II. Epidemiology
- Common complication in late AIDS
III. Pathophysiology
- Spectrum from subtle deficits to HIV-Associated Dementia
- Higher severity (including Dementia) with decreasing CD4 Counts
- Involves three neurologic domains
- Cognitive (memory, concentration, planning, comprehension)
- Behavioral (apathy, depression, Agitation)
- Motor (Incoordination, unsteady gait, Tremor)
IV. Signs
- Early
- Impaired concentration
- Forgetfulness
- Slowed cognitive function
- Late
- Impaired rapid movements
- Hyperreflexia
- Release reflexes
- Weakness
- Ataxia
- Spasticity
- Bladder and bowel Incontinence
- Myoclonus
V. Differential Diagnosis
- See Dementia Causes
- See Delirium
- Toxoplasmosis
- Progressive Multifocal Leukoencephalopathy (PML)
- Primary Lymphoma
- Meningitis
- Neurosyphilis
- Psychiatric conditions
- Substance Abuse
VI. Imaging: Brain MRI findings
- Cerebral atrophy
-
Patchy, diffuse increased white matter signal intensity
- Excludes other causes
VII. Labs: CSF Exam
- Mildly elevated Protein
- Mild Pleocytosis, predominance of mononuclear cells
VIII. Evaluation
- Montreal Cognitive Assessment (MoCA)
- Neuropsychiatric testing
IX. Management
-
Antiretroviral drugs
- May improve neuropsychiatric performance
- May alleviate symptoms
X. Complications
- Poor compliance with Antiretroviral therapy (with risk of resistance)
- Decreased functional capacity