HIV

AIDS Dementia Complex

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AIDS Dementia Complex, Dementia in HIV, HIV-Associated Neurocognitive Disorder, HIV-Associated Dementia

  • Epidemiology
  1. Common complication in late AIDS
  • Pathophysiology
  1. Spectrum from subtle deficits to HIV-Associated Dementia
  2. Higher severity (including Dementia) with decreasing CD4 Counts
  3. Involves three neurologic domains
    1. Cognitive (memory, concentration, planning, comprehension)
    2. Behavioral (apathy, depression, Agitation)
    3. Motor (Incoordination, unsteady gait, Tremor)
  • Signs
  1. Early
    1. Impaired concentration
    2. Forgetfulness
    3. Slowed cognitive function
  2. Late
    1. Impaired rapid movements
    2. Hyperreflexia
    3. Release reflexes
    4. Weakness
    5. Ataxia
    6. Spasticity
    7. Bladder and bowel Incontinence
    8. Myoclonus
  • Imaging
  • Brain MRI findings
  1. Cerebral atrophy
  2. Patchy, diffuse increased white matter signal intensity
    1. Excludes other causes
  1. Mildly elevated protein
  2. Mild Pleocytosis, predominance of mononuclear cells
  • Evaluation
  1. Montreal Cognitive Assessment (MoCA)
    1. https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf
  2. Neuropsychiatric testing
  • Management
  1. Antiretroviral drugs
    1. May improve neuropsychiatric performance
    2. May alleviate symptoms
  • Complications
  1. Poor compliance with Antiretroviral therapy (with risk of resistance)
  2. Decreased functional capacity