Computerized Cognitive Training Interventional Sub-Study
Cognitive deficits in HIV may reflect degraded brain network functioning, due to a combination of brain health insults: some generic (aging), some HIV-specific (inflammation, diffuse demyelination and inherent vulnerability that varies across individuals). These deficits can amenable to remediation through cognitive training. In this sub-study, we will make use of Plasticity-based Adaptive Cognitive Remediation (PACR), which applies well-understood techniques derived from brain plasticity and implicit/procedural/perceptual learning to improve the speed and accuracy of information processing, with exercises that are designed to drive generalized improvements. Simultaneously, these exercises heavily engage neuromodulatory systems to re-establish their normal control over learning and memory. As an individual restores these degraded abilities through intensive procedural learning, the encoding of naturalistic information significantly improves, and all resulting declarative memory and cognitive functions based on the quality of that incoming information necessarily improve as well, leading to improvement that generalizes beyond the trained tasks. A subset of 60 HIV+ individuals will be randomly drawn from the main study population, to test the hypothesis that eight weeks of cognitive training (PACR) is feasible and acceptable for people with mild cognitive difficulties related to HIV infection, and will lead to better cognitive performance compared to education on general strategies to improve brain health. The results of this study are expected to be pivotal in generating data to create an optimal training program aimed at stabilizing or improving brain function in HIV infected individuals experiencing cognitive decline.