Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study

Imaging the translocator protein 18 kDa within cognitive control and declarative memory circuits in virally suppressed people with HIV

OBJECTIVES

Virally suppressed people with HIV (VS-PWH) show heterogeneity in patterns of cognitive dysfunction. To better understand the relationship between the neuroimmune response and cognition, we used PET to image the translocator protein 18 kDa (TSPO). The study examined HIV-serostatus differences in TSPO as well as associations between regional TSPO and select cognitive processes defined using the Research Domain Criteria (RDoC) framework.

DESIGN

Cross-sectional investigation in VS-PWH ( n  = 25) versus HIV-uninfected individuals ( n  = 18) of cognitive control and declarative memory, as well as [ 11 C]DPA-713 PET measures of TSPO within cognitive control and declarative memory regions of interest (ROI).

METHODS

Group differences in [ 11 C]DPA-713 binding ( VT ) in cognitive control or declarative memory regions were examined using linear mixed models. Tests of associations between factor-derived cognitive system measures and PET measures were performed, controlling for TSPO genotype.

RESULTS

There were no group differences in any of the four factor-derived cognitive system measures. VS-PWH had higher log [ 11 C]DPA-713 VT across cognitive control regions [unstandardized beta coefficient reflecting mean difference [ B ] = 0.23, SE = 0.11, 95% confidence interval (CI) 0.01-0.45, P  = 0.04] and declarative memory regions ( B   =  0.24, SE = 0.11, 95% CI 0.02-0.45, P  = 0.03). Higher log [ 11 C]DPA-713 VT in cognitive control regions related to poorer cognitive control in each group, and to worse self-reported cognitive performance in VS-PWH. Log [ 11 C]DPA-713 VT in each declarative memory region did not associate with measured declarative memory.

CONCLUSION

A localized neuroimmune response marked by high TSPO in brain regions that subserve cognitive control may contribute to poorer cognitive control in VS-PWH.

CoGames: Development of an adaptive smartphone-based and gamified monitoring tool for cognitive function in Multiple Sclerosis

AIM

As part of the development of a smartphone-based app for monitoring MS disease activity and progression (dreaMS, NCT05009160), we developed six gamified tests with multiple difficulty levels as a monitoring tool for cognition. This study quantified the relative difficulty between levels and investigated their reliability, ability to depict practice effects, and user acceptance.

METHODS

Healthy volunteers played each game, covering five cognitive domains, twice per day for 11 consecutive days. Linear mixed models determined the relative difficulty of the levels. Spearman's correlation of the two daily repetitions measured test-retest reliability. Difficulty increased daily except for days 2, 6, and 11, when the easiest level ("Beginner") was repeated to estimate practice effects. Participants rated enjoyment and other components of acceptance on a 5-point scale.

RESULTS

We included 82 participants from April to July 2023 in Basel, Switzerland, of which 76 (51 female, age: 40.3 ± 13.9 years, range 18-69) completed the study according to protocol. Generally, mean performances decreased with higher difficulty levels. Across all levels of all games, the median test-retest correlation was 0.825 (range of medians 0.55-0.9). Mean performance in level "Beginner" improved across all games. The mean enjoyment rating was 3.9 (range: 3.1-4.3).

CONCLUSION

Our study showed that the CoGames yield reliable measures across different cognitive domains and difficulty levels and were enjoyable to play. The observed practice effects must be considered, but also indicate sensitivity to change. These results support the hypothesis that adaptive gamified digital tests can serve as a reliable and well-accepted monitoring tool of cognition in PwMS.

Examining acquired brain injury-associated symptoms and fluid-based biomarkers in females surviving intimate partner violence: An observational pilot study protocol

BACKGROUND

Acquired brain injury (ABI), including traumatic brain injury and hypoxic/anoxic injury, presents significant public health concerns; however, existing literature has focused primarily on male populations, such as military personnel and contact sports participants. Sex-related differences in ABI outcomes necessitate focused research due to potential heightened risk and distinct physiological responses among females.

OBJECTIVES

This pilot study aims to explore fluid-based biomarkers for neurological injury and inflammation in females experiencing intimate partner violence (IPV)-related assaults to the head, neck, or face. It seeks to assess the feasibility and acceptability of non-invasive sweat patch collection for biomarker analysis and its association with post-injury symptoms.

DESIGN

This study will be a prospective longitudinal observational pilot study involving approximately 50 participants recruited from two mid-Atlantic-based hospital emergency departments.

METHODS AND ANALYSIS

Participants will undergo clinical interviews, provide blood and sweat samples, and complete questionnaires assessing ABI history, IPV-related symptoms, cognitive function, psychological well-being, and sweat patch acceptability, across three study visits. Screening procedures will identify eligible participants, followed by consent procedures, biosample collection, brain injury and IPV history survey administration, symptom and cognitive function instrument administration, and acute medical record data collection. Analyses will include random effects regression, product moment correlations, and descriptive statistics.

