Building Resources to Assess Impaired Neurocognition for Care and Research among Adults Aging with HIV (BRAIN Care HIV)

建立资源来评估神经认知受损，以促进老年艾滋病毒感染者的护理和研究（BRAIN Care HIV）

• 批准号: 10756384
• 负责人: Reuben N Robbins
• 金额: $ 22.97万
• 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: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10756384
• 关键词: Adolescent; Adult; Affect; Age; Aging; Behavioral; Big Data; Brain; Caring; Chronic; Clinical; Clinical Research; Computer Literacy; Country; Data; Data Set; Decision Making; Detection; Development; Disease; Elderly; Evaluation; Face; General Population; HIV; HIV Infections; HIV-associated neurocognitive disorder; Human immunodeficiency virus test; Immune response; Impairment; Income; Inflammation; Inflammatory; Institution; Interdisciplinary Study; Internet; Intervention; Knowledge; Language; Machine Learning; Malaysia; Malaysian; Measures; Medical; Multilingualism; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychology; Participant; Pathogenesis; Patients; Persons; Phenotype; Population; Prevalence; Prevention; Provider; Psychometrics; Psychosocial Stress; Research; Research Project Grants; Resources; Risk; Risk Factors; Socioeconomic Factors; South Africa; Statistical Data Interpretation; Tablets; Techniques; Testing; Thailand; Time; Translations; Visit; clinical care; cohort; comorbidity; cost; dementia risk; design; epidemiology study; ethnic diversity; experience; instrument; longitudinal dataset; low and middle-income countries; medication compliance; meetings; mortality; multimodal data; multimodality; neuroAIDS; neurocognitive test; research in practice; sociodemographics; socioeconomics; timeline; tool; usability

Neurocognitive impairment (NCI) is highly prevalent in older (≥50 years) people with HIV (PWH). Older PWH have higher rates of NCI than the general population of the same age; prevalence rates are as high as 50% – even among the virologically controlled. Having NCI is associated with increased mortality, decline in independence, lower medication adherence, poor decision making, and possibly greater dementia risk. The pathogenesis of NCI in HIV is likely multifactorial due to extensive diversity of PWH and factors that affect the brain (e.g., HIV, demographic, socioeconomic, chronic inflammation, comorbidities, and psychosocial stress). This knowledge, however, comes mostly from high-income countries (HICs). Yet, the burden of HIV is greatest in low- and middle- income countries (LMICs) where our understanding of NCI (e.g., prevalence; risk; patient/provider needs) in aging PWH is only just emerging and risk may differ than in HICs. Multimodal phenotypes of NCI risk can help elucidate NCI’s mechanisms and assist in developing more targeted interventions for it. Critical aspects of HIV disease differ between HICs and LMICs (e.g., immune responses, age of patients, duration of HIV infection, type of treatment, and socio-economic factors), but most phenotyping studies have been done with PWH in HICs. We propose to leverage multimodal data (e.g., demographic, medical, inflammation) from a cohort of diverse, aging, and treated PWH in Malaysia from two time points across 4-6 years and add one more time point to develop longitudinal phenotypes of NCI risk – a first for PWH in Malaysia. A pre-requisite, however, is high quality, accurate, unbiased, and valid neurocognitive test data that can be easily collected in any setting and is suitable for cross-study/-country comparisons and Big Data applications. Because few tests meeting these requirements exist in Malaysia, we propose to adapt and preliminarily norm a battery of tests (NeuroScreen) that do. NeuroScreen is brief (~25 minutes), highly automated, easy-to-administer by all levels of staff, disseminated via the internet, designed for adaptation across countries/languages and in harmonized cross-study data sets. It assesses six neurocognitive domains most affected by HIV, and has a growing body of evidence demonstrating that it is unbiased, culturally fair, and psychometrically valid in adolescent and adult populations with HIV and varying levels of computer literacy in multiple countries and languages (US, South Africa, and neighboring Thailand). No testing apps have been adapted and normed for ethnically diverse Malaysians, where the most commonly spoken languages are Bahasa Malaysia, Mandarin, Tamil, and English. Using NeuroScreen’s data will enhance our phenotyping. Moreover, having an easy-to-use and valid tool to measure neurocognition and screen for NCI can enhance research and clinical care for PWH in Malaysia. We will build neuropsychological expertise in Malaysia (where there is little); promote multidisciplinary research into the causes, risks, and detection of NCI in HIV; and expand capacity to use state-of-the-art statistical analyses (i.e., machine learning).

在艾滋病毒（PWH）的年龄较大（≥50岁）的患者中，神经认知障碍（NCI）高度普遍。较老的PWH有 NCI的比率高于同一年龄的一般人群；患病率高达50％ - 甚至 在病毒学控制中。拥有NCI与死亡率的增加有关，独立性下降， 降低药物依从性，决策不力以及可能更大的痴呆症风险。 NCI的发病机理 由于PWH的广泛多样性和影响大脑的因素，HIV中的HIV可能是多因素的（例如，HIV， 人口统计学，社会经济，慢性感染，合并症和社会心理压力）。这个知识， 但是，主要来自高收入国家（HIC）。然而，艾滋病毒的燃烧在低和中间是最大的 收入国家（LMIC）我们对NCI的理解（例如患病率；风险；患者/提供者需求） PWH只是出现的，风险可能与HIC相比。 NCI风险的多模式表型可以帮助阐明 NCI的机制并有助于为其开发更多针对性的干预措施。艾滋病毒疾病的关键方面不同 在HIC和LMIC之间 和社会经济因素），但是大多数表型研究都是在HIC中对PWH进行的。我们建议 从潜水员，老化和处理过的队列中利用多模式数据（例如人口统计学，医学，炎症） 马来西亚的PWH从4 - 6年的两个时间点开始，并增加了一个时间点以发展纵向 NCI风险的表型 - 马来西亚PWH的首次。但是，先决条件是高质量，准确，公正， 以及有效的神经认知测试数据，可以在任何情况下轻松收集，适合跨研究/ - 国家 比较和大数据应用程序。因为在马来西亚很少有满足这些要求的测试，所以我们 提出适应和初步规范的一系列测试（神经扫描）的建议。 Neuroscreen是简短的（〜25 分钟），通过互联网传播的各个级别的员工高度自动化，易于管理 跨国家/语言以及统一的跨研究数据集的适应。它评估了六个神经认知 受艾滋病毒影响最大的领域，并有越来越多的证据表明它是公正的，在文化上是 公平且心理上有效于艾滋病毒和不同计算机水平的青少年和成人人群 多种国家和语言（美国，南非和邻国泰国）的识字能力。没有测试应用程序 适应和规范的马来西亚人，最常见的语言是 马来西亚巴哈萨，普通话，泰米尔语和英语。使用Neuroscreen的数据将增强我们的表型。 此外，拥有一种易于使用和有效的工具来测量NCI的神经认知和屏幕可以增强 马来西亚PWH的研究和临床护理。我们将在马来西亚建立神经心理学专业知识（那里 几乎没有）；促进艾滋病毒中NCI的原因，风险和检测的多学科研究；并扩展 使用最先进的统计分析的能力（即机器学习）。