Cognitive Training for People With HIV-Associated Neurocognitive Disorder

Segment Description: In an interview at ANAC 2019, Shameka L. Cody, PhD, AGNP-C, assistant professor at Capstone College of Nursing at The University of Alabama, discusses the impact of cognitive training on quality of life outcomes for people with HIV-associated neurocognitive disorder.

Contagion®: Can you discuss the burden of HIV-associated neurocognitive disorder in general and why interventions are needed?

Cody: We have medications that are used to prolong the life of those with HIV. However, despite those medications, there's still problems with cognitive impairment and the amount of forms of cognitive impairment among people living with HIV. And a lot of these kinds of impairments interfere with everyday functioning. And we're talking about everyday tasks like taking medications, driving, employment, and interference with these everyday activities tends to also negatively impact quality of life. So we want to not only improve cognitive function, but we want to help people with HIV age successfully as well as have a great quality of life.

Contagion®: Can you summarize the data presented at ANAC 2019?

Cody: First, we're talking about cognitive training, the different types of cognitive training that's been shown to be effective in people living with HIV. Cognitive training goes all the way back to the largest study in older adults called the active study. And in that study, cognitive training has been shown to improve not just cognitive function in older adults, but also has been transferring to everyday functioning improvements, like driving. And also it has shown to be effective in improving depression, quality of life, health related factors, psychological outcomes, so there's a lot of cognitive as well as non-cognitive gains with cognitive training. And the particular cognitive training we're going to be focusing on is speed of processing training. And so speed of processing is the rate at which you can process information once it's presented to you visually. And we're talking about speed of processing training and how it's been used in people with HIV.

There are a few pilot studies done by Dr. David E. Vance and it has shown that speed of processing has been effective in improving the speed of processing ability in people living with HIV.

Today, we're focusing also on an individualized cognitive training. And that's been driven by a theory that shows that perhaps improvements in speed of processing as well as attention processes may drive some of the improvements in some of the other cognitive areas. So this individualized cognitive training is designed to train the areas in which an individual has a cognitive impairment. If they have impairments in memory, they will have training in memory. If they have impairments in speed of processing, they’ll have particular training for speed of processing. And we're looking at individualized cognitive training in relation to “does it have an effect on general cognitive ability as well as any type of quality of life outcomes?”

Contagion®: Your research is ongoing. Any hypotheses on potential outcomes?

Cody: Speed of processing, again, has shown to improve cognitive ability and there's been non-cognitive gains in older adults with the active study. So, we definitely have seen improvements in older adults with HIV.

There is a case study done by Dr. David E. Vance, looking at speed of processing and adult response. And there are three participants, one participant receive 10 hours of speed of processing over several weeks, and the second participant receive 20 hours of speed of processing training over several weeks, and then the third participant is a no contact control, which means they do not receive speed of processing. And what he and his colleagues found is that the person that received 20 hours of speed of processing no longer met the criteria for HAND [HIV-associated neurocognitive disorders.]

At baseline these three participants met the criteria for HAND but the person that completed 20 hours of speed of processing actually no longer met the criteria for HAND which is promising, that speed of processing may actually reverse symptoms of HAND.