Question 1 of 10

    AIDS Dementia Complex

    AIDS dementia complex is a term used in literature to describe the most severe complication of human immunodeficiency virus (HIV) infection when it comes to the central nervous system (CNS) and is also known as HIV-associated dementia (HAD). Various cognitive, motor and behavioral symptoms are described. The diagnosis can be achieved through an extensive workup and findings from physical examination.

    The disorder stems from this process: infectious.

    Presentation

    Acquired immunodeficiency syndrome (AIDS) dementia complex, now more frequently termed HIV- associated dementia (HAD), is the most severe CNS complication of HIV infection [1] [2]. Despite the introduction of antiretroviral therapy (ART) in recent decades and marked success in therapy that led to a reduction in CNS complications, the increased life expectancy of patients suffering from this viral infection has actually increased the rate of HAD according to certain reports [1] [3] [4]. Failure to comply with therapy is the single most important risk factor, and the clinical presentation is distinguished by the onset of subcortical dementia, due to the fact that aphasia, apraxia and other signs of cortical damage are absent [5]. The clinical hallmarks of AIDS dementia complex is a slowly progressive deceleration in, motor, cognitive and behavioral functions over the course of weeks or months [4] [6] [7]. In the initial stages, only minor symptoms, such as difficulties performing complex tasks and memory loss, may be observed [5]. Over time, however, more pronounced signs include psychomotor decline, mood changes (depression, apathy, but also mania), anxiety (and even psychosis), reduced capacity to process information, as well as more severe memory, but also language and attention deficits, which are rather common and can significantly impair daily life [3] [4] [5] [8]. Olfactory senses are also reduced [3], and notable neurologic symptoms can be paraparesis, spasticity of the lower extremities, less pronounced reflexes, postural tremor, ataxia and gait disturbances [5] [9].

    Entire body system
    Pallor
    • Histopathologically, it is identified by the infiltration of monocytes and macrophages into the central nervous system (CNS), gliosis, pallor of myelin sheaths, abnormalities of dendritic processes and neuronal loss.[en.wikipedia.org]
    • Diffuse myelin pallor may be present but is more commonly due to changes in the blood-brain barrier than to demyelination.[emedicine.medscape.com]
    • Glass et al (19) recently completed a prospective analysis of HIV dementia and found that only 25% of patients with ADC had multifocal giant cell encephalitis, and 50% showed neither multifocal giant cell encephalitis nor white matter pallor.[ajnr.org]
  • more...
  • neurologic
    Clumsiness
    • Motor symptoms include a loss of fine motor control leading to clumsiness, poor balance and tremors.[en.wikipedia.org]
    • […] cognitive, motor and behavioral function, the symptoms of which can include: memory and concentration problems diminished emotional and/or intellectual response marked behavioral changes diminished strength/frailty loss of fine motor skills (e.g. tremors, clumsiness[verywell.com]
    • […] in months  A decade ago, 40%-70% of AIDS patients suffered from ADC; now it is about 20% Symptoms and Stages  Stages of dementia range from mind to severe  Motor and cognitive skills decline progressively  Become mentally slow, weak physically, clumsy[scribd.com]
    • Other common symptoms are changes in personality and behavior, speech problems, and motor (movement) problems such as clumsiness and poor balance.[webmd.com]
    • Motor problems include imbalance, clumsiness, and weakness.[emedicine.medscape.com]
    Lethargy
    • Behavioral changes may include apathy, lethargy and diminished emotional responses and spontaneity.[en.wikipedia.org]
    • 1]; pain and numbness [n 1]; fever, pain, diaphoresis, numbness, tingling, nausea, and fatigue [n 1]); three in the Placebo/No Gap group (fatigue and mental cloudiness [n 1], seizure [n 1], depression [n 1]); and two in the Gap group (somnolence and lethargy[pubmedcentralcanada.ca]
  • more...
  • gastrointestinal
    Fecal Incontinence
  • more...
  • urogenital
    Urinary Incontinence
    • Paraparetic or paraplegic with urinary incontinence and fecal incontinence.[en.wikipedia.org]
  • more...
  • psychiatrical
  • more...
  • Workup

