Detect: A novel device to assess how HIV affects neurocognitive decline and postural instability in older adults at risk for Alzheimer's Disease

检测：一种新型装置，用于评估艾滋病毒如何影响有阿尔茨海默病风险的老年人的神经认知衰退和姿势不稳定

• 批准号: 10321221
• 负责人: Albert Anderson
• 金额: $ 78.37万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-15 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10321221
• 关键词: 3D virtual reality; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adoption; Adult; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease risk; Assessment tool; California; Classification; Clinic; Clinical; Cognition; Cognitive; Data; Dementia; Detection; Devices; Diagnosis; Elderly; Environment; Epidemic; Equilibrium; Evaluation; Foundations; Frequencies; Fright; Future; General Population; Geriatric Assessment; Goals; HIV; HIV-associated neurocognitive disorder; Hearing problem; Home; Home environment; Impaired cognition; Impairment; Individual; Institution; Investigation; Literature; Longitudinal Studies; Measures; Memory; Methods; Monitor; Motor; Musculoskeletal Equilibrium; Neurocognitive Deficit; Neuropsychology; Participant; Pathway interactions; Patients; Pattern; Performance; Persons; Population; Posture; Prospective Studies; Reaction Time; Research; Research Design; Resources; Risk; Risk Factors; Screening procedure; Self Administration; Sensory; Signal Transduction; Site; System; Techniques; Testing; Time; Traumatic Brain Injury; Triage; Universities; Work; accurate diagnosis; amnestic mild cognitive impairment; auditory processing; base; clinical care; clinical phenotype; clinical practice; cognitive change; cognitive function; cognitive testing; cohort; design; diagnostic strategy; digital health; epidemiology study; experience; frailty; geriatric neuroHIV; healthy aging; hearing impairment; improved; individual patient; memory recall; memory recognition; mild cognitive impairment; motor deficit; multimodality; neuroAIDS; neurobehavioral; novel; portability; posture instability; primary care setting; programs; response; screening; sensory integration; tool; virtual; virtual reality

Project Summary/Abstract This application is in response to the NIA’s Strategic Directions Goal D-3, which calls for better tools to assess cognitive function in the clinic, primary care setting, and home environment in order to distinguish persons at risk for developing Alzheimer’s disease (AD) from persons not at risk. Persons living with HIV (PLHIV) are now living well into the age demographic in which they are at increasing risk for developing AD. Because up to 50% of PLHIV experience cognitive impairment from HIV or related factors that often include memory problems, AD may go unidentified in a significant proportion of older PLHIV. There is a pressing need in geriatric neuroHIV for the ability to accurately identify and disentangle HIV- and AD-associated cognitive impairment and predict individuals who are at risk for further cognitive decline. Evidence from epidemiological studies suggests that sensory (e.g., auditory processing) and motor (e.g., balance) impairments are observed more frequently in PLHIV compared to the general population of a similar age and that these impairment may impact the progression of cognitive impairment in PLHIV and in AD. Building on substantial evidence demonstrating that virtual reality is widely accepted among older adults, we propose to use a novel and portable 3-D virtual reality automated tool, called DETECT, to accurately measure cognition decline and changes in postural stability over time in older PLHIV with and without amnestic mild cognitive impairment (aMCI), a precursor to AD. DETECT was developed for rapid and brief cognitive testing in diverse settings, such as busy geriatric HIV clinics or the home, and can accurately discriminate between normal cognition, MCI, and dementia. Additionally, our pilot work indicates that DETECT is a sensitive screening tool for differentiating between normal cognition and HIV-associated neurocognitive disorder (HAND) in PLHIV. The system is also accurate for diagnosing postural instability using a novel technique that obviates the need for standing and ambulation. To expand on this work, we propose a two site (UCSD and Emory) prospective study of 120 older individuals representing three different clinical phenotypes: PLHIV with HAND and aMCI (HAND+/aMCI+), PLHIV with HAND but without aMCI (HAND+/aMCI-), and HIV-uninfected persons with aMCI (HIV-/aMCI+). An empirically-based neuropsychological diagnostic approach will be used to identify aMCI among PLHIV. We will use DETECT to: (Aim 1) compare the determinants of cognitive decline in these groups, and (Aims 2 and 3) understand how non-cognitive functional changes such as postural instability, hearing loss, and central auditory processing dynamically influence cognitive decline in these groups. Our longitudinal study design will allow us to better understand how cognitive change differs over time between these groups of individuals. The long-term goal of this work is to bring rapid, accurate tools that can identify those at increased risk for progression to AD dementia into clinical practice. The eventual adoption of such tools into clinical practice could provide clarity to patients and clinicians, alleviate fears among PLHIV who do not have aMCI, improve efficiency, and guide the triage of individual patients into specific treatment pathways.

项目概要/摘要 该应用程序是为了响应 NIA 的战略方向目标 D-3，该目标要求更好的工具来评估 诊所、初级保健机构和家庭环境中的认知功能，以区分高危人群 预防艾滋病毒感染者 (PLHIV) 感染者罹患阿尔茨海默病 (AD)。 进入 AD 风险增加的年龄段，因为高达 50% 的人患 AD 的风险增加。 HIV 感染者会因 HIV 或相关因素而出现认知障碍，通常包括记忆问题、AD 可能 很大一部分老年艾滋病毒感染者的身份尚未确定，因此迫切需要老年神经艾滋病毒。 准确识别和解开 HIV 和 AD 相关认知障碍并预测个体的能力 流行病学研究的证据表明，感官（例如， 与感染者相比，艾滋病毒感染者更容易观察到听觉处理）和运动（例如平衡）障碍 与年龄相近的一般人群相比，这些障碍可能会影响认知能力的进展 大量证据表明虚拟现实已广泛应用。 为老年人所接受，我们建议使用一种新颖的便携式 3D 虚拟现实自动化工具，称为 DETECT，准确测量老年 PLHIV 随时间的认知衰退和姿势稳定性变化 并且没有遗忘性轻度认知障碍（aMCI），DETECT 的前身是为快速开发的。 以及在不同环境中进行简短的认知测试，例如繁忙的老年艾滋病诊所或家庭，并且可以准确地 此外，我们的试点工作表明，可以区分正常认知、MCI 和痴呆症。 是一种灵敏的筛查工具，用于区分正常认知和 HIV 相关神经认知 该系统还可以使用新技术准确诊断姿势不稳定。 为了扩展这项工作，我们提出了两个站点（加州大学圣地亚哥分校和加州大学圣地亚哥分校）。 Emory）对 120 名老年人进行的前瞻性研究代表了三种不同的临床表型： PLHIV HAND 和 aMCI (HAND+/aMCI+)、患有 HAND 但不具有 aMCI 的 HIV 感染者 (HAND+/aMCI-) 以及未感染 HIV 的 aMCI 患者（HIV-/aMCI+）将采用基于经验的神经心理学诊断方法。 识别 PLHIV 中的 aMCI 我们将使用 DETECT 来：（目标 1）比较认知能力下降的决定因素。 这些群体，以及（目标 2 和 3）了解姿势不稳定等非认知功能变化如何， 听力损失和中枢听觉处理动态地影响这些群体的认知能力下降。 纵向研究设计将使我们能够更好地了解这些因素之间的认知变化如何随着时间的推移而变化。 这项工作的长期目标是提供快速、准确的工具来识别这些人。 最终在临床实践中采用此类工具会增加 AD 痴呆的风险。 临床实践可以为患者和信徒提供清晰的信息，减轻感染者的恐惧 aMCI，提高效率，并指导个别患者分流到特定的治疗途径。