Interventions for Symptom Management in Older Patients with HAND

AIM I: Using a RCT design, we will test the efficacy of Mindfulness Based Stress Reduction (MBSR) vs. standard of care control to improve four HAND-associated symptoms (poor attention, stress, anxiety, and depressive symptoms), executive functioning and quality of life. We will target PLWH age 60 and above with undetectable plasma HIV RNA who suffer from HAND and have no targeted treatment options. Hypothesis: MBSR will reduce the symptom burden and have a positive influence on everyday function, executive functioning and quality of life. AIM II: Using a RCT design, we will determine if MBSR impacts connectivity of the salience (SAL) and default mode networks (DMN) by ICN analyses using rs-fMRI. We will further determine if the degree of change in ICN correlates to improved attention and executive functioning on neuropsychological tests. Hypotheses: MBSR will result in measurably improved connectivity of the SAL and DMN. The degree of improvement will directly correlate to improvement on the neuropsychological testing measures. SECONDARY AIM: We will investigate factors that influence the magnitude of the effects seen with MBSR. Hypotheses: The quality of social support and loneliness (potential moderators) and change in positive and negative affect and mindfulness (potential mediators) will impact the strength of our observed effect.