A Metacognition-based Approach to Improve HAND Among Methamphetamine Users

基于元认知的方法可改善甲基苯丙胺使用者的 HAND

• 批准号: 8699510
• 负责人: Kaitlin B Casaletto
• 金额: $ 3.53万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8699510
• 关键词: AIDS neuropathy; Address; Affect; Age; Awareness; Behavior Therapy; Brain Injuries; Brain region; Characteristics; Clinical; Cognition; Cognitive; Cognitive remediation; Dependence; Development; Disease; Economic Burden; Educational process of instructing; Ensure; Evaluation; Executive Dysfunction; Future; Goals; HIV; HIV Infections; Illicit Drugs; Impairment; Individual; Injury; Knowledge; Learning; Life; Major Depressive Disorder; Medication Management; Mentored Patient-Oriented Research Career Development Award; Mentors; Methamphetamine; Methamphetamine dependence; Modeling; Monitor; Neurocognitive; Neurorehabilitation; Occupational activity of managing finances; Outcome; Perception; Performance; Persons; Pharmaceutical Preparations; Plasma; Population; Predisposition; Prevalence; Problem Solving; Public Health; Quality of life; Rehabilitation therapy; Research; Research Design; Research Infrastructure; Research Project Grants; Risk Factors; Scientist; Substance Use Disorder; System; Task Performances; Techniques; Thinking; Training; Traumatic Brain Injury; Unemployment; Viral Load result; Writing; addiction; base; cognitive rehabilitation; daily functioning; disability; executive function; high risk; implementation research; improved; in vivo; insight; instrumental activity of daily living; learned behavior; medication compliance; neurobehavioral; neurotoxic; novel; pill; programs; public health relevance; relating to nervous system; remediation; response; success; transmission process

DESCRIPTION (provided by applicant): Methamphetamine (MA) is one of the most commonly used illicit drugs worldwide and is a major risk factor for the transmission of HIV infection. The neurotoxic effects of comorbid MA dependence and HIV infection (MA/HIV) preferentially impact the frontostriatal regions of the brain leading to increased prevalence of HIV-associated neurocognitive disorders (HAND) that affect up to 60% of the population, particularly disrupting higher-order executive functions (e.g., problem-solving abilities). In both HIV and MA, executive dysfunction is associated with dependence in instrumental activities of daily living (IADLs; e.g., medication or financial management). Despite the high risk for and economic burden of HAND-related disability (e.g., unemployment), there are currently no empirically validated techniques to treat HAND among MA users. One cognitive rehabilitation technique that has been effective for improving IADL functioning in other populations with executive dysfunction (e.g., traumatic brain injury) is metacognitive training. Metacognition involves the capacity for introspection including accurate perception and assessment of one's everyday performance and its consequences. Metacognition is commonly impaired following brain injury to the prefrontal systems and is associated with integrity of executive functions; in fact, up to 50% of HIV individuals show poor insight into their cognitive abilities, which is directly associated with poorer IADL outcomes in these individuals. Impaired metacognition may therefore represent an important mechanism by which executive dysfunction impacts successful IADL abilities in individuals with MA/HIV. Metacognitive training thus represents a potentially powerful technique to improve IADL functioning in MA/HIV. Metacognitive training is a cognitive rehabilitation technique that teaches individuals to self-regulate and monitor their thoughts and actions in order to gain control over their learning and behaviors. The proposed dissertation project aims to evaluate the efficacy of a brief metacognitive training module for neurocognitive rehabilitation in MA/HIV individuals with executive dysfunction. Due to the current absence of such techniques in this population, results from this study will inform future development of novel behavioral interventions to improve HAND among MA users. Through the implementation of this research project and the comprehensive training plan outlined in this F31 proposal including close interaction with expert mentors in a successful and collaborative research infrastructure (i.e., HIV Neurobehavioral Research Program), the applicant will enhance her scientific knowledge, research design techniques, and ability to further contribute to the fields of IADL functioning and neurocognitive rehabilitation in neuroAIDS and addictions. The opportunities afforded via this F31 mechanism will significantly contribute to the applicant's intermediate goal of attaining a K23 award focused on the development of empirically-based neurorehabilitation techniques and her long-term goal of becoming an independent neurorehabilitation scientist dedicated to improving the lives of persons living with substance use disorders and HIV infection.

描述（由申请人提供）：甲基苯丙胺（MA）是全世界最常用的非法药物之一，也是传播艾滋病毒感染的主要危险因素。共病 MA 依赖和 HIV 感染 (MA/HIV) 的神经毒性作用优先影响大脑的额纹状体区域，导致 HIV 相关神经认知障碍 (HAND) 的患病率增加，影响高达 60% 的人口，特别是扰乱较高的认知功能。命令执行功能（例如解决问题的能力）。在 HIV 和 MA 中，执行功能障碍都与日常生活工具性活动（IADL；例如药物或财务管理）的依赖有关。尽管手相关残疾（例如失业）的风险和经济负担很高，但目前还没有经过经验验证的技术来 对待MA用户之间的HAND。元认知训练是一种能够有效改善其他执行功能障碍（例如创伤性脑损伤）人群的 IADL 功能的认知康复技术。元认知涉及内省的能力，包括对一个人的日常表现及其后果的准确感知和评估。前额叶系统脑损伤后，元认知通常会受到损害，并且与执行功能的完整性相关；事实上，高达 50% 的艾滋病毒感染者对其认知能力表现出较差的洞察力，这与这些人较差的 IADL 结果直接相关。因此，元认知受损可能代表执行功能障碍影响 MA/HIV 患者成功的 IADL 能力的重要机制。因此，元认知训练代表了一种潜在的强大技术，可以改善 MA/HIV 中的 IADL 功能。元认知训练是一种认知康复技术，教导个人自我调节和监控自己的思想和行为，以控制自己的学习和行为。拟议的论文项目旨在评估简短的元认知训练模块对患有执行功能障碍的 MA/HIV 个体的神经认知康复的功效。由于目前该人群中缺乏此类技术，本研究的结果将为未来开发新型行为干预措施提供信息，以改善 MA 用户的 HAND。通过实施该研究项目以及本 F31 提案中概述的综合培训计划，包括在成功的协作研究基础设施（即 HIV 神经行为研究计划）中与专家导师的密切互动，申请人将增强其科学知识、研究设计技术，以及进一步为神经艾滋病和成瘾的 IADL 功能和神经认知康复领域做出贡献的能力。通过此 F31 机制提供的机会将极大地有助于申请人获得 K23 奖项的中期目标 关于基于经验的神经康复技术的发展以及她成为一名独立的神经康复科学家的长期目标，致力于改善药物滥用障碍和艾滋病毒感染者的生活。