Neuropsychological Benefits of Cognitive Training in Ugandan HIV Children

认知训练对乌干达艾滋病毒儿童的神经心理学益处

基本信息

批准号：
7926216
负责人：
Michael Joseph Boivin
金额：
$ 20.11万
依托单位：
MICHIGAN STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-05 至 2013-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7926216
关键词：
AIDS clinical trial group Acute Adolescence Africa Africa South of the Sahara African American Anti-Retroviral Agents Anxiety Area Attention Auditory Brain CD8B1 gene Caregivers Caring Cellular Phone Cerebral Malaria Cessation of life Child Child Behavior Checklist Childhood Chronic Disease Clinical Cognitive Cognitive Therapy Computers Consequences of HIV Control Groups Data Developing Countries Development Disease Educational Intervention Effectiveness Encephalopathies Enrollment Ensure Exhibits Goals HIV HIV Infections HIV therapy Highly Active Antiretroviral Therapy Home environment Immunologics Immunology Impaired cognition Impairment Infection Internet Intervention Iron Lead Learning Lymphocyte Lymphocyte Activation Malaria Malnutrition Marketing Measures Mediating Medical Memory Mental Depression Monitor Motor Neurocognitive Neurocognitive Deficit Neuronal Plasticity Neurons Neuropsychological Tests Neuropsychology Orphan Outcome Outcome Assessment Outcome Measure Participant Performance Personal Satisfaction Pharmaceutical Preparations Poverty Primary Schools Process Public Health Quality Control Randomized Rehabilitation therapy Reporting Research Resources Risk Risk Factors Sampling School-Age Population Schools Screening procedure Services Short-Term Memory Special Education Staging Survivors Symptoms T-Lymphocyte Testing Training Uganda Viral Load result Visual Visual attention Visuospatial Wireless Technology active control base child battery clinical care cognitive rehabilitation cognitive training computerized cost design effective intervention effective therapy executive function follow-up group intervention immunological status improved neglect neuropsychological nutrition outcome forecast pediatric AIDS pediatric human immunodeficiency virus pediatric human immunodeficiency virus infection prevent programs psychiatric disability psychosocial public health relevance response restoration social social stigma tool treatment strategy

AIDS clinical trial group Acute Adolescence Africa Africa South of the Sahara African American Anti-Retroviral Agents Anxiety Area Attention Auditory Brain CD8B1 gene Caregivers Caring Cellular Phone Cerebral Malaria Cessation of life Child Child Behavior Checklist Childhood Chronic Disease Clinical Cognitive Cognitive Therapy Computers Consequences of HIV Control Groups Data Developing Countries Development Disease Educational Intervention Effectiveness Encephalopathies Enrollment Ensure Exhibits Goals HIV HIV Infections HIV therapy Highly Active Antiretroviral Therapy Home environment Immunologics Immunology Impaired cognition Impairment Infection Internet Intervention Iron Lead Learning Lymphocyte Lymphocyte Activation Malaria Malnutrition Marketing Measures Mediating Medical Memory Mental Depression Monitor Motor Neurocognitive Neurocognitive Deficit Neuronal Plasticity Neurons Neuropsychological Tests Neuropsychology Orphan Outcome Outcome Assessment Outcome Measure Participant Performance Personal Satisfaction Pharmaceutical Preparations Poverty Primary Schools Process Public Health Quality Control Randomized Rehabilitation therapy Reporting Research Resources Risk Risk Factors Sampling School-Age Population Schools Screening procedure Services Short-Term Memory Special Education Staging Survivors Symptoms T-Lymphocyte Testing Training Uganda Viral Load result Visual Visual attention Visuospatial Wireless Technology active control base child battery clinical care cognitive rehabilitation cognitive training computerized cost design effective intervention effective therapy executive function follow-up group intervention immunological status improved neglect neuropsychological nutrition outcome forecast pediatric AIDS pediatric human immunodeficiency virus pediatric human immunodeficiency virus infection prevent programs psychiatric disability psychosocial public health relevance response restoration social social stigma tool treatment strategy

