Prospective Memory in HIV-1 Infection

HIV-1 感染中的前瞻性记忆

• 批准号: 8243702
• 负责人: Steven Paul Woods
• 金额: $ 51.7万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-03-04 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8243702
• 关键词: AIDS Dementia Complex; Activities of Daily Living; Adult; Adverse effects; Affect; Aging; Anti-Retroviral Agents; Area; Biological Markers; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Clinical Research; Cognitive; Cognitive Therapy; Data; Dementia; Dependence; Development; Diagnosis; Disease; Disease Outcome; Disease Progression; Early Diagnosis; Early identification; Education; Elderly; Epidemic; Episodic memory; Etiology; Event; Funding; Future; Grant; HIV; HIV Infections; HIV-1; Health; Household; Impaired cognition; Impairment; Incidence; Independent Living; Infection; Intention; Life; Literature; Longitudinal Studies; Measures; Memory; Memory impairment; Modeling; Morbidity - disease rate; Nature; Neuraxis; Neurobiology; Neurocognitive; Neuronal Injury; Neuropathogenesis; Neuropsychology; Occupational; Occupational activity of managing finances; Outcome; Parkinson Disease; Patient Self-Report; Performance; Persons; Pharmaceutical Preparations; Play; Population; Prevalence; Process; Provider; Public Health; Publishing; Quality of life; Relative (related person); Research; Research Design; Research Project Grants; Research Support; Retrieval; Risk; Risk Factors; Risk Marker; Role; Screening procedure; Substance Addiction; Time; age effect; antiretroviral therapy; base; clinical practice; cognitive function; cognitive system; daily functioning; executive function; follow-up; functional decline; functional disability; functional outcomes; health related quality of life; improved; infancy; innovation; instrumental activity of daily living; interest; medical appointment; medication compliance; mortality; neuropsychiatry; neuropsychological; novel; programs; prospective; prospective memory; public health relevance; relating to nervous system; remediation; social; tau Proteins; therapy design; volunteer

DESCRIPTION (provided by applicant): Prospective memory (ProM), which refers to the successful execution of a future intention (i.e., "remembering to remember"), plays a vital role in everyday functioning (e.g., remembering to attend medical appointments), maintaining optimal health (e.g., remembering to take medications), and enabling independent living (e.g., remembering to pay the household bills). The uniqueness of this construct is supported by research showing that ProM is separable from retrospective memory (and global cognitive functioning) at the neuropsychological, functional, and neurobiological levels. The scientific merits of examining ProM in HIV infection are fourfold: 1) it enhances our understanding of the cognitive systems affected by the disease; 2) it impacts public health by improving the early identification of neuropsychological and functional impairments, which remain prevalent in the era of combination antiretroviral therapies; 3) it advances standard clinical neuropsychological practice; and 4) it informs targeted treatments. The current R01 has yielded the first published evidence that HIV is associated with elevated ProM complaints and impaired ProM performance, which are functionally and neurobiologically distinct from HIV-associated deficits in retrospective memory. Importantly, HIV-associated ProM impairment is a unique and robust predictor of declines in daily functioning, demonstrating incremental ecological validity relative to traditional measures of retrospective memory, executive functions, and global cognitive impairment. A novel direction for this revised competing renewal, as supported by pilot data from the initial funding period, will be to examine the additive effects of aging on HIV-associated ProM impairment. The incidence and prevalence of HIV infection in older adults are rising and consequently of considerable public health importance. The study of ProM is highly relevant to older HIV-infected adults, who may be at greater risk for exacerbated HIV-associated CNS complications (e.g., dementia), which increases the likelihood of dependence in daily functioning (e.g., medication nonadherence). Although ProM is impaired in healthy older adults and persons with HIV infection, no studies to date have evaluated the combined effects of these risk factors on ProM. Accordingly, this competing renewal aims to extend the findings from the initial grant period by: 1) focusing on older adults with HIV, who are a growing but understudied population in the changing HIV epidemic; 2) expanding the study design to examine the incidence of ProM impairment and its risk factors; 3) broadening our conceptual model to include habitual ProM; and 4) examining an important new functional outcome, health-related quality of life. To accomplish these aims, we propose a 5-year, longitudinal study to evaluate 125 older HIV+, 75 older HIV-, 125 younger HIV+, and 75 younger HIV- volunteers on comprehensive neuropsychological, functional, psychiatric, and neuromedical assessments. This new direction of research aims to bolster the clinical value of HIV-associated ProM impairment as an early marker of functional declines (e.g., medication nonadherence) and poorer health outcomes in older HIV-infected adults, as well as to directly inform the development of targeted pharmacological and cognitive-behavioral therapies. PUBLIC HEALTH RELEVANCE This study will evaluate the combined effects of aging and HIV infection on prospective memory, which is a unique cognitive ability that describes one's ability to "remember to remember" and plays a vital role in performing normal daily functions, especially adhering to medications. As such, this project will identify the day- to-day impact of prospective memory impairment in older adults with HIV infection, including its relationship to medication adherence and quality of life. Findings from this study will help in the early detection of HIV- associated prospective memory impairment, as well as in the development of treatments designed to limit the everyday effects of such deficits on older adults with HIV infection and their care providers.

