Over 50% of adults with HIV have some form of HIV-Associated Neurocognitive Disorder (HAND) which represents a significant symptom that interferes with everyday functioning and quality of life. As adults age with HIV, they are more likely to develop comorbidities such as cardiovascular disease, hypertension, and insulin resistance which will further contribute to poorer cognitive functioning and HAND. Based upon the Frascati criteria, HAND is diagnosed when a person performs less than 1 to 2 SD below their normative mean (education & age) on measures of two or more cognitive domains (e.g., attention, speed of processing, verbal memory, executive functioning). Yet, from the cognitive literature and our prior studies, we know we can administer certain computerized cognitive training programs to improve specific cognitive domains in older adults and those with HIV. Such cognitive training programs may be effective in older adults with HIV and therefore we may be able to change the diagnosis of HAND in such cognitively vulnerable adults. In this pre- post experimental study, 146 older adults (50+) with HAND will be randomized to be in either: 1) the Individualized-Targeted Cognitive Training, or 2) a no-contact control group. We will focus on those cognitive domains in which participants express an impairment and train them with the corresponding cognitive program. Such an Individualized-Targeted Cognitive Training approach using standard cognitive training programs may offer hope and symptom relief to those individuals diagnosed with HAND. Furthermore, we assert that these changes will result in improved everyday functioning (e.g., IADLs) and quality of life. This approach represents a paradigm shift in possibly changing the way we look at HAND.
Specific Aim 1 : Compare adults who do receive Individualized-Targeted Cognitive Training to those who do not in order to determine whether a change in HAND prevalence and severity occurs between groups. Exploratory Aim 1: Compare adults who do receive individualized-targeted cognitive training to those who do not in order to determine whether this improves everyday functioning (e.g., IADLs). Exploratory Aim 2: Determine whether improvements in HAND and/or everyday functioning over time mediate improvements in quality of life.

Public Health Relevance

Program Narrative Those with HIV-Associated Neurocognitive Disorder are vulnerable to speed or processing and attention impairments that can impact everyday functioning and quality of life. Unfortunately, only two cognitive training studies have attempted to improve functioning in adults with HIV; yet, from the cognitive aging literature, it is clear that such cognitive training can improve cognition, IADLs, and quality of life.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Grants (R21)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Henry, Rebecca
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University of Alabama Birmingham
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Schools of Nursing
United States
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Vance, David E; Fazeli, Pariya L; Azuero, Andres et al. (2018) Can computerized cognitive training reverse the diagnosis of HIV-associated neurocognitive disorder? A research protocol. Res Nurs Health 41:11-18
Vance, David E; Jensen, Michael; Tende, Frida et al. (2018) Individualized-Targeted Computerized Cognitive Training to Treat HIV-Associated Neurocognitive Disorder: An Interim Descriptive Analysis. J Assoc Nurses AIDS Care 29:604-611
Meneses, Karen; Benz, Rachel; Bail, Jennifer R et al. (2018) Speed of processing training in middle-aged and older breast cancer survivors (SOAR): results of a randomized controlled pilot. Breast Cancer Res Treat 168:259-267
Vance, David E; Gakumo, C Ann; Childs, Gwendolyn D et al. (2017) Feedback on a Multimodal Cognitive Intervention for Adults Aging With HIV: A Focus Group Study. J Assoc Nurses AIDS Care 28:685-697
Vance, David E; Gakumo, C Ann; Childs, Gwendolyn D et al. (2017) Perceptions of Brain Health and Cognition in Older African Americans and Caucasians With HIV: A Focus Group Study. J Assoc Nurses AIDS Care 28:862-876
Hossain, Shyla; Fazeli, Pariya L; Tende, Frida et al. (2017) The Potential of Computerized Cognitive Training on HIV-Associated Neurocognitive Disorder: A Case Comparison Study. J Assoc Nurses AIDS Care 28:971-976