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HIV and AIDS Dementia

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Decline in mental processes is a common complication of HIV infection.

  • Although the specific symptoms vary from person to person, they may be part of a single disorder known as AIDS dementia complex, or ADC. Other names for ADC are HIV-associated dementia and HIV/AIDS encephalopathy.
  • Common symptoms include decline in thinking, or "cognitive," functions such as memory, reasoning, judgment, concentration, and problem solving.
  • Other common symptoms are changes in personality and behavior, speech problems, and motor (movement) problems such as clumsiness and poor balance.
  • When these symptoms are severe enough to interfere with everyday activities, a diagnosis of dementia may be warranted.

AIDS dementia complex typically occurs as the CD4+ count falls to less than 200 cells/microliter. It may be the first sign of AIDS. With the advent of highly active antiretroviral therapy (HAART), the frequency of ADC has declined. HAART may not only prevent or delay the onset of AIDS dementia complex in people with HIV infection, it can also improve mental function in people who already have ADC.

Causes of AIDS Dementia

AIDS dementia complex is caused by the HIV virus itself, not by the opportunistic infections that occur commonly in the course of the disease. We do not know exactly how the virus damages brain cells.

HIV may affect the brain through several mechanisms. Viral proteins may damage nerve cells directly or by infecting inflammatory cells in the brain and spinal cord. HIV may then induce these cells to damage and disable nerve cells. HIV appears to cause generalized inflammation, which causes chronic disease, memory issues, accelerated aging processes, heart disease, and other diseases.

Symptoms of AIDS Dementia

AIDS dementia complex can affect behavior, memory, thinking, and movement. At first, symptoms are subtle and may be overlooked, but they gradually become troublesome. The symptoms vary widely from person to person.

Symptoms of early dementia include:

  • Reduced productivity at work
  • Poor concentration
  • Mental slowness
  • Difficulty learning new things
  • 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 -- Severe mental and behavioral disorder, with features such as extreme agitation, loss of contact with reality, inability to respond appropriately to the environment, hallucinations, delusions
  • Mania -- Extreme restlessness, hyperactivity, very rapid speech, poor judgment
  • Seizures

Without HAART, these symptoms gradually worsen. They can lead to a vegetative state, in which the person has minimal awareness of his or her surroundings and is incapable of interacting.

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