AIDS Dementia Complex
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AIDS Dementia Complex

HCA image for AIDS and dementiaDementia is a brain disorder characterized by a general loss of intellectual abilities involving impairment of memory, judgment, and abstract thinking as well as changes in personality. AIDS dementia complex (also known as AIDS-related dementia and HIV-associated dementia) is a condition in people with AIDS that results in the loss of cognitive capacity, affecting the ability to function in a social or occupational setting.

Prior to effective antiretroviral therapy, AIDS Dementia Complex occurred in more than 60% of patients who developed AIDS. With the use of combination highly active antiretroviral therapy (HAART), the incidence has declined to about 10% to 15%.

What Is AIDS Dementia Complex?

AIDS Dementia Complex (ADC) is one of the most common and clinically important nervous system complications of late stage HIV infection. It is a serious complication and, if left untreated, can progress to a fatal outcome. There is no way to know how quickly the disease will progress, however, since the rate varies greatly from person to person.

ADC is marked by severe changes in three areas:

  1. Cognition—the ability to understand, process, and remember information
  2. Behavior—emotions (mood, personality) as well as the ability to perform tasks of daily living
  3. Motor coordination—the ability to coordinate muscles and movement

What Causes AIDS Dementia Complex?

The cause of ADC has not been determined exactly, but is believed to result from HIV infection. Scientists think that HIV can indirectly kill neurons (nerve cells).

What Are the Symptoms of AIDS Dementia Complex?

Symptoms usually develop slowly and become worse as time goes on.

Symptoms of stage .5 or stage 1 (mild stage) ADC include:

  • Difficulty concentrating
  • Difficulty remembering phone numbers or appointments
  • Slowed thinking
  • Longer time needed to complete complicated tasks
  • Reliance on list keeping to track daily activities
  • Irritability
  • Unsteady gait, tremor, or difficulty keeping balance
  • Poor hand coordination
  • Change in handwriting
  • Depression

Symptoms of stage 2 (moderate stage) ADC include:

  • Muscle weakness
  • Poor performance on regular tasks
  • More concentration and attention required
  • Slow responses
  • Frequently dropping objects
  • General feelings of indifference or apathy
  • Slowness in normal activities, like eating and writing
  • Walking, balance, and coordination requires a great deal of effort

Symptoms of stage 3 and 4 (severe and end stage) ADC include:

  • Loss of bladder or bowel control
  • Spastic gait, making walking more difficult
  • Muteness
  • Withdrawing from life
  • Psychosis or mania
  • Confinement to bed

How Is AIDS Dementia Complex Diagnosed and Treated?

Three tests are used to diagnose ADC:

  1. Mental status exam (neuropsychological testing)—The main way to diagnose and evaluate ADC, the mental status exam, is designed to reveal problems like memory loss, disorientation, concentration, and abstract thinking, as well as mood swings.
  2. Standard scan—MRI or CT scans are used to rule out other causes of symptoms of ADC (such as toxoplasmosis, progressive multifocal leukoencephalopathy, or lymphoma).
  3. Spinal tap (lumbar puncture)—Like the scans, examination of cerebrospinal fluid (which fills the ventricles of the brain and central canal of the spinal cord) with a spinal tap is useful for detecting other conditions.

The best treatments for ADC seem to be anti-HIV drugs. In general, an anti-HIV regimen with the extra goal of treating ADC follows three basic principles:

  1. ADC patients should be started on a potent (aggressive) antiretroviral therapy to decrease HIV levels to below the limit of detection in viral load tests
  2. Consideration of anti-HIV therapy used previously
  3. Use of anti-HIV drugs that cross the blood-brain barrier as part of a combination therapy regimen

High-dose Zidovudine (AZT) is the most researched drug for treating ADC. Several groups have reported improvements in cognitive function as well as prevention of HIV infection of the brain with AZT. However, many people with HIV are often unable to tolerate its side effects. Other anti-HIV drugs that cross the blood-brain barrier may be equally useful, but they haven’t been studied as extensively.

Other therapies that have been considered for treating ADC as add-on to antiretroviral therapy include treatment with selegiline, a monoamine oxidase b inhibitor, or treatment with valproic acid, lithium, or erythropoietin.

To treat symptoms of ADC, psychoactive drugs are often used, including antipsychotics, antidepressants, anxiolytics, psycho-stimulants, anti-manics, and anticonvulsants. Other drugs may be used to ease apathy, increase energy and appetite, and improve concentration.

What Do I Do If I Think I Have AIDS Dementia Complex?

If you think you might have ADC, tell your doctor or other healthcare provider that you suspect something is wrong. Contact a local AIDS organization for help in finding care if you don’t have a doctor. In the meantime, keep track of your symptoms by writing them down and build as much support as possible from friends and family.

What If Someone I Care for Was Diagnosed With AIDS Dementia Complex?

If someone you know was diagnosed with ADC, help him or her get proper treatment. Offer your support and encouragement during this frightening time. Be alert for mood changes and memory problems. Finally, it is a good idea for you to seek support for yourself, since caregiving can be overwhelming and burdensome.

RESOURCES:

American Foundation for AIDS Research
http://www.amfar.org

National Association of People with AIDS
http://www.napwa.org

National Institute of Allergy and Infectious Diseases (NIAID)
http://www.niaid.nih.gov

National Institute of Mental Health (NIMH)
http://www.nimh.nih.gov

References:

AIDS Dementia Complex. Project Inform website. Available at: http://www.projinf.org/. Accessed August 6, 2003.

AIDS Dementia Complex. University of California at San Francisco website. Available at: http://hivinsite.ucsf.edu/. Accessed August 6, 2003.

AIDS Dementia Complex. Washington University website. Available at: http://www.neuro.wustl.edu/. Accessed August 6, 2003.

Luo X, Carlson KA, Wojna V, et al. Macrophage proteomic fingerprinting predicts HIV-1-associated cognitive impairment. Neurology. 2003;60:1931-1937.

Meehan RA, Brush JA. An overview of AIDS dementia complex. Am J Alzheimers Dis Other Demen. 2001;16:225-229.

Royal, W. HIV-associated. In: Gilman S, editor. MedLink Neurology. San Diego, CA: MedLink Corp. Medlink website. Available at: http://www.medlink.com.



Last reviewed July 2007 by J. Thomas Megerian, MD, PhD, FAAP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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