Mixed Results With Cognitive Training in HIV

Results from 2-year Think Fast Study evaluating a new training approach for people with HIV experiencing neurocognitive disorders were presented at the Association of Nurses in AIDS Care (ANAC) 2023 Annual Meeting in New Orleans, Louisiana.

“Nearly 40% of people with HIV have an associated neurocognitive disorder, which can compromise instrumental activities of daily living and everyday functioning,” David E. Vance, PhD, Professor at the University of Alabama at Birmingham told Medscape Medical News. “So we wanted to see how effective speed processing training could be in this population,” he said.

“We are using speed of processing training to see if we can improve how people think because how people think impacts everyday function,” Vance said.

We are using speed of processing training to see if we can improve how people think because how people think impacts everyday function.

There are different types of speed processing training. One that is especially useful for seniors is Useful Field of View training, which is designed to increase how much information can be processed in one’s visual field.

“Useful Field of View training helps people learn to quickly take in their surroundings. This is important for driving because it helps open up our useful field of view. We may be able to see everything in your environment, but that doesn’t mean that you are actually processing the information in your visual field. This type of speed of processing has been used in older adults to improve their driving and reduce at-fault crashes,” he said.

In previous work, Vance and his team have shown that speed of processing training can enhance the ability of seniors aged 65 years or older who do not have HIV to do everyday activities of daily living.

In the current study, the researchers sought to determine whether speed of processing could produce similar results in people with HIV-associated neurocognitive disorder.

They evaluated 216 people with HIV-associated neurocognitive disorder. They were randomly assigned to one of three groups. Group one received 10 hours of training and group two had 20 hours of training; group three received 10 hours of Internet Navigation Control Training and served as controls.

Participants completed a battery of everyday functioning measures at baseline, immediately after completing the training, and at year 1 and year 2 follow-up.

Participants in both the 10- and 20-hour training groups had better scores on both Medication Adherence and Visual Analog Scale questionnaires than did those in the control group with effects (Cohen’s d) ranging from 0.13 to 0.41 for medication adherence and from 0.02 to 0.43 for visual analogue scale.

“As we hypothesized, speed of processing training improved some indicators of everyday functioning, specifically on measures of medication adherence which is important for sustaining health and survival in adults with HIV,” Vance said. “Unfortunately, these treatment effects were robust for only a short time.”

The treatment effects lasted up to the first follow-up period at 1 year but were not sustained at 2 years. The training also did not transfer to other measures of everyday function.

Disappointing Results

“We didn’t see as robust a training effect on everyday functioning as we had hoped,” Vance said. “The smaller studies that we’ve done in older adults tended to find more effect than we did. We were happy to find some modest improvement in medication adherence, but that faded over time.”

Vance said that they didn’t find the overall effects that they were hoping for, like improvements in Timed Instrumental Activities of Daily Living.

One explanation for the relative lack of effectiveness of speed of processing training could be due to the fact that the study population was younger, and therefore not as impaired cognitively as an older group.

“When we think about people with HIV, sometimes we think these are poor, sick people, and that is really not the case these days,” he said. “These are highly functioning people. Perhaps, if this had been a much older sample, we would have seen an effect.”