A pilot study of the effects of internet-based cognitive stimulation on neuropsychological function in HIV disease

Abstract

Purpose: Mild cognitive deficits associated with HIV disease can affect activities of daily living, so interventions that reduce them may have a long-term effect on quality of life. We evaluated the feasibility of a cognitive stimulation program (CSP) to improve neuropsychological test performance in HIV disease.

Methods: Sixty volunteers (30 HIV-infected) participated. The primary outcome was the change in neuropsychological test performance as indexed by the Global Impairment Rating; secondary outcomes included mood (Brief Symptom Inventory subscales) and quality of life rating (Medical Outcomes Survey-HIV) scales.

Results: Fifty-two participants completed all 24 weeks of the study, and 54% of the participants in the CSP group successfully used the system via internet access from their home or other location. There was a significant interaction between usage and study visit such that the participants who used the program most frequently showed significantly greater improvements in cognitive functioning (F(3, 46.4 = 3.26, p = 0.030); none of the secondary outcomes were affected by the dose of CSP.

Conclusions: We found it possible to complete an internet-based CSP in HIV-infected individuals; ease of internet access was a key component for success. Participants who used the program most showed improvements in cognitive function over the 24-week period, suggesting that a larger clinical trial of CSP may be warranted.

Conflict of interest statement

Declarations of Interests

This work was supported in part by funds from the National Institute of Mental Health (MH081723), the National Institute on Aging (AG05133) and the National Institute for Allergy and Infectious Diseases (AI35041). The authors have no other interests to disclose.

Figures

Figure 1

Bar graphs showing the effect of level of exposure to the CSP on Global Impairment in neuropsychological functioning. N.B., the lower the Global Impairment Rating, the better the performance on the neuropsychological tests. Dose, or level of exposure was defined based the total number of stimulation activities completed during the 24 weeks; participants’ scores on this variable were divided into quartiles due to skewness in its distribution. The quartiles ranged from little to no exposure (mean=31.5, SD=7.0, activities completed; this quartile included control group participants for purposes of analyses), low exposure (43.3 (2.7) activities completed), moderate exposure (146.6 (108) activities), and high exposure (545.5 (169) activities). The CSP had its effect in the group with the highest dose, which was the equivalent of at least one session of activities each week for 24 weeks.