A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States.
David E Vance, Caitlin N Pope, Pariya L Fazeli and 6 others
PMID 34864757WHAT IT FOUND
Computerized cognitive training gave mixed quality-of-life results in adults with HIV-associated neurocognitive disorder.
Depression improved slightly overall, but subgroup results varied, and the trial was too small to prove which training helped.
Key findings
01In the main comparison with no-contact controls, the training group showed a small beneficial effect on depression scores (d = −0.23), while effects on other quality-of-life measures were trivial.
02When compared with matched controls by training domain, results were mixed: delayed spatial memory training showed moderate to large improvements on most quality-of-life measures except depression, while attention training showed small to moderate worsening on self-rated health and physical health.
03Twenty-one participants dropped out, and those who dropped were more likely to have been assigned to training, be younger, have fewer years of education, and report more depressive symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an underpowered pilot, so the study could not draw firm between-group conclusions; the authors state that results apply only to this sample. The sample was small for many subgroup analyses, especially executive functioning training (4 participants), so those estimates varied widely. Twenty-one participants dropped out, and dropouts were more likely to be in the training group, younger, less educated, and more depressed, which may bias results. The randomization ratio changed halfway through the study from 1:1 to 1:1.4 favoring the training group. HIV-associated neurocognitive disorder diagnosis was based only on cognitive test scores, not everyday functioning or comorbidities as in clinical practice. Follow-up was short, with an average interval of 85.25 days between pretest and post-test. Quality-of-life measures were broad but not exhaustive, and cognitive tests and training are not pure domain measures because of spillover. Attrition rate was 19.26%, which may limit generalizability to younger, less educated, or more depressed patients.
Declared interests
The article is reported as NIH extramural supported. Karlene Ball owns stock in Visual Awareness Research Group and Posit Science, companies that market speed of processing training software; Posit Science acquired Visual Awareness, and Ball continues to collaborate on design and testing of these programs as a member of the Posit Science Scientific Advisory Board. Other authors declared no vested interest.
The easy way to misread this
Do not read the small depression improvement or the positive subgroup findings as proof that computerized cognitive training improves quality of life in HIV-associated neurocognitive disorder. The trial's stated primary aim was to reduce cognitive impairment and reverse diagnosis, while this report focuses on quality-of-life indicators. The training package combined software, supervision, and time in the center, and the study was an underpowered pilot with many subgroup comparisons.