Abstract
Approximately 50% of older adults with HIV meet the Frascati diagnostic criteria of HIV-associated neurocognitive disorders (HAND) which can interfere with everyday function such as medication adherence, employment, and driving ability, thus reducing quality of life. As the number of older adults with HIV continues to grow, many will become vulnerable to cognitive frailty, especially as they experience multimorbidities, polypharmacy, and geriatric syndromes. Healthcare professionals need strategies to prevent, remediate, and compensate for cognitive losses observed in memory, language, executive functioning, and speed of processing. Sadly, there are no standard protocols or accepted treatment/intervention guidelines to address HAND at this time. Fortunately, evidence from the cognitive aging literature indicates that cognitive training can protect and improve cognition in normal older adults and may even reduce the incidence of dementia/MCI. This article provides the scientific context in which computerized cognitive training approaches have been successfully used in older adults and provides examples of how these approaches have been translated to adults with HIV. Evidence from ongoing clinical trials are also presented that suggest that reversing a diagnosis of HAND may be possible. Recommendations for clinical practice and research are provided.
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Acknowledgments
This study was funded by an NIH/NINR R21 award (1R21NR016632-01; ClinicalTrials.gov (NCT03122288); Vance, Principal Investigator) titled “Individualized-Targeted Cognitive Training in Older Adults with HAND,” by an NIH/NIMH R01 award (1R01MH106366-01A1; ClinicalTrials.gov (NCT02758093); Vance, Principal Investigator) titled “An RCT of Speed of Processing Training in Middle-aged and Older Adults with HIV”), and by a NIH/NIA P30 award (Edward R. Roybal Center for Translational Research in Aging and Mobility; P30 AG022838).
Disclosures
David E. Vance was a consultant for Posit Science, Inc.
All the other authors report no real or perceived vested interest that relates to this article that could be construed as a conflict of interest. David Vance was a paid consultant of Posit Science, Inc. in 2014.
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Vance, D.E., Fazeli, P.L., Cheatwood, J., Nicholson, C., Morrison, S., Moneyham, L.D. (2019). Targeting HIV-Related Neurocognitive Impairments with Cognitive Training Strategies: Insights from the Cognitive Aging Literature. In: Cysique, L.A., Rourke, S.B. (eds) Neurocognitive Complications of HIV-Infection. Current Topics in Behavioral Neurosciences, vol 50. Springer, Cham. https://doi.org/10.1007/7854_2018_80
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