Executive Functioning Training for Reducing Cognitive Intra-Individual Variability in People Living with HIV: A Pilot Randomized, Controlled Trial Protocol.

Abstract

Background and purpose: Cognitive training programs have been attempted to improve cognition in cognitively vulnerable people living with HIV (PLWH). Some have attempted to improve episodic memory or speed of processing, while others have used an individualized cognitive domain approach targeting each person's cognitive deficits. Although effective, none of these approaches considered the influence of cognitive intra-individual variability (IIV). Cognitive IIV refers to the fluctuations in one's individual cognitive ability across cognitive domains (dispersion) or within the same test (inconsistency). Greater cognitive IIV predicts cognitive decline as well as decreased cognitive integrity and increased neuropathology. Some neuroscientists posited that poor executive functioning, known as the Executive Dyscontrol Hypothesis, increases cognitive IIV. Thus, if we can improve executive functioning, we may be able to decrease cognitive IIV and improve overall cognitive functioning. This article provides the rationale and protocol for a feasibility clinical trial examining an executive functioning training intervention in middle-aged and older PLWH.

Study design: This study utilizes a two-arm baseline/posttest experimental design to examine the primary aim 1 (feasibility and acceptability) and the exploratory aim 1 (cognition) in 120 community-dwelling PLWH aged 40 and older. Participants will be randomized into one of the two arms: 1) 20 hours of computerized executive functioning training group, or 2) a no-contact control group. The proposed training time is 10 to 12 weeks (1 to 2 one-hour training sessions/week, while working around participants' schedules). At baseline and posttest, participants will receive a 1.5 to 2-hour assessment that includes many measures including the Connor's Continuous Performance Test (Version 3), and a 50-minute self-administered computerized cognitive performance battery (BRACE+ = BrainBaseline Assessment of Cognition and Everyday Functioning).

Conclusion: This study tests an innovative intervention designed to reduce cognitive IIV; to our knowledge, no other study has targeted cognitive IIV as an intervention outcome.