HIV

AIDS Dementia Complex

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

  • See Also
  1. Neurologic Manifestations of HIV
  2. 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
  • Differential Diagnosis
  1. See Dementia Causes
  2. See Delirium
  3. Toxoplasmosis
  4. Progressive Multifocal Leukoencephalopathy (PML)
  5. Primary Lymphoma
  6. Meningitis
  7. Neurosyphilis
  8. Psychiatric conditions
  9. Substance Abuse
  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
  • References
  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]