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Detect: A novel device to assess how HIV affects neurocognitive decline and postural instability in older adults at risk for Alzheimer's Disease

Award Number: R01AG062387
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Project Summary/Abstract This application is in response to the NIA’s Strategic Directions Goal D-3, which calls for better tools to assess cognitive function in the clinic, primary care setting, and home environment in order to distinguish persons at risk for developing Alzheimer’s disease (AD) from persons not at risk. Persons living with HIV (PLHIV) are now living well into the age demographic in which they are at increasing risk for developing AD. Because up to 50% of PLHIV experience cognitive impairment from HIV or related factors that often include memory problems, AD may go unidentified in a significant proportion of older PLHIV. There is a pressing need in geriatric neuroHIV for the ability to accurately identify and disentangle HIV- and AD-associated cognitive impairment and predict individuals who are at risk for further cognitive decline. Evidence from epidemiological studies suggests that sensory (e.g., auditory processing) and motor (e.g., balance) impairments are observed more frequently in PLHIV compared to the general population of a similar age and that these impairment may impact the progression of cognitive impairment in PLHIV and in AD. Building on substantial evidence demonstrating that virtual reality is widely accepted among older adults, we propose to use a novel and portable 3-D virtual reality automated tool, called DETECT, to accurately measure cognition decline and changes in postural stability over time in older PLHIV with and without amnestic mild cognitive impairment (aMCI), a precursor to AD. DETECT was developed for rapid and brief cognitive testing in diverse settings, such as busy geriatric HIV clinics or the home, and can accurately discriminate between normal cognition, MCI, and dementia. Additionally, our pilot work indicates that DETECT is a sensitive screening tool for differentiating between normal cognition and HIV-associated neurocognitive disorder (HAND) in PLHIV. The system is also accurate for diagnosing postural instability using a novel technique that obviates the need for standing and ambulation. To expand on this work, we propose a two site (UCSD and Emory) prospective study of 120 older individuals representing three different clinical phenotypes: PLHIV with HAND and aMCI (HAND+/aMCI+), PLHIV with HAND but without aMCI (HAND+/aMCI-), and HIV-uninfected persons with aMCI (HIV-/aMCI+). An empirically-based neuropsychological diagnostic approach will be used to identify aMCI among PLHIV. We will use DETECT to: (Aim 1) compare the determinants of cognitive decline in these groups, and (Aims 2 and 3) understand how non-cognitive functional changes such as postural instability, hearing loss, and central auditory processing dynamically influence cognitive decline in these groups. Our longitudinal study design will allow us to better understand how cognitive change differs over time between these groups of individuals. The long-term goal of this work is to bring rapid, accurate tools that can identify those at increased risk for progression to AD dementia into clinical practice. The eventual adoption of such tools into clinical practice could provide clarity to patients and clinicians, alleviate fears among PLHIV who do not have aMCI, improve efficiency, and guide the triage of individual patients into specific treatment pathways.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2023	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DRIVE	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	000	5	12/7/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $783,107 )
2023	2023	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	000	5	1/6/2023	NON-COMPETING CONTINUATION	$783,107
														Subtotal = $783,107

Issue Date FY: 2022 ( Subtotal = $783,655 )
2022	2022	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	001	4	4/22/2022	NON-COMPETING CONTINUATION	$78,366
2022	2022	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	000	4	12/9/2021	NON-COMPETING CONTINUATION	$705,289
														Subtotal = $783,655

Issue Date FY: 2021 ( Subtotal = $783,090 )
2021	2021	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	001	3	2/10/2021	NON-COMPETING CONTINUATION	$78,311
2021	2021	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	000	3	12/22/2020	NON-COMPETING CONTINUATION	$704,779
														Subtotal = $783,090

Issue Date FY: 2020 ( Subtotal = $782,303 )
2020	2020	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	000	2	12/23/2019	NON-COMPETING CONTINUATION	$704,071
2020	2020	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	001	2	1/23/2020	NON-COMPETING CONTINUATION	$78,232
														Subtotal = $782,303

Issue Date FY: 2019 ( Subtotal = $811,216 )
2019	2019	UNIVERSITY OF CALIFORNIA, SAN DIEGO	9500 GILMAN DR DEPT 621	LA JOLLA	CA	92093	SAN DIEGO	USA	Aging Research	000	1	2/7/2019	NEW	$811,216
														Subtotal = $811,216

Grand Total All Awards = $3,943,371

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Detect: A novel device to assess how HIV affects neurocognitive decline and postural instability in older adults at risk for Alzheimer's Disease

Award Number: R01AG062387

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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