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AIDS Dementia Complex
Aka: AIDS Dementia Complex, Dementia in HIV, HIV-Associated Neurocognitive Disorder, HIV-Associated Dementia
- See Also
- Neurologic Manifestations of HIV
- Dementia
- Epidemiology
- Common complication in late AIDS
- 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)
- Signs
- Early
- Impaired concentration
- Forgetfulness
- Slowed cognitive function
- Late
- Impaired rapid movements
- Hyperreflexia
- Release reflexes
- Weakness
- Ataxia
- Spasticity
- Bladder and bowel Incontinence
- Myoclonus
- Differential Diagnosis
- See Dementia Causes
- See Delirium
- Toxoplasmosis
- Progressive Multifocal Leukoencephalopathy (PML)
- Primary Lymphoma
- Meningitis
- Neurosyphilis
- Psychiatric conditions
- Substance Abuse
- Imaging: Brain MRI findings
- Cerebral atrophy
- Patchy, diffuse increased white matter signal intensity
- Excludes other causes
- Labs: CSF Exam
- Mildly elevated protein
- Mild Pleocytosis, predominance of mononuclear cells
- Evaluation
- Montreal Cognitive Assessment (MoCA)
- https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf
- Neuropsychiatric testing
- Management
- Antiretroviral drugs
- May improve neuropsychiatric performance
- May alleviate symptoms
- Complications
- Poor compliance with Antiretroviral therapy (with risk of resistance)
- Decreased functional capacity
- References
- Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]