HIV and AIDS Dementia

Decline in mental processes is a common complication of HIV infection (and many other conditions).

• 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 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 from 30%-60% of people infected with HIV to less than 20%. 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.

Symptoms of AIDS Dementia

AIDS dementia complex affects 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.

AIDS Dementia Exams and Tests

In a person known to have HIV infection, the appearance of cognitive, behavioral, or motor symptoms suggests that the person has AIDS dementia complex. It is important to consider, however, other possible causes of these symptoms, such as metabolic disorders, infections, degenerative brain diseases, stroke, tumor, and many others. Your health care provider will carry out an evaluation to determine the cause of your symptoms. This will include a medical interview, physical, and mental status exams, CT and/or MRI scans, neuropsychological testing, and, possibly, a spinal tap.

Imaging studies