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

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.

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.

Using the Connor's Continuous Performance Test 3^rd 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.

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.