    The diagnosis of AIDS dementia complex requires a comprehensive workup, starting with a meticulous patient history that will confirm the presence of an HIV infection and exclude other potential causes of such symptoms (for eg. recent substance abuse, Alzheimer disease, Parkinson's disease, CNS infections or other disorders) [4] [8]. In addition to the patient interview, the onset and course of symptoms should be assessed with the family of the patient, as they can provide vital information. Compliance with therapy and possible coinfections must be noted as well, after which a thorough physical examination, considered as the essential component of the workup, is performed. The diagnosis of AIDS dementia complex primarily rests on findings obtained during a physical exam, and a full physical and neurologic exam followed by a complete cognitive assessment are imperative [1] [2] [4] [6]. The HIV dementia scale and other proposed criteria roughly divide patients suffering from HIV-associated dementia (HAD) into 3 categories: HAD with motor symptoms, HAD with either psychosocial or behavioral symptoms and HAD with both motor and behavioral/psychosocial signs [5] [6] [9]. Regardless of the stage and severity of symptoms, determination of CD4+ T-cell counts is recommended in all HIV+ patients who exhibit such complaints, and HAD is often diagnosed in individuals with a CD4+ T-cell count of < 200/mm3 [8]. A polymerase chain reaction (PCR) testing to detect the viral load of HIV RNA in serum and cerebrospinal fluid (obtained through a lumbar puncture) must be carried out [5] [9]. Imaging studies are also an important part of the diagnosis of AIDS dementia complex [9]. Computed tomography (CT), but more commonly magnetic resonance imaging (MRI), can show atrophy of the subcortical, but also cortical structures in the advanced stages of the disease [4] [5].

    Pathology

    Other Pathologies
    Gliosis
    • Typical neuropathologic findings include gliosis, focal necrosis of neurons, perivascular inflammation, formation of microglial nodules, multinucleated giant cells, and demyelination.[annals.org]
    • Histopathologically, it is identified by the infiltration of monocytes and macrophages into the central nervous system (CNS), gliosis, pallor of myelin sheaths, abnormalities of dendritic processes and neuronal loss.[en.wikipedia.org]
    • In persons with ADC, neuronal injury is confirmed by finding lower N -acetyl aspartate (NA) levels (a marker of neuronal metabolism) in the frontal white matter. [ 41 ] In the basal ganglia and white matter, where gliosis and inflammatory changes are[emedicine.medscape.com]
  • more...
  • Laboratory

    Serum
  • more...
  • Treatment

    Prognosis

    Complications

    Central Nervous System Disorder
    • SIGNIFICANCE OF AIDS DEMENTIA COMPLEX FOR OTHER CENTRAL NERVOUS SYSTEM DISORDERS Research on the AIDS dementia complex and CNS HIV infection has importance not only for understanding the nature and course of HIV infection, but also more generally for[nap.edu]
    Cryptococcal Meningitis
    • Other opportunistic infections (eg, cryptococcal meningitis , other fungal meningitis , some bacterial infections, TB meningitis , viral infections, toxoplasmosis ) may also contribute.[msdmanuals.com]
    • The differential diagnosis includes the following: Other problems to be considered in the differential diagnosis include the following: Cerebral lymphoma CNS infections (eg, tuberculosis, toxoplasmosis, cryptococcal meningitis, neurosyphilis) Metabolic[emedicine.medscape.com]
    • Among the major CNS complications of AIDS are cerebral toxoplasmosis, primary CNS lymphoma (an opportunistic neoplasm associated with Blymphocyte infection by Epstein-Barr virus), cryptococcal meningitis, and progressive multifocal leukoencephalopathy[nap.edu]
    Dementia
    • Dementia only exists when neurocognitive impairment in the patient is severe enough to interfere markedly with day-to-day function.[en.wikipedia.org]
    • HIV-associated dementia or AIDS dementia complex (ADC).[aidshivresearch.com]
    • Dementia , Dementia Complex, AIDS Related , Dementia Complex, AIDS-Related , Dementias, HIV , HIV Dementias , AIDS Dementia Complex [Disease/Finding] , dementia HIV , aids-related dementia , dementia AIDS , HIV dementia , HIV Associated Cognitive Motor[fpnotebook.com]
    • AIDS dementia is also called AIDS dementia complex or HIV-associated dementia.[hopkinsmedicine.org]
    • Symptoms of AIDS Dementia AIDS dementia complex can affect behavior, memory, thinking, and movement.[webmd.com]
    Depression
    • At first symptoms resemble those of depression.[alzheimer-europe.org]
    • Antidepressant drugs may improve symptoms of depression .[webmd.com]
    • For example, concern about HIV infection can lead to anxiety or depression.[nap.edu]
    • These include anti-psychotics, anti-depressants, anxiolytics, psycho-stimulants, anti-manics, and anti-convulsants.[thebody.com]
    • The symptoms include apathy, difficulty concentrat ing, irritability, depression, and personality changes.[books.google.com]
    Psychosis
    • People in the later stages can have seizures , psychosis , and loss of bladder or bowel control.[webmd.com]
    • Early motor deficits commonly included ataxia, leg weakness, tremor, and loss of fine‐motor coordination, while behavioral disturbances were manifested most commonly as apathy or withdrawal, but occasionally as a frank organic psychosis.[onlinelibrary.wiley.com]
    • Sometimes psychosis , depression and suicide occur.[alzheimer-europe.org]
    • Rare features include sleep disturbances, psychosis (with mania), and seizures.[emedicine.medscape.com]
  • more...
  • Etiology