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项目摘要

DESCRIPTION (provided by applicant): Research Topic: Over 110,000 HIV Ugandan children are at risk for neurocognitive disorders due to the progressive encephalopathy of CNS HIV infection. Even if clinically stable, these children can have motor, attention, memory, visual-spatial processing, and other executive function impairment. One-hundred and fifty school-age children with HIV in Kayunga District, Uganda, will serve as our participants. Fifty of these children will be randomly selected to receive 24 training sessions of a computerized cognitive rehabilitation therapy (CCRT) program called Captain's Log, marketed mostly for American children with attention or learning problems. A locked version of Captain's Log which does not direct the child's training in a progressive manner will be administered to a second "active control" group; while a third group will be a passive control group not receiving any computer training intervention. Study Aim 1: To compare the neuropsychological benefit of 24 training sessions of Captain's Log CCRT to the active and passive control groups over a 8-week period, and at 3-month follow-up. Study Aim 2: To compare the psychiatric benefit of 24 training sessions of Captain's Log CCRT to the active and passive control groups over an 8-week period, and at 3-month follow-up. Study Aim 3: To evaluate how HIV subtype, ART treatment status, and the corresponding clinical stability of the child modifies CCRT neuropsychological performance gains and psychiatric symptom reduction. Outcome Assessments: The Kaufman Assessment Battery for Children, 2nd ed. (KABC-2), Tests of Variables of Attention (TOVA) visual and auditory tests, CogState computerized neuropsychological screening test, Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and Achenbach Child Behavior Checklist (CBCL) will be administered before and after the 8-week training period and at 3-month follow-up. We have previously used all these assessments with Ugandan children with HIV to effectively evaluate neuropsychological and psychiatric problems. Captain's Log has an internal evaluator feature which will help us monitor the specific training tasks to which the children best respond. Based on our prior research with Kayunga children with HIV, we anticipate that about 40% of our sample will be on ART at study enrollment, and about 20% will be Subtype D while 60% will be subtype A. We also observed that children with HIV Subtype A are at greater risk for neurocognitive deficits. Analyses: We will compare neuropsychological and psychiatric gains over the 8-week training period and at 3-mo follow-up for our three study groups, anticipating that they will be significantly greater for the CCRT intervention children (Study Aims 1 & 2). These neuropsychological gains will be associated with improved school performance over the long-term. Intervention children on ART will have greater gains than those not on ART, and HIV subtype D children will have lower viral loads and higher lymphocyte activation levels, resulting in greater gains from CCRT (Study Aim 3). Conclusion: CCRT will prove effective and sustainable in potentiating the neurocognitive benefit of ART in HIV children. It will prove viable for assessing and treating children in resource-poor settings. PUBLIC HEALTH RELEVANCE: Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV children and orphans globally is monumental when considering how it further compromises quality of home environment and educational opportunity for children already impoverished. If computerized cognitive training proves practical and effective for enhancing neuropsychological function and psychiatric well-being in HIV children, then this would support the second of the UN Millennium Development Goals, which is to ensure that all children have the best opportunity to complete primary schooling. Computerized cognitive training and assessment might also allow for cost/effective interventions in resource poor settings throughout the developing world where special education or medical rehabilitative care by trained professionals are not available.

描述（由申请人提供）：研究主题：由于中枢神经系统HIV感染的进行性脑病，超过11万名HIV乌干达儿童有神经认知疾病的风险。即使临床稳定，这些孩子也可以具有运动，注意力，记忆力，视觉空间处理和其他执行功能障碍。乌干达Kayunga区的一百五十名艾滋病毒的学龄儿童将担任我们的参与者。这些儿童中有50名将被随机选择接受24次计算机认知康复疗法（CCRT）计划的培训课程，称为Captain的日志，主要是针对具有关注或学习问题的美国儿童销售的。上尉的日志的锁定版本，该日志不会以渐进的方式指导孩子的培训，将被管理为第二个“主动控制”组；虽然第三组将是一个被动控制组，但没有接受任何计算机培训干预措施。研究目的1：比较在8周的时间内和3个月的随访中，将24个船长对数CCRT训练的神经心理学益处与主动和被动控制组的神经心理益处进行比较。研究目的2：将24个训练训练的日志CCRT培训课程与在8周的活跃和被动对照组中的精神病益处进行比较，并在3个月的随访中进行了比较。研究目标3：评估HIV亚型，艺术治疗状况以及儿童相应的临床稳定性如何修饰CCRT神经心理学表现增长和降低精神病症状。结果评估：Kaufman评估儿童评估电池，第二版。（KABC-2），关注（TOVA）视觉和听觉测试的变量，Cogstate计算机化的神经心理学筛查测试，Bruininks-Oseretsky运动能力测试（BOT-2）和Achenbach儿童行为检查清单（CBCL）将在8周培训期间和后期进行3分钟的培训和之后。我们以前曾与乌干达艾滋病毒儿童一起使用所有这些评估来有效评估神经心理学和精神病问题。队长的日志具有内部评估器功能，该功能将帮助我们监视孩子们最能做出反应的特定培训任务。基于我们先前与Kayunga HIV儿童的研究，我们预计我们的样本中约有40％将在研究入学时进行艺术，而大约20％的样本将是亚型D，而60％的样本将是亚型A。我们还观察到HIV亚型A的儿童具有更大的神经认知缺陷风险。分析：我们将在8周的培训期间和三个研究小组的3-MO随访中比较神经心理学和精神病学的成就，预计CCRT干预儿童的神经心理学和精神病学期望将大大更大（研究目标1和2）。这些神经心理学的成就将与长期的学校表现相关。干预儿童对艺术的增长将比不在艺术方面的增长更大，HIV亚型D儿童的病毒载量较低，淋巴细胞激活水平较高，从而导致CCRT的增长较大（研究目标3）。结论：CCRT将证明有效且可持续性在增强艾滋病毒儿童艺术的神经认知益处。它将证明可以在资源贫乏的环境中评估和治疗儿童。公共卫生相关性：除了小儿艾滋病毒感染的直接神经发育影响外，艾滋病毒疾病的公共卫生负担是数千万的艾滋病毒儿童和全球孤儿的艾滋病毒疾病负担，在考虑如何进一步危害已经陷入贫困的儿童的家庭环境质量和教育机会时，这是巨大的。如果计算机认知培训证明了实用和有效的艾滋病毒儿童神经心理学功能和精神病的福祉，那么这将支持联合国千年发展目标的第二个，即确保所有儿童都有最好的机会完成小学。计算机化的认知培训和评估也可能允许在不可用训练有素的专业人员的特殊教育或医疗康复护理的整个发展中国家的资源较差的情况下进行成本/有效的干预措施。