As people age with HIV, the synergistic effects with normal age-related cognitive declines will accentuate and/or accelerate declines in cognitive functioning which can be detected as early as in one's 40s. Although interventions are needed to protect/improve cognitive functioning, one intervention already exists to improve speed of processing. NINR/NIA (January 14, 2014) announced that Speed of Processing Training used in the ACTIVE Study (N = 2,802 community-dwelling older adults) has the ability to enable older people to maintain their cognitive abilities as they age even 10 years after training. As shown in the ACTIVE Study, this intervention uniquely improves driving, instrumental activities of daily living (IADL), health-related quality of life, self-rated health, internal locus of control, and protects one from depression; these represent areas of needed intervention for adults with HIV as well. In adults with HIV, our pilot studies likewise indicate speed of processing declines are associated with poorer driving simulator performance and more self-reported at-fault automobile crashes; such speed of processing declines on driving alone represent a significant public health concern. We also demonstrated that Speed of Processing Training improved this cognitive ability and translated into improved performance on a timed measure of IADLs. Based on our prior research, this RCT proposal consists of a pre-post two-year longitudinal experimental design whereby 264 adults with HIV, 40+ years and diagnosed with HIV-Associated Neurocognitive Disorder, will be randomly assigned to one of three training conditions: 1) 10 hours of laboratory-based Speed of Processing Training, 2) 20 hours of laboratory- based Speed of Processing Training, or 3) 10 hours of a standardized computer-contact control (sham) condition.
AIM 1 : Determine whether 10 vs 20 hours of speed of processing training will improve this cognitive ability at post-test, year 1, and year 2 after baseline.
AIM 2 : Determine whether 10 vs 20 hours of speed of processing training will improve everyday functioning at post-test, year 1, and year 2 after baseline. Exploratory AIM: Determine whether improvement in speed of processing and/or everyday functioning over time mediate improvement in quality of life (e.g., depression).
Cognitive aging with HIV is concerning due to three facts: 1) using Fascati criteria, ~50% of adults with HIV experience HIV-associated Neurocognitive Disorders (HAND), 2) by 2020, 70% of those with HIV will be 50 and older, and 3) age-related cognitive declines may exacerbate HAND. Such cognitive impairments occur in a number of domains (i.e., memory, attention) that negatively impact everyday functioning and quality of life. Fortunately, as observed in the 10-year ACTIVE Study (N = 2,802) which examined memory, reasoning, and speed of processing training, speed of processing training has superior properties to improve this cognitive ability and translate to improvements in everyday functioning and quality of life which has been shown in our pilot studies to improve outcomes for middle-aged (40+) and older adults with HIV; this study will build upon this existing science to improve cognitive and everyday functioning in adults with HIV.
