For AIDS Patients, Subtle Thinking Problems Could Signal Later Dementia
Specifically, the study found that patients with a condition known as minor cognitive/motor disorder (MCMD), characterized by slight thinking, mood, or neurological problems not serious enough to impact day to day functioning, were found to be at significantly increased risk for dementia.
"Our findings suggest that MCMD is not a separate syndrome at all, but is instead a forerunner to later dementia," study author Yaakov Stern, PhD, of New York's Columbia University College of Physicians and Surgeons tells WebMD. "Although we can't draw firm conclusions from this one study, we can say that patients with early [thinking] deficits or MCMD are certainly more likely to develop dementia."
Clifford, who is a professor of neurology at Washington University in St. Louis, and is principal investigator for the Neurologic AIDS Research Consortium, says about 7% of AIDS patients now develop dementia. Just a few years ago, before the new therapies were widely available, the incidence was far higher -- as high as 60% according to 1998 figures from the CDC.
"One other reason that dementia is still a significant issue is that it is really too early in the HAART era to know whether it is going to be a problem down the line," Clifford says. "It is possible that the brain is the last bastion of this virus, and that ... dementia ... may be a problem."
San Francisco General Hospital chief of neurology Richard W. Price, MD, says he has seen no evidence that patients who do well on the new AIDS therapies are progressing to dementia. He says the AIDS-related dementia cases he generally sees occur in patients with advanced disease who have not been treated or built up a resistance to therapy because of irregular use.
"There is no question that the incidence of AIDS dementia in the current era of treatment is markedly reduced," Price says. "I usually see dementia these days in people who are outside of the treatment system, either because they have elected not to be treated or they have fallen through the cracks. It is a very different group of patients than we saw a few years ago."