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Self-assessment

    Ask Question


    5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.

    References

    1. Kaul M. HIV-1 associated dementia: update on pathological mechanisms and therapeutic approaches. Curr Opin Neurol. 2009;22(3):315-320.
    2. Ghafouri M, Amini S, Khalili K, Sawaya BE. HIV-1 associated dementia: symptoms and causes. Retrovirology. 2006;3:28.
    3. Lindl KA, Marks DR, Kolson DL, Jordan-Sciutto KL. HIV-Associated Neurocognitive Disorder: Pathogenesis and Therapeutic Opportunities. J Neuroimmune Pharmacol. 2010;5(3):294-309.
    4. Alfahad TB, Nath A. Update on HIV-associated Neurocognitive Disorders. Curr Neurol Neurosci Rep 2013;13(10):387.
    5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
    6. Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69(18):1789-1799.
    7. Zhou L, Saksena NK. HIV Associated Neurocognitive Disorders. Infect Dis Rep. 2013;5(1):e8. Mandell GL, Bennett JE, Dolin R.
    8. Watkins CC, Treisman GJ. Cognitive impairment in patients with AIDS – prevalence and severity. HIV AIDS (Auckl). 2015;7:35-47.
    9. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.

    • Brief battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex - P Maruff, E Thomas, L Cysique - Archives of clinical , 2009 - acn.oxfordjournals.org
    • AIDS dementia complex and HIV‐1 brain infection: clinical‐virological correlations - BJ Brew, M Rosenblum, K Cronin - Annals of , 1995 - Wiley Online Library
    • AIDS dementia complex and HIV‐1 brain infection: clinical‐virological correlations - BJ Brew, M Rosenblum, K Cronin - Annals of , 1995 - Wiley Online Library
    • Cerebral blood flow SPECT with Tc-99m exametazine correlates in AIDS dementia complex stages: a preliminary report - A Ajmani, E Habte-Gabr, M Zarr, V Jayabalan - Clin Nucl Med, 1991 - ukpmc.ac.uk
    • A detailed phenomenological comparison of complex visual hallucinations in dementia with Lewy bodies and Alzheimer's disease - C Ballard, I McKeith, R Harrison - International , 1997 - Cambridge Univ Press
    • HIV-associated neurologic disease incidence changes: Multicenter AIDS Cohort Study, 1990–1998 - N Sacktor, RH Lyles, R Skolasky, C Kleeberger - Neurology, 2001 - AAN Enterprises
    • AIDS Dementia Complex and HIV‐1 Infection: A View From the Clinic - RW Price, JJ Sidtis, BJ Brew - Brain Pathology, 1991 - Wiley Online Library
    • AIDS dementia complex and HIV‐1 brain infection: clinical‐virological correlations - BJ Brew, M Rosenblum, K Cronin - Annals of , 1995 - Wiley Online Library

    Languages

    Self-assessment