This proposal involves an initial pilot study to determine if a cognitive intervention that has been useful for persons with Alzheimer's disease (AD) and related dementias, as well as for persons with traumatic brain injury (TBI), can also be effective for HIV+ older adults. The intervention involves the combination of two therapeutic approaches. The first approach involves the use of external aids to address disorders in executive function. Learning to utilize such aids, e.g., following steps in a sequence, can be accomplished with behavioral techniques such as backward chaining and vanishing cues. However, a key component of the intervention must include training the individual to attend to external aids at the appropriate time and place. It is here that the second therapeutic approach plays a critical role. This second approach, called Spaced-Retrieval (SR), is a method of learning and retaining information by recalling that information over increasingly longer periods of time. It is, in essence, a shaping paradigm applied to memory (Bjork, 1988; Camp & McKitrick, 1992; Landauer & Bjork, 1978). SR has been successfully used to enable persons with memory disorders to learn and retain new information over long time intervals (days, weeks, and months). We have recently demonstrated that SR can produce similar outcomes in two older adults with HIV who demonstrated memory impairments (Lee & Camp, 2000). Twenty-four HIV+ individuals with deficits in executive function will be trained using a combination of practice using external cues and SR to reach four individually selected therapeutic target goals. Each target goal will have two components: appropriate utilization of an external memory aid and the ability to learn a strategy involving when and how to use the external aid. Training sessions will be given (30 minutes/session) twice a week for eight weeks (16 sessions). There will be a 2-month follow-up posttest to assess retentioin of goals that are mastered. Objectives of the project are as follows: Objective 1a: To determine if cognitive intervention for older adults with HIV can be an effective treatment modality for problems associated with executive dysfunction. Objective 1b: To determine whether goals initially attained by participants can be retained at a 2-month posttest. Objective 2a: To determine if goal components associated with use of external cues are acquired at a different rate than goal components associated with strategy learning/SR training. Objective 2b: To determine if goal components associated with use of external cues are differentially maintained compared with goal components associated with strategy learning/SR training.
