Cognitive Training to Reduce Impulsivity in HIV-infected Cocaine Users

认知训练可减少感染艾滋病毒的可卡因使用者的冲动

基本信息

批准号：
9198077
负责人：
CHRISTINA S MEADE
金额：
$ 22.66万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-01 至 2018-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9198077
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Affect Aging American Area Attention Automobile Driving Behavioral Biological Models Brain Clinical Cocaine Cocaine Users Cognitive deficits Communities Complication Data Decision Making Disease Drug user Educational Intervention Effectiveness Employment Evidence based treatment Funding Gambling Goals HIV HIV Infections HIV risk Health Impulsivity Incidence Individual Informal Social Control Intervention Lead Life Major Depressive Disorder Memory impairment Morbidity - disease rate Neurocognitive Deficit Neurologic Neuropsychology Outcome Participant Persons Pharmaceutical Preparations Population Prevalence Prevention approach Process Research Research Support Resources Rewards Risk Behaviors Risk Reduction Schizophrenia Short-Term Memory Specialist Substance abuse problem System Testing Training Training Activity Training Programs Translations Vulnerable Populations Work addiction clinical practice cocaine use cognitive function cognitive training computerized daily functioning design discount discounting effective therapy executive function experience follow-up high risk improved innovation intervention effect medication compliance mortality neurobehavioral neuroimaging novel pilot trial preference primary outcome programs public health relevance randomized trial secondary outcome sex substance misuse theories transmission process trial design

项目摘要

Project Summary Of the 1.2 million Americans living with HIV, over half experience neurocognitive impairments (NCI) that adversely affect daily living and are predictive of increased morbidity and mortality. HIV-infected individuals who are addicted to stimulant drugs like cocaine are at even higher risk for NCI, which contributes to impulsive decision making, and engage in high rates of risky behaviors that are associated with both poor clinical outcomes and HIV transmission to others. Delay discounting, a key aspect of impulsivity, describes the tendency to devalue a reward as the delay to its receipt increases. Individuals addicted to drugs tend to prefer smaller, immediate rewards over larger, delayed rewards. Excessive discounting is associated with a wide range of other health risk behaviors, including risky sex. The Competing Neurobehavioral Decision Systems model posits that excessive discounting results from greater relative strength of the impulsive system over the executive control system. Our own work suggests that HIV infection modulates the effect of cocaine on brain functioning in the executive control network during delay discounting. Prior research supports a robust association between excessive discounting and working memory impairment. As a core executive function that supports self-regulation, working memory is theoretically an intervention target for HIV risk reduction. Computerized working memory training has been shown to decrease delay discounting in stimulant users, but it has not yet been tested in HIV-infected drug users. The proposed R21 study will test the preliminary efficacy of a computerized cognitive training program to improve working memory and reduce delay discounting in HIV- infected cocaine users. Using a randomized trial design, we will assign 50 participants to either the experimental cognitive training condition or an attention-matched control condition. Participants will complete 16 sessions in 8 weeks, with assessments at baseline, post-training, and 1-month follow-up to evaluate intervention effects. We hypothesize that cognitive training will, relative to the control condition, lead to greater improvements in working memory and reductions in delay discounting. We will also examine change in HIV risk behaviors (cocaine use, risky sex, and medication adherence). Results will support an R01 application for a larger scale trial to rigorously test the impact of cognitive training on HIV-related behavioral and clinical outcomes. This innovative line of research has important translational implications for HIV clinical practice, including dissemination in resource-limited settings with few neuropsychology specialists. This proposal directly advances a high priority topic for AIDS-designated funding by testing a novel treatment for HIV- associated NCI in drug users. By focusing on a high-risk population that continues to drive HIV transmission, this research has strong potential to improve neurobehavioral functioning in HIV-infected persons, and ultimately to reduce the incidence of new HIV infections.

项目概要在 120 万美国人艾滋病毒感染者中，超过一半患有神经认知障碍 (NCI)，对日常生活产生不利影响，并预示着发病率和死亡率增加。 HIV感染者沉迷于可卡因等刺激性药物的人患 NCI 的风险更高，这会导致冲动决策制定，并从事与不良临床相关的高风险行为结果和艾滋病毒传播给他人。延迟贴现是冲动的一个关键方面，它描述了随着收到奖励的延迟增加，奖励贬值的倾向。吸毒成瘾的人往往更喜欢较小的、即时的奖励胜过较大的、延迟的奖励。过度折扣与广泛的一系列其他健康风险行为，包括危险性行为。相互竞争的神经行为决策系统模型认为，过度贴现是由于冲动系统相对强度更大的结果。执行控制系统。我们自己的工作表明，艾滋病毒感染调节可卡因对大脑的影响在延迟贴现期间在执行控制网络中运行。先前的研究支持了强有力的过度贴现与工作记忆损伤之间的关联。作为核心执行职能支持自我调节，理论上工作记忆是降低艾滋病毒风险的干预目标。计算机化工作记忆训练已被证明可以减少兴奋剂使用者的延迟折扣，但是尚未在感染艾滋病毒的吸毒者中进行测试。拟议的R21研究将测试初步疗效计算机化认知训练计划，以改善工作记忆并减少艾滋病毒的延迟贴现受感染的可卡因使用者。使用随机试验设计，我们将 50 名参与者分配到实验认知训练条件或注意力匹配控制条件。参与者将完成 8 周内 16 次课程，包括基线评估、培训后评估和 1 个月的随访评估干预效果。我们假设，相对于控制条件，认知训练将导致更大的工作记忆的改善和延迟贴现的减少。我们还将检查艾滋病毒的变化危险行为（可卡因使用、危险性行为和药物依从性）。结果将支持 R01 申请一项更大规模的试验，旨在严格测试认知训练对艾滋病毒相关行为和临床的影响结果。这一创新研究领域对艾滋病毒临床实践具有重要的转化意义，包括在资源有限且神经心理学专家很少的环境中传播。这个提议通过测试一种新的艾滋病毒治疗方法，直接推进艾滋病指定资金的高度优先主题吸毒者中相关的 NCI。通过关注持续推动艾滋病毒传播的高危人群，这项研究具有改善艾滋病毒感染者神经行为功能的巨大潜力，并且最终减少新发艾滋病毒感染的发生率。