Two-year clinical trial examining the effects of speed of processing training on everyday functioning in adults with human immunodeficiency virus-associated neurocognitive disorder (HAND) and borderline HAND in the U.S. Deep South: Findings of the Think Fast Study

Abstract

Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient’s Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen’s d) ranging 0.13–0.41 for MAQ and 0.02–0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.

Keywords:

• AIDS
• brain fitness
• cognitive impairment
• cognitive remediation therapy
• cognitive reserve
• cognitive training
• HIV-Associated neurocognitive disorder
• neuroplasticity
• speed of processing

Acknowledgments

Special thanks to our research team, especially Brittany Bradley, Delaney Diehl, Shyla Hossain, Michael Jenson, Peggy McKie, Josiah Robinson, Frida Tende, and Tess Walker.

Disclosure statement

Non-financial Interests – David E. Vance, Pariya L. Fazeli, Andres Azuero, Jennifer S. Frank, Virginia G. Wadley, James L. Raper, and Caitlin N. Pope report no real or perceived vested interest that related to this article that could be construed as a conflict of interest.

Financial Interests – Karlene Ball owns stock in the Visual Awareness Research Group (formerly Visual Awareness, Inc.), and Posit Science, Inc., the companies that market the Useful Field of View Test and speed of processing training software. Posit Science acquired Visual Awareness, and Dr. Ball continues to collaborate on the design and testing of these Assessment and training programs as a member of the Posit Science Scientific Advisory Board.

Research involving human participants and/or animals

Written informed consent was obtained using procedures approved by the investigational review board at each of the collaborating institutions. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Consent to Participate: Informed consent was obtained from all individual participants included in the study.

Consent to Publish: Participants consented that their data would be used in aggregate form for publication purposes.

Additional information

Funding

The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). The following funding is acknowledged: NIH/National Institute of Mental Health R01-award [1R01MH106366-01A1; ClinicalTrials.gov; NCT02758093; PI: Vance] titled “An RCT of Speed of Processing Training in Middle-aged and Older Adults with HIV”; NIH/National Institute on Aging (NIA) R00-award [R00 AG048762; PI: Fazeli], ORWH and NIH/NIDA BIRCWH grant [5K12DA035150; PI: Curry with Pope]; NIH/NIA P30-award (Edward R. Roybal Center for Translational Research in Aging and Mobility; P30 AG022838; PI: Ball).