Improving Assessment for Neurocognitive Impairment Among Older Adults with Alzheimer's Disease and Related Dementias

改进对患有阿尔茨海默病和相关痴呆症的老年人的神经认知损伤的评估

• 批准号: 10094688
• 负责人: Reuben N Robbins
• 金额: $ 35.36万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-17 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10094688
• 关键词: 15 year old; Academic Medical Centers; Academic achievement; Address; Adherence; Administrative Supplement; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Alzheimer' s disease related dementia; Behavior; Behavioral; Biological; Brain; Brain imaging; CD4 Positive T Lymphocytes; Caring; Cells; Child; Chronic; Clinical; Cognitive; Collaborations; Collection; Computer software; Congenital neurologic anomalies; Decision Making; Development; Diagnosis; Elderly; Employment; Europe; Evaluation; Exposure to; Gold; HIV; HIV Encephalopathy; Health; Health behavior; Healthcare Systems; Hour; Human Resources; Immune; Impairment; Infection; Inflammation; Institutes; Instruction; Language; Letters; Life; Link; Medical; Mental Health; Mentors; Neuraxis; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; New York; Outcome; Paper; Parents; Performance; Perinatal; Pharmaceutical Preparations; Play; Population; Postdoctoral Fellow; Prefrontal Cortex; Psychometrics; Psychosocial Assessment and Care; Puberty; Research; Research Infrastructure; Research Personnel; Resources; Risk; Risk Behaviors; Risk-Taking; Schools; Science; Short-Term Memory; South Africa; South African; Tablet Computer; Tablets; Testing; Training; Translating; Unsafe Sex; Viral Load result; Viral reservoir; Virus Diseases; Youth; attentional control; base; behavioral health; biobehavior; computerized; design; executive function; flexibility; imaging study; improved; low and middle-income countries; mHealth; macrophage; medication compliance; neurocognitive test; neurodevelopment; neuroimaging; peer; performance tests; processing speed; response; stressor; touchscreen; transmission process

South Africa (SA), a resource limited setting with the world’s largest population of people living with HIV, has hundreds of thousands of youth living with perinatally acquired HIV (PHIV) who are rapidly becoming adolescents and young adults. Adolescents with PHIV must contend with the negative effects of life-long viral infection and chronic inflammation on their neurodevelopment, medical status, mental health, and, for many, the demands of lifelong ART adherence – placing them at risk for not achieving these important milestones. Neurocognitive impairment (NCI) is chief among these negative effects. NCI in adolescents with PHIV most commonly affects the neurocognitive domains of working memory, executive function and processing speed, and may be particularly vulnerable to NCI related to the prefrontal cortex, which plays a key role in cognitive flexibility, response inhibition and attentional control (i.e., executive functioning). NCI can affect youth’s ability to perform in and complete school, interact successfully with peers and adults, find employment, initiate and maintain long- term relationships, and function independently. NCI can also interfere with adherence to medication, which is critical in HIV, and increase poor decision-making and greater HIV transmission risk behaviors (e.g., unprotected sex). The first step in addressing NCI adolescents with PHIV is detecting and diagnosing it, but doing so in South Africa is seriously hampered. Few neurocognitive tests exist for the hundreds of thousands of youth with PHIV in SA. The tests that do exist require highly trained personnel to administer and score, take several hours to administer, lack ecological validity to predict real-world outcomes, and many suffer from cultural biases because they were developed for and normed on youth in the US or Europe. Given how overburdened the SA healthcare system is and its reliance on task-shifting various components of care to lay health workers (LHWs), without accurate, clinically useful, and relatively brief neurocognitive tests that can detect NCI and meet the demands of task-shifting in resource-limited settings, adolescents with PHIV in SA will not be assessed, missing opportunities to detect NCI and intervene. This supplement will develop and add two new tests of executive functioning to the NeuroScreen app that is being evaluated in the parent study (R01 HD095256; PI: Robbins), and will strengthen our ability to detect executive functioning problems in youth with PHIV in SA – key neurocognitive domains that may be particularly vulnerable in adolescents with PHIV and are highly related to academic, behavioral and health outcomes.

南非（SA）是一种资源有限的环境 成千上万的年轻人与围产期收购的艾滋病毒（PHIV）一起迅速成为 青少年和年轻人。具有pHIV的青少年必须与终身病毒的负面影响 其神经发育，医学状况，心理健康以及许多人的感染和慢性感染 对终身艺术依从性的需求 - 使他们有没有实现这些重要里程碑的风险。 神经认知障碍（NCI）是这些负面影响的主要作用。 NCI在phiv的青少年中 通常影响工作记忆，执行功能和处理速度的神经认知领域，以及 可能特别容易受到与前额叶皮层相关的NCI的影响，该皮质在认知灵活性中起着关键作用 响应抑制和注意力控制（即执行功能）。 NCI会影响青年的表现能力 完整的学校，与同龄人和成年人成功互动，找到就业，启动和维持长期 术语关系和独立运作。 NCI也可能干扰遵守药物，即 在艾滋病毒中至关重要，增加决策不良和更大的艾滋病毒传播风险行为（例如，未受保护 性别）。解决具有PHIV的NCI青少年的第一步是检测和诊断，但在南方这样做 非洲受到严重阻碍。对于数十万个PHIV的青年，很少有神经认知测试 SA。确实存在的测试需要经过高训练的人员来管理和得分，需要几个小时才能 管理，缺乏生态有效性来预测现实世界的结果，许多人都有文化偏见，因为 它们是为美国或欧洲的青年开发并规范的。鉴于SA Healthcare负担负担如何 系统及其依赖于任务转换各种护理组成部分（LHWS），而没有 准确，临床上有用且相对简短的神经认知测试，可以检测NCI并满足 在资源有限的设置中，任务转换，SA中具有PHIV的青少年将不会评估，机会丢失了 检测NCI和干预。该补充剂将开发并添加两项有关执行功能的新测试 在父母研究（R01 HD095256; PI：Robbins）中评估的Neuroscreen应用程序，并将 增强我们发现SA中PHIV青年的执行功能问题的能力 - 关键的神经认知 在phiv的青少年中可能特别容易受到攻击的领域，并且与学术相关， 行为和健康结果。