A Brief Report of an Executive Functioning Training Pilot RCT in Adults with HIV: A Descriptive Case Comparison Study

Ikenna Obasi Odii,1,2 Hathaichanok Phaowiriya,1,3 Shayla B Brooks,1 Nicholas K Wright,1 Andres Azuero,1 Pariya L Fazeli,1 Junghee Lee,4 Crystal Chapman Lambert,1 Dara L James,5 Emma Sophia Kay,1 David E Vance1 1School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; 2College of Nursing and Health Sciences, Metropolitan State University, Saint Paul, MN, USA; 3Princess Agrarajakumari Faculty of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand; 4Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 5Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USACorrespondence: David E Vance, School of Nursing, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL, USA, Email [email protected] and Purpose: Cognitive intra-individual variability (IIV) refers to the fluctuations observed in cognitive performance. The aim of this article was to characterize and describe for illustrative purposes an approach to administer executive functioning training to people living with HIV (PLWH) to reduce their cognitive IIV. This brief report highlights four cases in an on-going study investigating cognitive IIV in HIV. In HIV, cognitive IIV has been associated with cognitive decline, cortical atrophy, and mortality risk. The Executive Dysfunction Hypothesis suggests improving executive functioning could reduce cognitive IIV.Study Design: In the parent on-going pilot RCT (called the Executive Functioning Training (EFT) Study), 120 PLWH are randomized to either a no-contact control group or an executive functioning training group which receives 20 hours of computerized exercises. To characterize this study, this article describes an interim descriptive case analysis (N = 4) that was conducted with the first two participants who completed training (n = 2) and compared to demographically matched control (n = 2) participants.Results: Using the Connor’s Continuous Performance Test 3rd Edition, results showed improvements in reaction time (Hit RT, by − 24.5 points) and cognitive IIV (HRT SD, Variability, by − 16 points) in the training group compared to the no-contact control group. In other words, the training appeared to reduce cognitive IIV.Conclusion: This finding suggests that by improving executive functioning through executive functioning training, this may stabilize cognitive functioning in general, as indicated by reduced cognitive IIV. Although preliminary, these encouraging results support the Executive Dysfunction Hypothesis and suggests further exploration of cognitive IIV may provide insights on how to improve cognition in aging PLWH. Implications for neuroscience nursing are provided.Plain Language Summary: People living with HIV (PLWH) may experience more cognitive fluctuation which interferes with performing instrumental activities of daily living (IADLs). When our cognitive abilities fluctuate a lot, a phenomenon called cognitive intra-individual variability, this can affect how well we perform everyday activities such as driving a car or paying attention to a TV program. In fact, cognitive fluctuation can impact whether an activity is performed correctly or completed at all. If we can reduce cognitive fluctuation, we might be able to improve everyday functioning. We tested whether PLWH receiving 20 hours of cognitive training, called executive functioning training, can reduce such cognitive fluctuation. We compared two participants who received the cognitive training to two participants who did not. Those who received the cognitive training had less cognitive fluctuation. Although more participants are needed to determine whether this cognitive training is helpful, these findings are encouraging. Perhaps this cognitive training can reduce cognitive fluctuation and improve everyday functioning such as remembering to take one’s medications or performing an activity.Keywords: HIV/AIDS, cognition, cognitive variability, executive function, executive dysfunction