Article of the Month - March 2013
Dr. David Vance’s ability to develop and maintain his vector of research is well illustrated in a recent publication with co-authors from the Departments of Psychology and Medicine (Gerontology) at UAB, Pariya Fazeli, Lesley Ross, Virginia Wadley and Karlene Ball in the Journal of the Association of Nurses in AIDS Care. The article entitled “Speed of processing training with middle-age and older adults with HIV: A pilot study” examines the efficacy and feasibility of using a cognitive remediation therapy which has proven results in improving speed of processing in the geriatric population and applying it to middle-aged patients with HIV who experience similar deficits.
The advent of improved pharmacological therapies (ART) has resulted in a dramatic shift in the age distribution of patients with HIV. Currently, more than 25% of patients with HIV in the United States are aged 50 or older and It is expected that this will increase to nearly 50% by 2015. As a result of both the disease and the treatment, however, patients with HIV are particularly vulnerable to age-related medical and cognitive changes and may experience them at an earlier age than is typical. Cognitive changes in older patients with HIV are particularly important as they influence factors such as adherence to a complex medication regimen, financial management, activities of daily living, and even driving. Speed of processing is one example of a cognitive process that is known to be affected in both the aging and the HIV populations.
Speed of processing training has been used for over a decade in older adults. It has been shown to improve both speed of processing itself and to generalize to other areas of cognition. In addition, older adults who have completed speed of processing training have shown other benefits including improved self-reported health, reduced depression scores, improved performance on activities of daily living and safer driving These benefits have persisted for up to five years following training.
Dr. Vance’s current study involved comparing an intervention group which received speed of processing training to a control group which did not. The intervention consisted of playing four computer games designed to tap speed of processing and visual attention by requiring the participant to identify both central and peripheral stimuli on a computer screen. The games involve four levels of difficulty and automatically adjust either up or down so that players are always near the threshold of their ability. The intervention condition consisted of 22 subjects with a mean age of 51.5 years while the control condition consisted of 24 subjects who did not differ demographically from the intervention group. Both groups of subjects received a brief neuropsychological examination prior to the intervention and again following the training.
Analysis of the neuropsychological test results revealed that subjects who received the speed of processing training showed improvement on the Useful Field of Vistion test (which is a measure of speed of processing) and the Timed Activities of Daily Living test (which is a measure of everyday functioning). Participants also indicated that they felt the training had resulted in useful improvements. In conclusion, cognitive remediation therapies such as speed of processing training are feasible and effective, cost effective and medically acceptable for improving cognitive abilities in HIV patients with neurologic sequelae or accelerated aging. This work reflects Dr. Vance’s vector of research on maintaining and improving cognition in vulnerable populations.