ETHICS

Participants will be informed about the study's purpose, procedures, and potential risks before providing consent. Compensation will be provided for participation, with withdrawal options available. Ethical considerations include ensuring participant confidentiality and addressing psychological disorders beyond exclusion criteria.

DISCUSSION

Understanding fluid-based biomarkers in IPV-related ABI can inform interdisciplinary interventions and precision care models. Findings may facilitate early detection, treatment, and safety planning for affected females, emphasizing the importance of tailored, accessible care for this vulnerable population. Future research should focus on translating these findings into evidence-based practice to improve outcomes for women with ABI, particularly those resulting from IPV.

From Practice to Public Health: Broadening Neuropsychology's Reach & Value-An Introduction to the National Academy of Neuropsychology's 2022 Annual Conference Special Issue

This special issue is centered around presentations from the National Academy of Neuropsychology 2022 Annual Conference. The theme of the conference, "From Practice to Public Health: Broadening Neuropsychology's Reach & Value" is pivotal for the field's future. With an ever-shifting technological landscape and recent changes in clinical practice post-COVID, we are left wondering how neuropsychology will develop. How will we use biomedical and technological advances, such as blood-based Alzheimer's disease biomarkers or passive digital recordings, to improve clinical care and further expand our understanding of disease mechanisms? As neuropsychologists, how can we use our expertise to empirically inform public health policy? The diagnosis and treatment of post-acute sequelae of COVID-19, the identification and characterization of post-pandemic educational setbacks, and the adaptation of new technological and diagnostic advances into clinical practice workflows represent a vital set of new challenges and opportunities poised to disrupt traditional modes of practice. The articles in this special issue convey the role of neuropsychology in addressing these emerging issues and illustrate how and why neuropsychology is well positioned to be at the forefront of clinical practice and scientific advancements.

Selection of cognitive impairment screening tools for longitudinal implementation in an HIV clinical care setting

To address and slow the increasing burden of cognitive impairment in people surviving to older ages with HIV requires longitudinal monitoring of cognition. We conducted a structured literature review to identify peer-reviewed studies employing validated cognitive impairment screening tools in adult populations of people with HIV. We identified three key criteria for selection and ranking of a tool: (a) strength of validity of the tool; (b) acceptability and feasibility of the tool; (c) ownership of the data from the assessment. From our structured review of 105, 29 studies met our inclusion criteria, within which 10 cognitive impairment screening measurement tools were validated in a population of people with HIV. The BRACE, NeuroScreen and NCAD tools were ranked highly when compared with the other seven tools. Additionally, patient population and clinical setting characteristics (such as availability of quiet space, timing of assessment, security of electronic resources, and ease of linkage to electronic health records) were included in our framework for selection of tools. Numerous validated cognitive impairment screening tools are available to monitor for cognitive changes in the HIV clinical care setting, detecting opportunities for earlier intervention to reduce cognitive decline and preserve quality of life.

Assessment of cognitive performance in multiple sclerosis using smartphone-based training games: a feasibility study

BACKGROUND

Cognitive impairment occurs in up to 70% of people with MS (pwMS) and has a large impact on quality of life and working capacity. As part of the development of a smartphone-app (dreaMS) for monitoring MS disease activity and progression, we assessed the feasibility and acceptance of using cognitive games as assessment tools for cognitive domains.

METHODS

We integrated ten cognitive games in the dreaMS app. Participants were asked to play these games twice a week for 5 weeks. All subjects underwent a battery of established neuropsychological tests. User feedback on acceptance was obtained via a five-point Likert-scale questionnaire. We correlated game performance measures with predetermined reference tests (Spearman's rho) and analyzed differences between pwMS and Healthy Controls (rank biserial correlation).

RESULTS

We included 31 pwMS (mean age 43.4 ± 12.0 years; 68% females; median Expanded Disability Status Scale score 3.0, range 1.0-6.0) and 31 age- and sex-matched HC. All but one game showed moderate-strong correlations with their reference tests, (|r_s|= 0.34-0.77). Performance improved in both groups over the 5 weeks. Average ratings for overall impression and meaningfulness were 4.6 (range 4.2-4.9) and 4.7 (range 4.5-4.8), respectively.

CONCLUSION

Moderate-strong correlations with reference tests suggest that adaptive cognitive games may be used as measures of cognitive domains. The practice effects observed suggest that game-derived measures may capture change over time. All games were perceived as enjoyable and meaningful, features crucial for long-term adherence. Our results encourage further validation of adaptive cognitive games as monitoring tools for cognition in larger studies of longer duration.

STUDY REGISTER

ClinicalTrials.gov: NCT04413032.

Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop

People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.