描述（由申请人提供）：前瞻性记忆（ProM）是指成功执行未来意图（即“记住要记住”），在日常功能中发挥着至关重要的作用（例如，记得参加医疗预约），保持最佳健康（例如，记得服药），并实现独立生活（例如，记得支付家庭账单）。这一结构的独特性得到了研究的支持，研究表明 ProM 在神经心理学、功能和神经生物学水平上与回顾性记忆（和整体认知功能）是分离的。研究 HIV 感染中 ProM 的科学价值有四重：1）它增强了我们对受该疾病影响的认知系统的理解； 2) 它通过改善神经心理和功能损伤的早期识别来影响公共健康，这种损伤在联合抗逆转录病毒疗法时代仍然普遍存在； 3）它推进标准的临床神经心理学实践； 4）它为有针对性的治疗提供信息。目前的 R01 首次发表了证据，证明 HIV 与 ProM 症状增加和 ProM 表现受损有关，这在功能和神经生物学上与 HIV 相关的回顾性记忆缺陷不同。重要的是，与 HIV 相关的 ProM 损伤是日常功能下降的独特而有力的预测因素，相对于回顾性记忆、执行功能和整体认知损伤的传统测量方法，显示出增量的生态有效性。在最初资助期的试点数据的支持下，这一修订后的竞争更新的一个新方向将是检查衰老对 HIV 相关 ProM 损伤的附加影响。老年人中艾滋病毒感染的发病率和患病率正在上升，因此具有相当大的公共卫生重要性。 ProM 的研究与老年 HIV 感染者高度相关，他们可能面临 HIV 相关中枢神经系统并发症（例如痴呆）加重的风险更大，这增加了日常功能依赖的可能性（例如不依从药物治疗）。尽管 ProM 在健康老年人和 HIV 感染者中受到损害，但迄今为止还没有研究评估这些危险因素对 ProM 的综合影响。因此，这一竞争性的更新旨在通过以下方式扩展最初资助期的研究结果：1）关注感染艾滋病毒的老年人，他们是不断变化的艾滋病毒流行中不断增长但未被充分研究的人群； 2) 扩大研究设计以检查 ProM 损伤的发生率及其危险因素； 3）扩大我们的概念模型以包括习惯性ProM； 4）检查重要的新功能结果，即与健康相关的生活质量。为了实现这些目标，我们提出了一项为期 5 年的纵向研究，对 125 名老年 HIV+、75 名老年 HIV-、125 名年轻 HIV+ 和 75 名年轻 HIV- 志愿者进行全面的神经心理学、功能、精神病学和神经医学评估。这一新的研究方向旨在增强 HIV 相关 ProM 损伤的临床价值，作为老年 HIV 感染者功能衰退（例如，药物不依从性）和较差健康结果的早期标志，并直接为疾病的发展提供信息。有针对性的药物和认知行为疗法。 公共健康相关性 这项研究将评估衰老和艾滋病毒感染对前瞻性记忆的综合影响，前瞻性记忆是一种独特的认知能力，描述了一个人“记得要记住”的能力，并在执行正常的日常功能，特别是坚持药物治疗方面发挥着至关重要的作用。因此，该项目将确定艾滋病毒感染老年人的前瞻性记忆障碍的日常影响，包括其与药物依从性和生活质量的关系。这项研究的结果将有助于早期发现与艾滋病毒相关的前瞻性记忆障碍，并有助于开发旨在限制此类缺陷对感染艾滋病毒的老年人及其护理人员的日常影响的治疗方法。