Project IMPACT: Improving Memory Performance by Applying Cognitive Training
Condition: Cocaine Use Disorders; HIV
Study type: Interventional

Summary: 
      The purpose of this study is to examine the effects of a cognitive training program in
      persons with Human Immunodeficiency Virus (HIV) infection who have used cocaine. This study
      tests the feasibility and preliminary efficacy of a computerized cognitive training program
      to improve working memory and decrease impulsivity (delay discounting) among HIV-infected
      individuals.
    

Detailed description: 
      Of the 1.2 million Americans living with HIV, over half experience neurocognitive impairments
      (NCI) that adversely affect daily living and are predictive of increased morbidity and
      mortality. HIV-infected individuals who are addicted to stimulant drugs like cocaine are at
      even higher risk for NCI, which contributes to impulsive decision making, and engage in high
      rates of risky behaviors that are associated with both poor clinical outcomes and HIV
      transmission to others. Delay discounting, a key aspect of impulsivity, describes the
      tendency to devalue a reward as the delay to its receipt increases. Individuals addicted to
      drugs tend to prefer smaller, immediate rewards over larger, delayed rewards. Excessive
      discounting is associated with a wide range of other health risk behaviors, including risky
      sex. The Competing Neurobehavioral Decision Systems model posits that excessive discounting
      results from greater relative strength of the impulsive system over the executive control
      system. The investigators' own work suggests that HIV infection modulates the effect of
      cocaine on brain functioning in the executive control network during delay discounting. Prior
      research supports a robust association between excessive discounting and working memory
      impairment. As a core executive function that supports self-regulation, working memory is
      theoretically an intervention target for HIV risk reduction. Computerized working memory
      training has been shown to decrease delay discounting in stimulant users, but it has not yet
      been tested in HIV-infected drug users. The proposed R21 study will test the preliminary
      efficacy of a computerized cognitive training program to improve working memory and reduce
      delay discounting in HIV-infected cocaine users. Using a randomized trial design, the
      investigators will assign 50 participants to either the experimental cognitive training
      condition or an attention-matched control condition. Participants will complete 48 sessions
      in 8 weeks, with assessments at baseline, post-training, and 1-month follow-up to evaluate
      intervention effects. The investigators hypothesize that cognitive training will, relative to
      the control condition, lead to greater improvements in working memory and reductions in delay
      discounting. The investigators will also examine change in HIV risk behaviors (cocaine use,
      risky sex, and medication adherence). Results will support an R01 application for a larger
      scale trial to rigorously test the impact of cognitive training on HIV-related behavioral and
      clinical outcomes. This innovative line of research has important translational implications
      for HIV clinical practice, including dissemination in resource-limited settings with few
      neuropsychology specialists. This proposal directly advances a high priority topic for
      AIDS-designated funding by testing a novel treatment for HIV-associated NCI in drug users. By
      focusing on a high-risk population that continues to drive HIV transmission, this research
      has strong potential to improve neurobehavioral functioning in HIV-infected persons, and
      ultimately to reduce the incidence of new HIV infections.
    

Intervention name(s): Active Cognitive Training (ACT); Control Training (CON)
Intervention type(s): Device; Device
Intervention description(s): Cognitive training games; Cognitive training games
Other intervention name(s): Lumosity; Lumosity
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Working memory; cognitive training; HIV; substance abuse