HIV-Associated Neurocognitive Decline Aided by Speed of Processing Training

As people living with HIV begin to age, their risk of developing HIV-associated cognitive decline increases. A specific training program to help patients with HIV with speed of processing (SOP) may help stall those effects.

Speed of processing (SOP) training has the potential to protect and/or improve daily functional capacity among the aging population with HIV, according to research presented by David E. Vance, PhD, MGS, at the Association of Nurses in AIDS Care (ANAC) annual meeting held November 17 to 19, 2022, in Tampa, Florida.1

Up to 50% of people living with HIV (PLWH) develop HIV-associated neurocognitive disorder (HAND) as they age.2 Neurocognitive decline is caused by HIV-induced systemic inflammation, which leads to cognitive impairment and decreased quality of life. The population of PLWH in the United States is aging and in 2030, the proportion of PLWH who are older than 50 years is projected to be 70%, indicating that strategies for preventing and treating HAND are urgently needed, explained Dr Vance, who is a professor of nursing at the University of Alabama at Birmingham.

Table. Criteria for HAND

TypeDiagnostic Criteria
Asymptomatic>1 SD below the normative mean in at least 2 cognitive domains
No impairment in daily function
Mild>1 SD below the normative mean in at least 2 cognitive domains
Mild to moderate interference in activities of daily living
HIV-associated dementia>2 SD the normative mean in at least 2 cognitive domains
Marked interference in activities of daily living
HAND, HIV-associated neurocognitive decline; SD, standard deviation.
Source: Fazeli PL, Marceaux JC, Vance DE, Slater L, Long CA.  J Neurosci Nurs. 2011;43(1):36-50.

To evaluate whether SOP training may improve or protect against negative cognitive effects of HAND, investigators from the University of Alabama at Birmingham recruited PLWH (N=216) aged older than 40 years who had HAND. The participants were randomized in a 1:1:1 ratio to receive less intensive (n=70), more intensive (n=73), or sham (n=73) SOP training. The less intensive training included 10 1-hour active sessions, the more intensive training included 20 1-hour active sessions, and the control condition included 10 1-hour sham sessions delivered over 10 weeks. Useful field of view (UFOV) was evaluated at baseline and at 11 to 12 weeks, 1 year, and 2 years postintervention.

The mean age was similar in the 3 cohorts (range, 50.1-51.5 years) and approximately 60% of each cohort were men. The majority (82%-83%) of participants in each cohort were categorized as “non-White” and were prescribed antiretroviral therapy (87%-90%). Participants had been living with HIV for 14 to 18 years.

For patients concerned about protecting their cognition as they age, SOP training represents one approach to recommend.

Compared with the control group, improvement in UFOV was significantly greater in the less intensive SOP training group (mean difference [MD], 91.46; P =.002) and an even greater improvement was observed among the more intensive SOP group (MD, 139.12; P <.001). Although a greater improvement was found with more intensive SOP training, the effect was not doubled; thus, the relationship between SOP and UFOV was not dose-dependent. When outcomes in the active intervention groups were compared, the more intensive group tended to have a greater improvement in UFOV, but the difference was not significant (MD, 47.66; P =.09).

At 1 and 2 years postintervention, UFOV total scores did not differ significantly among the active intervention recipients compared with participants in the control group. However, the more intensive SOP training continued to have a small to medium effect at 2 years compared with the control arm (difference between paired data, 0.32).

The major limitation of this study is the lack of validated instruments for assessing cognitive status, the study authors noted.

These data indicated that SOP training may protect or improve cognitive functioning among PLWH as they age. Poor SOP is predictive of poor cognitive trajectory, vehicle driving, everyday functioning, and quality of life in patients with and without HIV, the study authors explained.

“For patients concerned about protecting their cognition as they age, SOP training represents one approach to recommend,” the study authors concluded.

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This article originally appeared on Clinical Advisor

References:

1. Vance DE, Fazeli PL, Azuero A, et al. Speed of processing training improves visual attention and speed of processing in aging adults with HIV-associated neurocognitive disorder: results of a 2-year longitudinal RCT. Presented at: ANAC2022; November 17-19, 2022; Tampa, FL.

2. Fazeli PL, Marceaux JC, Vance DE, Slater L, Long CA. Predictors of cognition in adults with HIV implications for nursing practice and research. J Neurosci Nurs. 2011;43(1):36-50.