The findings suggest that some types of cognitive training may have advantages over others in improving aspects of QoL.

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“…This may be attributable to the CRGT model of administering these interventions together, in a group setting. BTA has been delivered as a predominantly individual intervention 25 , whereby brain training software or activity books are given to people individually with the expectation that they will practice in isolation 46 . This passive approach leads to high drop-off rates; while completers receive the self-reported coping benefit discussed above, upwards of half of a BTA trial's participants do not adhere to the training regimen as prescribed [23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

Cognitive remediation group therapy versus mutual aid group therapy: A pilot randomized, controlled trial to determine the feasibility and acceptability of group therapy for people aging with HIV facing cognitive challenges

Eaton¹,

Craig²,

Rourke³

et al. 2020

Preprint

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Background: Cognitive impairment is an important comorbidity for people aging with HIV, yet we lack non-medical techniques to address the associated anxiety and stress. Combination psychosocial interventions may have better outcomes than single technique approaches. Mindfulness-Based Stress Reduction (MBSR) and tablet-based Brain Training Activities (BTA) are promising techniques. Using community-based participatory research, our objective was to determine the feasibility and acceptability of group therapy for HIV, aging, and cognition.Methods: A pilot, parallel design, two-arm RCT recruited from a Toronto neurobehavioural research unit. Eligibility criteria included: diagnoses with mild-to-moderate HIV-associated neurocognitive disorder (HAND), age ≥ 40 years, HIV-positive for 5+ years, and English fluency. Randomization was 1:1 concealed allocation to Cognitive Remediation Group Therapy (Experimental; combination of BTA and MBSR) or Mutual Aid Group Therapy (Control). Primary outcomes were feasibility, measured by recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome was intervention fidelity, assessed via facilitator session reports. Exploratory outcomes were anxiety, stress, coping, and use of mindfulness and brain training activities.Facilitators and analysts were blinded, however participants were not. eligible participants were contacted, 12 randomized, and 10 completed the study and were analyzed for outcomes. The trial met its a priori feasibility targets with 30% recruited and 25% completed. At post-intervention, acceptability was 90% in the novel and 85% in the control arm. Assessors confirmed intervention delivery with satisfactory fidelity, with no missing components or significant deviations. Anxiety decreased for all in the novel arm and half of the control. Stress decreased and coping increased for half in both arms. All participants increased and sustained BTA use and half with mindfulness activities. There were no reported study harms.Conclusions: Although the combination of BTA and MBSR proved equal or slightly better to mutual aid therapy on all outcomes, recruitment of people with a formal HAND diagnosis from a single site was challenging. We recommend that future exploration of these techniques broaden to those aging with Human Immunodeficiency Virus MBSR Mindfulness-Based Stress Reduction Declarations Ethics approval and consent to participateThis study was approved by the Research Ethics Boards of and the University of Toronto (35860). Informed consent was obtained from all study participants. Consent for publicationNot applicable.

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Individualized-Targeted Computerized Cognitive Training to Treat HIV-Associated Neurocognitive Disorder: An Interim Descriptive Analysis

Cited by 17 publications

References 11 publications

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

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

A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States

Cognitive remediation group therapy versus mutual aid group therapy: A pilot randomized, controlled trial to determine the feasibility and acceptability of group therapy for people aging with HIV facing cognitive challenges

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