Computerized cognitive training (CCT) programs were associated with improvements in cognitive and daily function among patients with HIV-associated neurocognitive disorder, according to study findings published in JAMA Network Open.
Investigators at Capital Medical University in China searched publication databases through November 2021 for randomized clinical trials (RCT) of CCT in the setting of HIV infection. Among a total of 1245 records, 12 studies met the inclusion criteria. Studies were excluded if they were not associated with HIV infection. Studies that were primarily research protocols, feedback reports, or case reports were also excluded, as well as those that did not report findings of domain interest.
The study researchers included a total of 596 total participants involved in RCTs, of whom 320 received CCT (mean age, 47.5-59.7 years) and 276 were assigned to control groups (mean age, 44.2-60.0 years). Of the participants included in the CCT and control groups, years of completed education were between 8.3 and 14.2 and 9.0 and 14.9 years, respectively. Participants in the control groups received 1 of 3 interventions: placebo, no contact, or other. Among the 9 studies that reported HIV status, CD4+ T-cell counts ranged between 471 and 833 cells/µL and HIV inhibition ratio ranged between 30% and 100%.
The CCT intervention included between 6 and 48 sessions, with each session ranging between 20 and 90 minutes. The CCT intervention differed among various studies (BrainHQ.com, GT Racing 2, Cogmed, Captain’s Log MindPower Builder, InSight) and some combined the intervention with transcranial direct current stimulation (tDCS).
Participants in the control groups received sham tDCS, no contact, nonadaptive working memory training, or nonactive cognitive training. The researchers found that CCT improved abstraction and executive function (standardized mean difference [SMD], 0.58; 95% CI, 0.26-0.91; P <.001; I2, 30%), attention and working memory (SMD, 0.62; 95% CI, 0.33-0.91; P <.001; I2, 43%), memory (SMD, 0.59; 95% CI, 0.20-0.97; P <.001; I2, 48%), motor skills (SMD, 0.50; 95% CI, 0.24-0.77; P <.001; I2, 0%), speed of information processing (SMD, 0.65; 95% CI, 0.37-0.94; P <.001; I2, 13%), and daily function (SMD, 0.44; 95% CI, 0.02-0.86; P <.001; I2, 13%).
They also noted that CCT, however, did not improve sensory and perceptual skills (SMD, 0.06; 95% CI, -0.36 to 0.48; P =.78) or verbal and language skills (SMD, 0.46; 95% CI, -0.07 to 0.99; P =.09; I2, 69%).
In a sensitivity analysis, age had an effect on memory (P =.02), session hours on attention and working memory (P <.001), time since training on abstraction and executive function (P =.02), CD4+ T-cell counts on attention and working memory (P =.03), and HIV inhibition on attention and working memory (P =.03).
This study was limited by the small sample size and the various CCT and control interventions.
Study researchers concluded that despite these limitations, “…preliminary data suggest that CCT can, in principle, improve a broader range of essential functions, including cognitive and daily function” among patients with HIV infection.
Wei J, Hou J, Mu T, et al. Evaluation of computerized cognitive training and cognitive and daily function in patients living with HIV: a meta-analysis. JAMA Netw Open. 2022;5(3):e220970. doi:10.1001/jamanetworkopen.2022.0970