This research proposal seeks to improve the understanding of HIV-associated neurocognitive impairment on """"""""real-life"""""""" functional outcomes in African Americans (e.g., managing medications). The objective of this K23 application is to develop a model for predicting functional outcomes using methods of neuroimaging, neurocognitive assessment, and laboratory-based functional assessments, while controlling for potentially confounding sociocultural factors (e.g., educational experience). The following research proposal begins by first identifying sociocultural factors that explain differences in neurocognitive performance between African Americans and Caucasians. Next, we will use structural neuroimaging as an objective marker of brain organization to examine relationships between neurocognitive assessment and neuroimaging in both ethnic groups while modeling in potential explanatory variables. It is expected that the relationship between neurocognitive performance and neuroimaging will be strong for Caucasians, but relatively weak for African Americans (as this group is most often affected by disadvantaged social conditions). We expect that a model that factors in potential confounding variables will increase the validity of neurocognitive testing for measuring brain function and functional outcomes among African Americans. The candidate has a background in clinical neuropsychology and seeks two primary training goals from this award: 1) learn structural neuroimaging techniques, and 2) become an expert in NeuroAIDS, within emphasis on ethnic minority populations. The candidate's work environment at the UCLA Center for Cognitive Neuroscience and Semel Institute provides an excellent infrastructure for training in neuroimaging and NeuroAIDS. These labs have several funded, ongoing studies with strong ties to the Brain Mapping Center and the Laboratory of Molecular Neuroimaging (LONI). As part of this training, the candidate will attend courses and workshops in foundational neuroimaging topics (programming, statistics, image acquisition, neuroanatomy) and more advanced neuroimaging topics (e.g., DTI interpretation), as well as courses in the biological and neuropsychological sequelae of HIV infection. Training in cross-cultural psychology will be obtained through coursework offered through the Diversity Science Division within the Department of Psychology, weekly meetings with the Center for Culture, Trauma, and Mental Health and the Cultural Neuropsychology Initiative, in addition to weekly meetings with Dr. Hector Myers. She will also attend annual conferences in HIV (e.g., International Society of Neurovirology) and neuroimaging (e.g., Human Brain Mapping), and meet with mentors regularly. The candidate plans to apply for a R01 grant toward the end of the award period. Long term, she plans to establish an independent research career in health disparities focusing on brain-behavior relationships, cultural neuropsychology, and """"""""real-world"""""""" functional outcomes.
Neurocognitive assessment is commonly used to make diagnostic decisions and inferences about functional capacity;however, concerns have been raised about the validity of neurocognitive testing for use with African Americans. Using structural neuroimaging as the gold standard, the current project seeks to improve the assessment of cognitive and functional deficits associated with HIV infection among African Americans through examination of sociocultural variables (e.g., quality of education) that influence neurocognitive test performance. Improving the accuracy of neurocognitive assessment for use with African Americans will reduce the likelihood that patients are misdiagnosed with cognitive impairment.
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