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Targeting HIV-Related Neurocognitive Impairments with Cognitive Training Strategies: Insights from the Cognitive Aging Literature

  • David E. VanceEmail author
  • Pariya L. Fazeli
  • John Cheatwood
  • Chance Nicholson
  • Shannon Morrison
  • Linda D. Moneyham
Part of the Current Topics in Behavioral Neurosciences book series


Approximately 50% of older adults with HIV meet the Frascati diagnostic criteria of HIV-associated neurocognitive disorders (HAND) which can interfere with everyday function such as medication adherence, employment, and driving ability, thus reducing quality of life. As the number of older adults with HIV continues to grow, many will become vulnerable to cognitive frailty, especially as they experience multimorbidities, polypharmacy, and geriatric syndromes. Healthcare professionals need strategies to prevent, remediate, and compensate for cognitive losses observed in memory, language, executive functioning, and speed of processing. Sadly, there are no standard protocols or accepted treatment/intervention guidelines to address HAND at this time. Fortunately, evidence from the cognitive aging literature indicates that cognitive training can protect and improve cognition in normal older adults and may even reduce the incidence of dementia/MCI. This article provides the scientific context in which computerized cognitive training approaches have been successfully used in older adults and provides examples of how these approaches have been translated to adults with HIV. Evidence from ongoing clinical trials are also presented that suggest that reversing a diagnosis of HAND may be possible. Recommendations for clinical practice and research are provided.


Cognitive aging Cognitive efficiency Cognitive training HIV/AIDS NeuroHIV Neuroplasticity 



This study was funded by an NIH/NINR R21 award (1R21NR016632-01; (NCT03122288); Vance, Principal Investigator) titled “Individualized-Targeted Cognitive Training in Older Adults with HAND,” by an NIH/NIMH R01 award (1R01MH106366-01A1; (NCT02758093); Vance, Principal Investigator) titled “An RCT of Speed of Processing Training in Middle-aged and Older Adults with HIV”), and by a NIH/NIA P30 award (Edward R. Roybal Center for Translational Research in Aging and Mobility; P30 AG022838).


David E. Vance was a consultant for Posit Science, Inc.

All the other authors report no real or perceived vested interest that relates to this article that could be construed as a conflict of interest. David Vance was a paid consultant of Posit Science, Inc. in 2014.


