Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada.

INTRODUCTION: HIV-associated neurocognitive disorder (HAND) may affect 30%-50% of people ageing with HIV. HAND may increase stress and anxiety, and impede coping. Psychosocial group therapy may ameliorate HAND's symptoms, yet the ideal intervention is unclear. This protocol outlines a pilot randomised controlled trial (RCT)-designed using community-based participatory research-to pilot cognitive remediation group therapy (CRGT) against an active comparator. METHODS AND ANALYSIS: This is a pilot, parallel design, two-arm RCT that will recruit participants diagnosed with the mild neurocognitive disorder form of HAND from a neurobehavioural research unit at a tertiary care hospital in Toronto, Canada. Eligibility criteria include age ≥40 years, known HIV status for 5+ years, English fluency, able to consent and able to attend 8 weeks of group therapy. Eligible participants will be randomised to one of two treatment arms, each consisting of eight-session group interventions delivered once weekly at 3 hours per session. Arm 1 (novel) is CRGT, combining mindfulness-based stress reduction with brain training activities. Arm 2 (active control) is mutual aid group therapy. The primary outcomes are feasibility, measured by proportions of recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome is intervention fidelity, where content analysis will be used to assess facilitator session reports. A between-group analysis will be conducted on exploratory outcomes of stress, anxiety, coping and use of intervention activities that will be collected at three time points. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Research Ethics Boards of St. Michael's Hospital and the University of Toronto. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study could provide insight into design (eg, recruitment, measures) and intervention considerations (eg, structure, content) for a larger trial to lessen the burden of cognitive decline among people ageing with HIV. TRIAL REGISTRATION NUMBER: NCT03483740; Pre-results.

Impact of social support on cognitive symptom burden in HIV/AIDS.

As many as 50% of people living with HIV/AIDS report cognitive difficulties, which can be associated with objective neuropsychological impairments and depression. A number of studies have demonstrated an association between higher social support and lower rates of depression. Using a cross-sectional design, we examined the role social support may play in attenuating the effects of both neuropsychological status and depression on cognitive difficulties. A total of 357 participants completed a battery of neuropsychological tests, questionnaires about cognitive difficulties and depression, and an interview that included an assessment of perceived level of social support. A multivariate linear regression analysis revealed that higher levels of cognitive symptom burden were significantly associated with depression (P<0.05) while lower levels of cognitive symptom burden were significantly associated with greater social support (P<0.01) and higher level of education (P<0.05). There was a significant interaction between neuropsychological status and depression (P<0.001); the presence of neuropsychological impairment with depression was associated with higher levels of cognitive symptom burden. There was also a significant interaction between social support and depression (P<0.05). Interestingly, social support was also associated with a lower cognitive symptom burden for non-depressed individuals living with HIV/AIDS. These findings have important clinical implications for promoting psychological well-being in persons living with HIV/AIDS. To improve quality of life, it is important to screen for and identify individuals with HIV/AIDS who may be depressed and to intervene appropriately. Further research should examine the potential role of social support interventions in modifying the effects of both depression and neuropsychological status on cognitive symptom burden.

Demographic, clinical, and neurocognitive predictors of quality of life in schizophrenia patients receiving conventional neuroleptics.

We sought to evaluate demographic, clinical, and neurocognitive predictors of self-rated life quality and hospitalization in schizophrenia patients without the potentially cognition-enhancing influence of newer generation neuroleptic medication. A sample of 55 atypical neuroleptic-naive schizophrenia patients was assessed at index and 3 years later. Index neurocognitive measures included general intellectual ability (IQ), executive ability (Wisconsin Card Sorting Test [WCST]), verbal memory (California Verbal Learning Test [CVLT]), and manual dexterity (Purdue Pegboard). These measures, along with demographic (age, sex, education) and clinical (symptoms, prior hospitalizations) variables, were entered into regression equations to predict life quality (Sickness Impact Profile [SIP]) at follow-up, as well as rehospitalization during the 3-year period. Stability data were also analyzed. Demographic and cognitive data predicted subjective quality of life, but not rehospitalization. Changes in memory over time rather than performance levels related to life quality at follow-up. Rehospitalization was related only to demographic data and previous hospital admissions. The findings support the predictive value of selected aspects of neurocognition in relation to a subjective outcome domain in schizophrenia.

Sex differences in verbal memory in schizophrenia patients treated with "typical" neuroleptics.

The relationship between sex and verbal learning and memory was investigated in 70 males and 36 females with a diagnosis of schizophrenia. Ninety-seven percent of the sample was receiving typical neuroleptic medication as treatment and had never received atypical medications. Selected scores from the California Verbal Learning Test (CVLT) [Delis, D.C., Kramer, J.H., Kaplin, E., Ober, B., 1987. The California Verbal Learning Test-Research Edition. Psychological Corporation, New York] were dependent variables in a series of hierarchical multiple regression analyses. Predictors comprised demographic, clinical and general cognitive measures. Sex was the most powerful predictor of both cumulative learning (Trial A5 recall) and the absolute number of words recalled after 20 min (Long-Delay Free Recall), accounting for 14% and 16% of score variance, respectively. Chlorpromazine-equivalent dose was negatively related to learning and recall. However, recall savings (Percent Retention) was unrelated to any predictor. This pattern of results parallels sex differences observed in the general population, albeit at a lower overall level of performance and with the suggestion of greater relative deficit in males. Schizophrenia does not eliminate and may even increase the advantage women demonstrate over men in some aspects of verbal memory.