Abstract

Half of people with human immunodeficiency virus (HIV) have HIV-associated neurocognitive disorder (HAND). Fortunately, cognitive training programs can improve function across cognitive domains, which may translate to everyday functioning. The Training on Purpose (TOPS) Study was designed to reverse HAND by targeting cognitive training to specific cognitive impairments that contributed to the diagnosis. A secondary aim of TOPS was to determine whether such cognitive training improved subjective and objective everyday functioning. In this two-group pre–post experimental design study, 109 adults with HAND were randomized to either: (1) a no-contact control group (no training) or (2) the Individualized-Targeted Cognitive Training group. Each participant received approximately 10 hours of cognitive training in two selected cognitive domains based on her/his individual baseline cognitive performance. Thus, 20 hours of individualized training on these two cognitive domains occurred over a course of 12 weeks in 1–2 hour sessions. Specific to the secondary aim of TOPS, measures of everyday functioning were administered before and after cognitive training to examine transfer effects. The analyses revealed that in general, speed of processing training produced benefits in everyday functioning as measured by the medication adherence visual analogue scale and the Timed Instrumental Activities of Daily Living test. Inconsistent findings were found for the other seven cognitive training protocols in either improving everyday functioning or reducing perceived everyday functioning; however, there may be other contributing factors that obscured such effects needing further research. This study demonstrated that some training protocols vary in efficacy in altering both objective and subjective everyday functioning ability.

摘要

一半的人类免疫缺陷病毒 (HIV) 感染者患有与 HIV 相关的神经认知障碍 (HAND)。幸运的是，认知训练计划可以改善跨认知领域的功能，这可能会转化为日常功能。针对性训练 (TOPS) 研究旨在通过针对有助于诊断的特定认知障碍进行认知训练来逆转 HAND。TOPS 的第二个目的是确定这种认知训练是否改善了主观和客观的日常功能。在这项两组前后实验设计研究中，109 名患有 HAND 的成年人被随机分为：(1) 非接触对照组（无训练）或 (2) 个性化目标认知训练组。每个参与者根据她/他的个人基线认知表现在两个选定的认知领域接受大约 10 小时的认知训练。因此，在 12 周的课程中，针对这两个认知领域进行了 20 小时的个性化训练，每次训练时间为 1-2 小时。针对 TOPS 的次要目标，在认知训练之前和之后进行日常功能测量，以检查转移效应。分析显示，一般来说，处理训练的速度对日常功能产生了好处，这是通过药物依从性视觉模拟量表和日常生活计时仪器活动测试来衡量的。其他七种认知训练方案在改善日常功能或减少感知的日常功能方面发现了不一致的结果；然而，可能还有其他因素掩盖了这种影响，需要进一步研究。这项研究表明，一些训练方案在改变客观和主观日常功能能力方面的功效各不相同。