The K99/R00 award will provide Dr. Fazeli with focused training and mentoring in the design and implementation of cognitive neurorehabilitation approaches for older HIV-infected (HIV+) adults, which will facilitate her goal of becoming an independent academic scientist conducting novel cognitive intervention research with older HIV+ adults. The K99 mentored phase of this award will augment existing expertise by providing intensive training in: 1) the design of randomized controlled trials of cognitive interventions in older HIV+ adults, and 2) the theory and application of a non-invasive brain stimulation technique. The training and proposed research is of considerable relevance to public health because: 1) the older HIV+ population is growing, and 2) HIV and aging have additive detrimental effects on neurocognitive and everyday functioning. Cognitive intervention approaches grounded in the gerontological literature provide insights for strategies that may be effective for the treatment of HIV-associated neurocognitive disorders (HAND), which remain prevalent among the older HIV+ population. The present application will target speed of information processing (SOP) via cognitive remediation therapy (CRT), which is particularly germane given that: 1) HIV and age confer additive effects on SOP, 2) SOP may drive poorer performance in other neurocognitive domains, and 3) SOP is associated with performance of everyday functioning activities. Previous work by Dr. Fazeli showed that a computerized CRT improved SOP among older HIV+ adults; however, many important questions for future research remain, including: how can the effects of this intervention be strengthened? Transcranial direct current stimulation (tDCS) is a technique that has reemerged as a non-invasive therapeutic approach for a range of neurocognitive conditions and there is evidence that cognitive interventions coupled with tDCS yield stronger effects. No studies have examined the effect of tDCS on neurocognition among HIV+ persons. Both SOP CRT and tDCS have independently demonstrated positive effects on resting state functional connectivity, which is compromised in aging with HIV, therefore, a combined neurorehabilitation approach may be particularly valuable in older HIV+ adults. Thus, the purpose of the training and research objectives of the K99 and subsequent R00 is to test the hypothesis that combining tDCS with SOP CRT will improve neurocognitive outcomes. The K99 study will focus on feasibility and proximal (i.e., SOP) and secondary (e.g., executive functions) neurocognitive effects, while the R00 study will: 1) further examine generalizability to other domains, 2) examine translation to everyday function, 3) assess dosage and durability, and 4) examine the effect on neurocognitive trajectories over time (e.g., prophylaxis versus cognitive restoration) in a true randomized controlled trial fashion. The career development and training activities, including the carefully constructed multidisciplinary mentoring team, will facilitate the successful completion of these research projects and propel Dr. Fazeli?s transition to research independence. These mentors include a Primary Mentor who is an expert in cognitive interventions among older adults (Dr. Karlene Ball) and Co-Mentors with expertise in HIV (Drs. David Moore and Michael Mugavero) and tDCS (Dr. Adam Woods). The hands-on research training, strong mentorship team, coursework, didactics, and scholarly activities proposed in this application will prepare Dr. Fazeli for the R00 phase of this mechanism and will provide an unprecedented opportunity for Dr. Fazeli to transition from a Postdoctoral Fellow to an influential, independent academic scientist in the field. This training will facilitate her overarching goal of working to improve the health and quality of life of older adults aging with HIV-infection.

Public Health Relevance

HIV and aging confer additive deleterious effects on brain structure and function that may lead to problems with mental abilities and consequently, everyday functioning. Speed of information processing (SOP) is particularly compromised in aging with HIV, and the current study will use cognitive remediation therapy and non-invasive brain stimulation to improve SOP performance. If successful, the techniques will reduce the public health burden of HIV-associated neurocognitive disorders and promote successful cognitive aging with HIV.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Transition Award (R00)
Project #
5R00AG048762-06
Application #
9514776
Study Section
Special Emphasis Panel (NSS)
Program Officer
Mackiewicz, Miroslaw
Project Start
2016-09-01
Project End
2019-06-30
Budget Start
2018-07-01
Budget End
2019-06-30
Support Year
6
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of Alabama Birmingham
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
063690705
City
Birmingham
State
AL
Country
United States
Zip Code
35294
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
Moore, Raeanne C; Hussain, Mariam A; Watson, Caitlin W-M et al. (2018) Grit and Ambition are Associated with Better Neurocognitive and Everyday Functioning Among Adults Living with HIV. AIDS Behav 22:3214-3225
Dufour, Catherine A; Marquine, María J; Fazeli, Pariya L et al. (2018) A Longitudinal Analysis of the Impact of Physical Activity on Neurocognitive Functioning Among HIV-Infected Adults. AIDS Behav 22:1562-1572
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
Moore, David J; Fazeli, Pariya L; Moore, Raeanne C et al. (2018) Positive Psychological Factors are Linked to Successful Cognitive Aging Among Older Persons Living with HIV/AIDS. AIDS Behav 22:1551-1561
Marquine, María J; Heaton, Anne; Johnson, Neco et al. (2018) Differences in Neurocognitive Impairment Among HIV-Infected Latinos in the United States. J Int Neuropsychol Soc 24:163-175
Vance, David; Fazeli, Pariya; Shacka, John et al. (2017) Testing a Computerized Cognitive Training Protocol in Adults Aging With HIV-Associated Neurocognitive Disorders: Randomized Controlled Trial Rationale and Protocol. JMIR Res Protoc 6:e68
Fazeli, P L; Casaletto, K B; Paolillo, E et al. (2017) Screening for neurocognitive impairment in HIV-positive adults aged 50 years and older: Montreal Cognitive Assessment relates to self-reported and clinician-rated everyday functioning. J Clin Exp Neuropsychol 39:842-853
Montoya, Jessica L; Iudicello, Jennifer; Oppenheim, Hannah A et al. (2017) Coagulation imbalance and neurocognitive functioning in older HIV-positive adults on suppressive antiretroviral therapy. AIDS 31:787-795
Montoya, Jessica L; Iudicello, Jennifer; Fazeli, Pariya L et al. (2017) Elevated Markers of Vascular Remodeling and Arterial Stiffness Are Associated With Neurocognitive Function in Older HIV+ Adults on Suppressive Antiretroviral Therapy. J Acquir Immune Defic Syndr 74:134-141

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