Despite potent combination antiretroviral therapy, cognitive (memory and concentration) problems continue to occur in up to 50% of HIV-infected individuals, especially in older infected individuals, and those who abuse alcohol, marijuana or psychostimulants. Since no effective treatments are available to these individuals with cognitive problems, conservative estimates indicate that the cost of care for these patients could double in the next two decades. To address this urgent problem, this study will use a comprehensive approach (cognitive tests, functional MRI and several biomarkers) to evaluate whether a novel computer-based training program would improve the brain function, especially working memory and attention, in HIV-infected and infected individuals.
The Overall Goals are to perform a double blind placebo-controlled study using Cogmed™ to determine whether this adaptive WM training program will benefit HIV-infected individuals, and whether the investigators can identify individuals who might benefit most from the working memory (WM) training. Lastly, the investigators will explore how brain activation, neuroinflammation and cerebrospinal fluid (CSF) monoamine levels might be related to WM function before and after the training.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
180
12 different computerized visual and spatial Working Memory tasks will be presented at each sessoin. Each session will involve 8 of the 12 tasks, and each subject is required to complete 25 training sessions, 30-40 minutes per day, 4-5 days per week over a 5-8 week period (minimum 20 sessions). The tasks will become more difficult in an "adaptive" manner, which is hypothesized as optimal for learning and training effects.
The same 12 computerized visual and spatial working memory tasks will be presented, but at a fixed ("non-adaptive") and low difficulty level. 5 sessions per week x 5 weeks fora total of 25 sessions (minimum 20 sessions).
University of Maryland School of Medicine
Baltimore, Maryland, United States
Changes in the Improvement Index on Cogmed™
This is generated by the computer training program based on the trained tasks.
Time frame: 1 month after training, and 6 month after training completion
Changes in Performances on near transfer working memory tasks
Verbal working memory and spatial working memory tasks
Time frame: 1 month after training, and 6 month after training completion
Changes in Blood-Oxygenation Level-Dependent Functional MRI Measures
Brain activation during the performance of working memory and attention tasks
Time frame: 1 month after training, and 6 month after training completion
Changes in cognitive performance based on LIM homeobox transcription factor 1 alpha (LMX1A) genotypes (AA vs. GA/GG)
Performance and improvements on cognitive tests may vary at baseline and after training based on LMX1A genotypes
Time frame: Baseline, 1 month after training, and 6 month after training completion
Changes in Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A)
Improvement on BRIEF-A, a self-reported evaluation of the person's executive function during their activities of daily living.
Time frame: 1 month after training, and 6 month after training completion
Changes in Blood-Oxygenation Level-Dependent Functional MRI Measures based on LMX1A genotypes
Brain activation during working memory performance may vary at baseline, 1-month or 6-months based on the different LMX1A genotypes
Time frame: 1 month after training, and 6 month after training completion
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