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 (<i>n</i> = 70); (2) 20 h of SOP training (<i>n</i> = 73); or (3) 10 h of an active control training (<i>n</i> = 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.

研究目标：随着人类免疫缺陷病毒感染者（People with HIV, PWH）年龄增长，相较于血清阴性对照人群，其罹患认知障碍的风险显著升高。尽管加工速度（Speed of Processing, SOP）训练或可改善此类认知能力，但目前针对该训练向其他认知领域迁移效应的研究仍较为匮乏。本研究旨在探讨40岁及以上HIV感染者中，加工速度训练对次级认知领域的影响。

研究方法：本研究为一项3组、为期2年的纵向研究，共纳入216名伴人类免疫缺陷病毒相关性神经认知障碍（HIV-associated neurocognitive disorder, HAND）或边缘性HAND的HIV感染者，按随机原则分为三组：(1) 10小时加工速度训练组（n=70）；(2) 20小时加工速度训练组（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年时均接受全面认知功能测评。该测评工具可生成全局认知及特定认知领域的T值，以及认知障碍评估变量。本研究采用广义线性混合效应模型，以校正基线水平的方式估算各随访时间点的组间均值差异。

研究结果：所有认知结局指标均未出现具有临床或统计学意义的显著改善。本研究开展了敏感性分析，除两项指标外，其余结果与主分析一致：在训练结束即刻的测评中，干预组的全局功能T值与精神运动速度T值较对照组出现了具有临床意义的训练获益。

研究结论：尽管既往研究表明加工速度训练可改善与驾驶及运动能力相关的认知能力，但此类训练在改善伴HAND的HIV感染者其他认知领域的治疗效用较为有限。