All ETDs from UAB

Advisory Committee Chair

David E Vance

Advisory Committee Members

Michael G Crowe

Pariya F Wheeler

Mirjam-Colette Kempf

Linda D Moneyham

Despina Stavrinos

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

As adults age with HIV, they may encounter challenges with cognitive impairments. Perhaps, the neurobiological effects of HIV, subtle lifestyle changes, and the aging process may negatively influence cognitive functioning. Some cognitive impairments may interfere with everyday functioning and even compromise quality of life. In this dissertation, three articles were presented which focused on the overall theme of HIV and cognition. Article 1, a review of literature published in the Neurobiology of Disease, focused on how HIV affects the brain independently and the synergistic effects of HIV and aging on cognitive health. Also, the article closed with a section on cognitive interventions and future directions for novel cognitive interventions (e.g., transcranial direct current stimulation). Article 1 provided extensive literature that supports the relationship between HIV and cognition, which leads to Article 2 that examined the impact of HIV-related cognitive functioning on everyday outcomes such as proactive coping. Article 2, which was published in the Journal of Neuroscience for Nursing, examined the role of cognitive functioning in predicting proactive coping in middle-aged and older adults with HIV. Given some adults with HIV may incur cognitive damage to prefrontal areas, such damage may negatively influence their executive functioning ability which is necessary to engage in proactive coping behaviors such as planning and problem solving. In this study of 98 adults with HIV, spirituality/religiosity rather than cognitive functioning was found to be a significant predictor of proactive coping. Implications for research and nursing practice are provided. In addition, other everyday outcomes such as sleep quality has shown to be affected in older adults with HIV. Using data from two pilot studies, Article 3 examined the effects of a low current brain stimulation known as transcranial direct current stimulation (tDCS) and speed of processing (SOP) training on sleep quality in older adults (50+) with HIV (n = 33) and without HIV (n = 33). Participants were randomized to receive either tDCS with SOP training or sham tDCS with SOP training. At baseline, adults with HIV had significantly poorer sleep quality and worse performance on the Letter Comparison Test compared to adults without HIV. tDCS or sham tDCS with SOP training did not improve sleep quality in any of the groups; therefore, this finding must be considered when using tDCS in combination with cognitive training to ameliorate sleep quality. Performance on Useful Field of View, a measure of visual SOP and divided attention, improved across all training groups. Perhaps, novel cognitive interventions to improve cognitive functioning may in turn improve everyday outcomes for the growing HIV population, especially as more of them age with the disease.

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