  1. Antinori A, Arendt G, Becker JT et al (2007) Updated research nosology for HIV-associated neurocognitive disorder. Neurology 69(18):1879–1799. Scholar
  2. Ball KK, Vance DE (2007) Everyday life applications and rehabilitation of processing speed deficits: aging as a model for clinical populations. In: DeLuca J, Kalmar J (eds) Information processing speed in clinical populations. Taylor & Francis, New York, pp 243–263Google Scholar
  3. Blackstone K, Moore DJ, Franklin DR et al (2012) Defining neurocognitive impairment in HIV: deficit scores versus clinical ratings. Clin Neuropsychol 26(6):894–908. Scholar
  4. Cody SL, Vance DE (2016) The neurobiology of HIV and its impact on cognitive reserve: a review of cognitive interventions for an aging population. Neurobiol Dis 92(part B):144–156. Scholar
  5. Cody SL, Fazeli PL, Vance DE (2015) Feasibility of a home-based speed of processing training program in middle-aged and older adults with HIV. J Neurosci Nurs 47(4):247–254. Scholar
  6. Edwards JD, Xu H, Clark DO et al (2017) Speed of processing training results in lower risk of dementia. Alzheimers Dement 3:603–611. Scholar
  7. Edwards JD, Fausto BA, Tetlow AM et al (2018) Systematic review and meta-analyses of useful field of view cognitive training. Neurosci Biobehav Rev 84:72–91. Scholar
  8. Fazeli PL, Woods AJ, Pope CN et al (2018) The effect of transcranial direct current stimulation combined with cognitive training on cognitive functioning in older adults with HIV: a pilot study. Appl Neuropsychol Adult., epub ahead of print.
  9. Fellows RP, Byrd DA, Morgello S (2014) Effects of information processing speed on learning, memory, and executive functioning in people living with HIV/AIDS. J Clin Exp Neuropsychol 36(8):806–817. Scholar
  10. Fristoe NM, Salthouse TA, Woodard JL (1997) Examination of age-related deficits on the Wisconsin Card Sorting Test. Neuropsychology 11(3):428–436Google Scholar
  11. Goodkin K, Miller EN, Cox C et al (2017) Effect of ageing on neurocognitive function by stage of HIV infection: evidence from the Multicenter AIDS Cohort Study. Lancet HIV 4:e411–e422. Scholar
  12. Hossain S, Fazeli PL, Tende F et al (2017) The potential of computerized cognitive training on HIV-associated neurocognitive disorder: a case comparison study. J Assoc Nurses AIDS Care 28(6):971–976. Scholar
  13. Kinai E, Komatsu K, Sakamoto M et al (2017) Association of age and time of disease with HIV-associated neurocognitive disorders: a Japanese nationwide multicenter study. J Neurovirol 23(6):864–874. Scholar
  14. Lampit A, Hallock H, Valenzuela M (2014) Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers. PLoS Med 11(11):e1001756. Scholar
  15. Meneses K, Benz R, Ball JR et al (2018) Speed of processing training in middle-aged and older breast cancer suriviors (SOAR): results of a randomized controlled pilot. Breast Cancer Res Treat 168(1):259–267. Scholar
  16. Ngandu T, Lehtisalo J, Solomon A et al (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomize control trial. Lancet 385(9984):2255–2263. Scholar
  17. Rebok GW, Ball K, Guey LT et al (2014) Ten-year effects of advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc 62:16–24. Scholar
  18. Rojas GJ, Villar V, Iturry M et al (2013) Efficacy of a cognitive intervention program in patients with mild cognitive impairment. Int Psychogeriatr 25(5):825–831. Scholar
  19. Ross LA, Edwards JD, O’Connor ML et al (2016) The transfer of cognitive speed of processing training to older adults’ driving mobility across 5 years. J Gerontol B Psychol Sci Soc Sci 71(1):87–97. Scholar
  20. Salthouse TA (1996) Constraints on theories of cognitive aging. Psychon Bull Rev 3:287–299. Scholar
  21. United States Senate Special Committee on Aging (2013) Hearing: Older Americans: the changing face of HIV/AIDS in America. In: One Hundred Thirteenth Congress, First Session, WashingtonGoogle Scholar
  22. Valcour V, Shikuma C, Shiramizu B et al (2004) Age, apolipoprotein E4, and the risk of HIV dementia: the Hawaii Aging with HIV Cohort. J Neuroimmunol 157(1–2):197–202. Scholar
  23. Vance DE, Farr K, Struzick TC (2008) Assessing the clinical value of cognitive appraisal in adults aging with HIV. J Gerontol Nurs 34(1):36–41. Scholar
  24. Vance DE, Fazeli PL, Ross LA et al (2012) Speed of processing training with middle-age and older adults with HIV: a pilot study. J Assoc Nurses AIDS Care 23(6):500–510. Scholar
  25. Vance DE, Fazeli PL, Moneyham L et al (2013) Assessing and treating forgetfulness and cognitive problems in adults with HIV. J Assoc Nurses AIDS Care 24(1S):S40–S60. Scholar
  26. Vance DE, Cody SL, Moneyham L (2017a) Remediating HIV-associated neurocognitive disorders via cognitive training: a perspective on neurocognitive aging. Interdiscip Top Gerontol Geriatr 42:173–186. Scholar
  27. Vance D, Fazeli P, Shacka J et al (2017b) Testing a computerized cognitive training protocol in adults aging with HIV-associated neurocognitive disorder: an RCT in the Southern United States. J Med Internet Res 6(4):e68. Scholar
  28. Vance DE, Frank JS, Bail J et al (2017c) Interventions for cognitive deficits in breast cancer survivors treated with chemotherapy. Cancer Nurs 40(1):e11–e27. Scholar
  29. Vance DE, Fazeli PL, Azuero A et al (2018a) Can computerized cognitive training reverse the diagnosis of HIV-associated neurocognitive disorder? A research protocol. Res Nurs Health 41(1):11–18. Scholar
  30. Vance DE, Jensen M, Tende F et al (2018b) Individualized-targeted computerized cognitive training to treat HIV-associated neurocognitive disorder: a case comparison study. J Assoc Nurses AIDS Care 29(4):604–611. Scholar
  31. Vance DE, Fazeli PL, Cheatwood J et al (2019) Computerized cognitive training for the neurocognitive complications of HIV infection: a systematic review. J Assoc Nurses AIDS Care 30(1):51–72Google Scholar
  32. Wadley VG, Benz RL, Ball KK et al (2006) Development and evaluation of home-based speed of processing training for older adults. Arch Phys Med Rehabil 87:757–763. Scholar
  33. Wang P, Liu HH, Zhu XT et al (2016) Action video game training for healthy adults: a meta-analytic study. Front Psychol 7:907. Scholar
  34. Weber E, Woods SP, Kellogg E et al (2012) Self-generation enhances verbal recall in individuals with HIV. J Int Neuropsychol Soc 18(1):128–133. Scholar
  35. Wickens CD, Hollands JG, Bandbury S et al (2013) A model of human information processing. In: Engineering psychology and human performance. Pearson, Upper Saddle RiverGoogle Scholar
  36. Wolinsky FD, Vander Weg MW, Howren MB et al (2013) A randomized controlled trial of cognitive training using a visual speed of processing intervention in middle aged and older adults. PLoS One 8(5):e61624. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David E. Vance
    • 1
    Email author
  • Pariya L. Fazeli
    • 1
  • John Cheatwood
    • 1
  • Chance Nicholson
    • 1
  • Shannon Morrison
    • 1
  • Linda D. Moneyham
    • 1
  1. 1.School of NursingUniversity of Alabama at BirminghamBirminghamUSA

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