Towards Objective Metrics to Quantify the Role of HIV and Increasing Cognitive Demand on Instrumental ADLs in People Aging with HIV

制定客观指标来量化艾滋病毒的作用以及艾滋病毒感染者对工具性 ADL 认知需求的增加

• 批准号: 10327136
• 负责人: MICHELLE J. JOHNSON
• 金额: $ 23.24万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10327136
• 关键词: Activities of Daily Living; Acute; Address; Adult; Affect; Age; Aging; Area; Attention; Biological Markers; Brain; Brain region; Chronic; Clinical; Cognitive; Complex; Cross-Sectional Studies; Elderly; Employment; Face; Functional disorder; Goals; Gold; HIV; HIV-associated neurocognitive disorder; Health; Impaired cognition; Impairment; Individual; Intervention; Measures; Medication Management; Memory; Mental Health; Methods; Motor; Motor Activity; Nervous System Trauma; Neurocognitive; Neuropsychology; Outcome; Participant; Patient Outcomes Assessments; Performance; Play; Prevalence; Reporting; Risk; Risk Factors; Robot; Robotics; Role; Series; Stroke; Testing; Upper Extremity; base; central nervous system injury; cognitive function; cognitive task; disability; executive function; experience; functional decline; improved; information processing; innovation; insight; instrumental activity of daily living; mild neurocognitive impairment; motor impairment; neurological rehabilitation; novel; physical symptom; prevent; research clinical testing; robot rehabilitation; social engagement; tool

PROJECT SUMMARY About 37 million people are living with HIV (PLWH) worldwide. As they age and their HIV status becomes more chronic, they face new challenges associated with the chronic management of HIV and experience a range of physical, cognitive, and mental health-related issues that detrimentally impact their ability to perform instrumental activities of daily living (IADLs) such as managing finances and medication management. Studies indicate that 80% of PLWH report experiencing at least one impairment, activity limitation, or social participation restriction while others suggest 50%-70% have a “global” impairment in everyday functioning. While these impairments can be partially attributed to traditional risks factors associated with aging, HIV itself preferentially impacts the frontostriatal regions of the brain, leading to deficits in motor function, attention, information processing, executive function, and memory. Most often these issues are overlooked in HIV and very little attempt is made to rehabilitate them. Our long-term goal is to expand robot-based neurorehabilitation strategies to PLWH. The objective of this proposal is to first objectively quantify the impact of aging with HIV on real-world IADLs. Since IADLs often require both high levels of executive functioning during the performance of motor activities, we also seek to apply a novel robot-based method to study how “IADL-like conditions” characterized by systematically increasing cognitive demand in the executive function affect motor performance in adults aging with HIV as oppose to their counterparts aging without HIV. In Aim 1, we will assess concurrent validity of a novel robot- based motor and cognitive task with existing clinical tools used to predict motor impairment, cognitive impairment and IADL function in older adults living with HIV. 42 participants aging with HIV and controls with varying levels of IADL function will be evaluated using our robot-based task that simultaneously engages motor and cognitive domains and standard clinical test battery. We hypothesize that our new robot-based task will be an objective method that demonstrates concurrent validity with the clinical scales, especially those related to gross and fine upper limb motor impairment, executive function and IADL function. In Aim 2, we will assess interactions between increasing cognitive demand and motor performance in older adults living with HIV and controls without HIV. 59 participants aging with HIV and controls will be evaluated using our novel robot- based task while we will vary cognitive difficulty. We will measure changes in motor performance as a function of increasing levels of task difficulty and HIV status. We hypothesize that the HIV group will demonstrate worse motor performance as the task difficulty increases compared to controls. We will determine if this new task can objectively probe how performance on complex IADLs may suffer with HIV status. This project supports the use of robot-based assessment strategies for fast and objective assessment of cognitive-motor performance and IADL function and provides insight into differences between HIV and age-matched non-HIV controls.

项目概要 全球约有 3700 万人感染艾滋病毒 (PLWH)，随着年龄的增长，他们的艾滋病毒感染状况会变得更加严重。 慢性，他们面临着与艾滋病毒长期管理相关的新挑战，并经历了一系列 身体、认知和心理健康相关问题，痛苦地影响他们演奏器乐的能力 日常生活活动（IADL），例如财务管理和药物管理。 80% 的 PLWH 报告经历至少一种损伤、活动限制或社会参与限制 而其他人则认为 50%-70% 的人的日常功能存在“整体”障碍，而这些障碍可能会存在。 部分归因于与衰老相关的传统风险因素，艾滋病毒本身优先影响 大脑额纹状体区域，导致运动功能、注意力、信息处理缺陷， 大多数情况下，这些问题在艾滋病毒中被忽视，并且很少尝试。 我们的长期目标是将基于机器人的神经康复策略扩展到感染者。 该提案的目标是首先客观地量化艾滋病毒老龄化对现实世界 IADL 的影响。 IADL 在进行运动活动时通常需要高水平的执行功能，我们还 寻求应用一种基于机器人的新颖方法来研究“IADL 样条件”如何系统地表征 执行功能中认知需求的增加会影响艾滋病毒感染者的运动表现 在目标 1 中，我们将评估新型机器人的并发有效性。 基于运动和认知任务以及用于预测运动障碍的现有临床工具， 42 名感染艾滋病毒的老年人和对照组的老年人的损伤和 IADL 功能。 具有不同水平的 IADL 功能将使用我们基于机器人的任务进行评估，该任务同时参与 我们勇敢地面对基于机器人的新任务。 将是一种客观的方法，可以证明与临床量表（尤其是相关的量表）同时有效。 在目标 2 中，我们将评估上肢粗大和精细运动障碍、执行功能和 IADL 功能。 感染艾滋病毒的老年人不断增加的认知需求与运动表现之间的相互作用 将使用我们的新型机器人对 59 名感染 HIV 的老年参与者和对照进行评估。 基于任务，同时我们将改变认知难度，并将运动表现的变化作为函数进行测量。 我们勇敢地面对艾滋病病毒感染者的情况会变得更糟。 与对照相比，随着任务难度的增加，我们将确定这项新任务是否可以提高运动表现。 客观地探讨复杂 IADL 的表现可能会因 HIV 状态而受到影响。该项目支持使用。 基于机器人的评估策略，用于快速客观地评估认知运动表现 IADL 功能并提供对 HIV 和年龄匹配的非 HIV 对照之间差异的深入了解。