PROJECT ABSTRACT People with HIV (PWH) suffer from cognitive impairments known as HIV-Associated Neurocognitive Disorder (HAND). Cognitive impairments in PWH are not fully captured by traditional neuropsychological assessment; instead, more nuanced evaluation requires examining performance within individuals across cognitive domains, called Intra-Individual Variation (IIV). IIV predicts cognitive impairment/decline, altered brain morphology, and neuropathology. Conceptually, IIV results from “executive dyscontrol” or the efficiency with which executive control processes coordinate other cognitive processes/domains. Supported by the Executive Dyscontrol Hypothesis and based on the underlying concept of IIV, cognitive function in PWH can be improved through interventions that strengthen executive functioning so that it can better coordinate the function of other cognitive domains. Computerized cognitive training, widely used in the gerontological literature and in the study team’s prior work, has been demonstrated to target improvement in selected cognitive domains including executive functioning. The current proposal is therefore significant and innovative with its focus on Executive Functioning and IIV in the context of cognitive training in PWH. This feasibility study will use a two-group pre- post experimental design of adults with HAND including: 1) a 20-hours of Executive Functioning Training group (enroll 60, n=48 with attrition), and 2) a no-contact control (enroll 60, n=48 with attrition). Aim 1 – Feasibility: To determine feasibility and acceptability of the intervention (i.e., attrition, feedback). Exploratory Aim 1 – Cognition: Compare adults who receive Executive Functioning Training to those who receive no training to determine whether they improve in global cognitive ability and overall cognitive IIV. This high impact study is innovative in the following ways: 1) This is the first study aimed to reduce cognitive IIV in PWH. 2) This is the first study to use IIV as a guide to target solely executive functioning training to improve global cognitive ability, which may reduce the severity and prevalence of HAND. 3) Over the last decade, the epicenter of HIV has emerged in the Deep South where this study will occur. Most participants in this study will be older PWH who identify as lower SES and/or African Americans and experience HAND symptoms.

PROJECT NARRATIVE Cognitive aging in people with HIV (PWH) is of increasing concern for several reasons: 1) between 52%–59% of PWH experience cognitive impairment known as HIV-Associated Neurocognitive Disorder (HAND) which impacts everyday functioning and quality of life; 2) HAND increases in severity and prevalence with age; and 3) 70% of PWH in the United States will be 50 and older by 2030. Fortunately, cognitive training programs can individually target specific cognitive impairments in PWH and possibly reduce the severity and prevalence of HAND and improve everyday functioning and quality of life. This approach is based around the underlying concept of intra-individual variability as controlled through higher level allocation of cognitive resources, known as executive functioning.