Ikenna O Odii,1 Hathaichanok Phaowiriya,1,2 Cierra Hopkins,1 Pariya L Fazeli,2 Leah H Rubin,3 Andres Azuero,1 Junghee Lee,4 Shayla B Brooks,
Ikenna O Odii,1 Hathaichanok Phaowiriya,1,2 Cierra Hopkins,1 Pariya L Fazeli,2 Leah H Rubin,3 Andres Azuero,1 Junghee Lee,4 Shayla B Brooks,1 Crystal Chapman Lambert,1 David E Vance1 1School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; 2Princess Agrarajakumari College of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand; 3Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; 4Department of Psychiatry and Behavioral Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USACorrespondence: David E Vance, Email devance@uab.eduBackground 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.Plain Language Summary: Cognitive intra-individual variability (IIV) refers to the fluctuations in one’s individual cognitive ability across cognitive domains or within the same test. Greater cognitive IIV predicts cognitive decline as well as decreased cognitive integrity, increased neuropathology, and even greater mortality. We are using this concept to design cognitive interventions to help people with HIV to age successfully cognitively.Keywords: HIV-associated neurocognitive disorder (HAND), intra-individual variation, brain fitness, cognitive reserve, cognitive training, executive functioning
