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Evaluation of Computerized Cognitive Training and Cognitive and Daily Function in Patients Living With HIVA Meta-analysis
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Evaluation of Computerized Cognitive Training and Cognitive and Daily Function in Patients Living With HIV - PDF
March 3, 2022
The findings of this meta-analysis of pooled data from RCTs suggested that CCT programs were associated with significant improvements in 6 cognitive and daily function domains (including abstraction/executive function, attention/working memory, memory, motor skills, speed of information processing, and daily function) among people living with HIV. Future studies are needed to clarify whether there is a difference in training benefits between CCT programs and to examine the synergistic factors and outcomes of different auxiliary interventions (eg, tDCS or exercise). In addition, more studies are needed to confirm the impact of potential factors and to assess training protocols among a large population of individuals living with HIV who are at risk of developing HAND. Studies in the field of implementation science are especially needed to address the challenge of removing barriers and bringing CCT from scientific research into clinical practice and implementing CCT programs in the real world.
To our knowledge, this meta-analysis of 12 RCTs40-42,44-49,54-56 is the first to assess the association of CCT programs with cognitive and daily function among people living with HIV. Significant improvement was found in daily function and most cognitive domains, with the exception of sensory/perceptual and verbal/language skills, after CCT. Our results revealed no publication bias. The findings of the sensitivity analyses revealed that all pooled effects, with the exception of the memory and verbal/language skills domains, were statistically significant.
Multiple studies involving cognitively healthy adults57 and individuals with Alzheimer disease62 have reported that training benefits extended beyond the cognitive domains assessed after training to include other cognitive domains, and these benefits have transferred to daily function, psychological health, and other higher-order competencies.63,64 We also found an association between CCT and daily function among people living with HIV. Despite the limitations of these training tools,63 preliminary data suggest that CCT can, in principle, improve a broader range of essential functions, including cognitive and daily function.57
Regarding CCT dose, our analyses suggested that better results occurred after longer CCT sessions (ie, >60 minutes), possibly because synaptic plasticity is more likely to occur after 30 to 60 minutes of stimulation.57,66
The findings of the current meta-analysis also provided a better understanding of viral load and current CD4+ T-cell counts among people living with HIV. Those with undetectable viral loads and current CD4+ T-cell counts of more than 500 cells/μL performed better than those with detectable viral loads and lower CD4+ T-cell counts, particularly in the attention/working memory domain.
People living with HIV experience cognitive deterioration, also known as HIV-associated neurocognitive disorder (HAND), despite the widespread use of antiretroviral therapy (ART).1-4 Based on commonly used criteria,5 HAND is diagnosed by assessing 7 cognitive domains, including speed of information processing, sensory and perceptual (sensory/perceptual) skills, memory (learning and recall), attention and working memory (attention/working memory), motor skills, verbal and language (verbal/language) skills, and abstraction and executive function (abstraction/executive function).6,7 A diagnosis of HAND can have substantial consequences for an individual’s daily function.8,9 In addition, HAND has been associated with reduced life satisfaction10-12 and social isolation,13 producing public health and economic burdens worldwide.14,15 With the exception of ART, there is no specific pharmacologic treatment for HAND.16,17
What is CCT - Computerized Cognitive Training ?
The theoretical premise behind CCT is that it can stimulate neuroplasticity.24 From a neuropsychological perspective,25 CCT has the potential to shape brain structure and reorganize function among cognitively healthy older adults26-28 and individuals with Alzheimer disease,29,30 Parkinson disease,31,32 attention deficits,33 and acquired brain injury.34 Furthermore, physiological parameters, including brain metabolism35 and inflammatory,36 hormonal,37 and sleep-related factors,38 may also be transformed through brain plasticity.25 In addition, many studies involving people living with HIV have reported that CCT may reduce the risk of cognitive deterioration in several domains,39 such as working memory,40-43 speed of information processing,40,44 executive function and attention,45-47 and memory (learning and recall).42
This meta-analysis of RCTs found that CCT programs were associated with improvements in cognitive and daily function among people living with HIV. Future studies are needed to design optimal specific training programs and use implementation science to enable the transformation of CCT from a scientific research tool to a real-world clinical intervention.
After receipt of CCT, function significantly improved in 6 of the 8 domains: abstraction and executive function (standardized mean difference [SMD], 0.58; 95% CI, 0.26-0.91; P < .001), attention and working memory (SMD, 0.62; 95% CI, 0.33-0.91; P < .001), memory (SMD, 0.59; 95% CI, 0.20-0.97; P = .003), motor skills (SMD, 0.50; 95% CI, 0.24-0.77; P < .001), speed of information processing (SMD, 0.65; 95% CI, 0.37-0.94; P < .001), and daily function (SMD, 0.44; 95% CI, 0.02-0.86; P = .04). Sensory and perceptual skills (SMD, 0.06; 95% CI, -0.36 to 0.48; P = .78) and verbal and language skills (SMD, 0.46; 95% CI, -0.07 to 0.99; P = .09) did not significantly improve after CCT.
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