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CTNPT 026: Neuroimaging as a biomarker for cognitive training in HAND

Brain imaging to understand HIV-associated neurocognitive disorder and predict response to cognitive training

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About the study

This study aims to answer three questions. Which magnetic resonance imaging (MRI) techniques:

  1. are most effective at showing the difference between HIV+ people with high and low cognitive ability?
  2. are most effective at predicting the response to an 8-week computerized cognitive training program? (MRI scan at the start of the program)
  3. are most effective at showing the difference between those with a positive response to this program and those whose cognitive ability does not improve? (MRI scan at the end of the program)

About the disease/condition

Poor brain health (cognitive impairment) is a relatively common health concern in those living with HIV. It is now clear that the impact of HIV as a chronic illness can have negative effects on cognition and mental health, even with excellent viral control.

Modern neuroimaging provides us with powerful new ways of analyzing the possible causes of cognitive and mental health changes. This could potentially allow us to predict the risk of mental decline and how effective certain strategies (like computerized cognitive training) are in improving or preserving mental function.

But neuroimaging is a fast-moving field, with new methods and strategies being developed from month to month. The possibilities this creates are exciting, but also make for some challenges: what measures are most suitable? What are some of the effects and how will we predict them? How can we minimize the cost and burden on participants while maximizing what can be learned about brain measures?

Study Approach

The neuroimaging measures will be acquired in two samples taken from an on-going study of brain health in HIV (CTN 273). A total of 80 subjects will be selected from those enrolled in the main cohort. Participants will be enrolled in an 8-week Web-based cognitive training program focused on improving attention and executive function (mental skills helping you with getting tasks done). This intervention will be offered to a randomly selected group with cognitive symptoms and evidence of lower cognitive ability during testing. Some participants will begin this cognitive training immediately while others will begin their training after a waiting period but within 8 weeks of beginning the study.

To achieve the first aim of this study, another twenty subjects without cognitive complaints and with higher cognitive ability during testing will be recruited from the main group of participants. All subjects will have two MRI sessions, about 3 months apart.

Eligibility criteria

Inclusion Criteria:

  • age 35 years or older
  • HIV infection for at least 1 year
  • able to communicate in English or French
  • access to the internet and a computer/tablet
  • capable of providing informed consent

Exclusion Criteria:

  • presence of dementia
  • life expectancy less than three years
  • other neurological disorder including active opportunistic CNS infection
  • psychotic disorder
  • current substance dependence or abuse
  • hepatitis C requiring interferon therapy during the study period.

Participating sites

Montreal Neurological Institute and Hospital (McGill University)
Montreal, Quebec, Canada, H3A 2B4

Lesley K Fellows, MD, DPhil
514-398-8481    lesley.fellows@mcgill.ca

Ana Fernandez, PhDc
514-398-2083    ana.fernandezcruz@mail.mcgill.ca

Additional Information

If you would like more information on this clinical study, please refer to the principal investigator.

Principal Investigator:

Lesley Fellows
Associate Professor
Dept of Neurology & Neurosurgery
Montreal Neurological Institute, McGill University
3801 University St., Montreal, QC
514-398-8911 (office)
lesley.fellows@mcgill.ca

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