Two-year clinical trial examining the effects of speed of processing training on everyday functioning in adults with human immunodeficiency virus-associated neurocognitive disorder (HAND) and borderline HAND in the U.S. Deep South: Findings of the Think Fast Study

Abstract

Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient’s Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen’s d) ranging 0.13–0.41 for MAQ and 0.02–0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.