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].

psychiatrical
Visual Hallucination
  • 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[symptoma.ro]
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  • neurologic
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  • 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. [1] [2] ADC typically occurs after[en.wikipedia.org]
    • 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]
    • Diffuse myelin pallor may be present but is more commonly due to changes in the blood-brain barrier than to demyelination.[emedicine.medscape.com]
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  • 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].

    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]
    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]
    • Changes in behavior Decreased libido Forgetfulness Confusion Word-finding difficulty Apathy (indifference) Withdrawal from hobbies or social activities Depression Initially subtle disease can progress to more severe symptoms such as: Sleep disturbances Psychosis[webmd.com]
    Depression
    • At first symptoms resemble those of depression.[alzheimer-europe.org]
    • For example, concern about HIV infection can lead to anxiety or depression.[nap.edu]
    • Antidepressant drugs may improve symptoms of depression .[webmd.com]
    • These include anti-psychotics, anti-depressants, anxiolytics, psycho-stimulants, anti-manics, and anti-convulsants.[thebody.com]
    • Symptoms of HAND include at least two of the following: Short attention span Memory loss Headaches Mood swings Depression Irritability Poor judgment Confusion Slowed learning Poor coordination and balance Weakness in the arms and legs Three Classes of[webmd.com]
    Dementia
    • 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]
    • , AIDS-Related Dementia Dementia Complex, AIDS Related HIV Dementia Dementia, HIV Dementias, HIV HIV Dementias Acquired-Immune Deficiency Syndrome Dementia Complex Dementia Complex, Acquired Immune Deficiency Syndrome HIV-1-Associated Cognitive Motor[profiles.umassmed.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]

    Etiology

    Causes

    Virus
    • […] immunodeficiency virus infection Clinical Information A disease caused by human immunodeficiency virus (hiv).[icd10data.com]
    • Infected microglia add to the production of the virus.[en.wikipedia.org]
    • This dementia is due partially or wholly to a direct effect of the virus on the brain rather than to opportunistic infection, but its pathogenesis is not well understood.[science.sciencemag.org]
    • The HIV family of viruses is now better understood, both in terms of structure and function, than any other virus.[books.google.com]
    • The brain appears to be a prime target of the virus and may serve as a reservoir for the virus.[books.google.com]

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Other symptoms

    Speech Delay
    • 25] Without combination antiretroviral therapy, cognitive impairments increase with successive stages of HIV. [26] HIV patients in early stages show mild difficulties in concentration and attention. [27] In advanced cases of HIV-associated dementia, speech[en.wikipedia.org]
    Impaired Executive Function
    • Clinical features  substantial memory deficits  negative personality  mood changes  impaired executive functioning  poor attention and concentration  mental slowing  apathy 9.[slideshare.net]

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    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.

    • AIDS dementia complex and HIV‐1 brain infection: clinical‐virological correlations - BJ Brew, M Rosenblum, K Cronin - Annals of , 1995 - Wiley Online Library
    • 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 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
    • HIV-associated neurologic disease incidence changes: Multicenter AIDS Cohort Study, 1990–1998 - N Sacktor, RH Lyles, R Skolasky, C Kleeberger - Neurology, 2001 - AAN Enterprises
    • 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
    • AIDS dementia complex and HIV‐1 brain infection: clinical‐virological correlations - BJ Brew, M Rosenblum, K Cronin - Annals of , 1995 - Wiley Online Library
    • 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

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