A 2-year longitudinal randomized controlled trial examining the transfer of speed of processing training to secondary cognitive domains in middle-aged and older adults with HIV-associated neurocognitive disorder: Results of the think fast study

Objective: As people with HIV (PWH) age, they are at-risk of developing cognitive impairments compared to their seronegative counterparts. Although speed of processing (SOP) training may help improve this cognitive ability, less work has examined transfer to other cognitive domains. This study examined the effect of SOP training has on secondary cognitive domains in PWH aged 40+ years. Method: In this 3-group 2-year longitudinal study, 216 PWH with HIV-associated neurocognitive disorder (HAND) or borderline HAND were randomized to either: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of an active control training (n = 73). Participants completed a comprehensive cognitive battery at baseline, immediately after training, and at 1 and 2 years. This battery yielded global and domain specific T-scores as well as a cognitive impairment variable. Generalized linear mixed-effect models were fitted to estimate between-group mean differences at the follow-up time-points adjusted for baseline. Results: No clinically or statistically significant improvements in any of the cognitive outcomes were observed. A sensitivity analysis was conducted; conclusions replicated those of the main analysis, with two exceptions: Global Function T and Psychomotor Speed T showed relevant training improvements among the intervention groups over the control group at the immediate post time point. Conclusions: Although SOP training has been shown to improve cognitive abilities that correspond to driving and mobility, such training has limited therapeutic utility in improving cognition in other domains in PWH with HAND.

研究背景与目的：随着人类免疫缺陷病毒（HIV）感染者（People with HIV, PWH）年龄增长，相较于血清学阴性对照人群，其发生认知障碍的风险显著升高。尽管信息处理速度（Speed of Processing, SOP）训练或可改善该认知能力，但针对该训练向其他认知领域迁移效果的相关研究仍较为匮乏。本研究旨在探讨SOP训练对40岁及以上HIV感染者次级认知领域的影响。

研究方法：本研究为三分组、为期2年的纵向队列研究，共纳入216名确诊HIV相关神经认知障碍（HAND）或边缘性HAND的HIV感染者，按1:1:1比例随机分为三组：(1) 10小时SOP训练组（n=70）；(2) 20小时SOP训练组（n=73）；(3) 10小时主动对照训练组（n=73）。所有受试者在基线、训练结束即刻、随访1年及2年时完成一套全面的认知评估电池，该评估可生成整体认知及领域特异性T评分，同时纳入认知障碍变量。采用广义线性混合效应模型（Generalized linear mixed-effect models），以基线值为协变量，估算各随访时间点各组间的平均组间差异。

研究结果：未观察到任何认知结局指标存在临床或统计学意义上的显著改善。随后开展敏感性分析，结果与主要分析基本一致，仅存在两处例外：在训练结束即刻的随访节点，干预组的整体功能T评分与精神运动速度T评分较对照组出现了具有临床意义的训练获益。

研究结论：尽管既往研究已证实SOP训练可改善与驾驶及运动能力相关的认知能力，但该训练在改善合并HAND的HIV感染者其他认知领域的治疗效用较为有限。