AIDS dementia complex; AIDS encephalopathy; HIV-associated dementia (HAD)
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Pathology
- cerebral cortical atrophy, neuronal loss
- microglial nodules/multinucleated giant cells
- reactive astrocytosis
- elevated TNF-alpha mRNA in microglia & astrocytes
- implicated proteins: APLNR
Clinical manifestations
- features of subcortical dementia
- apathy
- psychomotor retardation
- difficulty with retrieval
- motor dysfunction
- features of cortical dementia may co-exist
- impaired concentration
- forgetfulness
- personality changes
- withdrawal
- agitation, irritability, confusion & psychosis are rare
- with progessive dementia
- impaired rapid movements
- hyper-reflexia
- release reflexes
- weakness
- ataxia
- spasticity
- bowel & bladder incontinence
- myoclonus
Laboratory
- cerebrospinal fluid
- mildly elevated protein
- mild pleocytosis with predominance of mononuclear cells
Radiology
- computed tomography (CT): cerebral atrophy
- magnetic resonance imaging (MRI):
- patchy or diffusely increased signal intensity in white matter & less frequently basal ganglia or thalamus
Differential diagnosis
- progressive multifocal leukoencephalopathy (PML)
- other opportunistic CNS infections in HIV infection include
Management
- antiretroviral therapy (see HIV1 infection Management:)
- antiretroviral therapy is likely to improve dementia
- some HIV1-associated cognitive deficits will remain
- sooner initiation of antiretroviral therapy increases likelihood of improving cognitive function[4]
- extensive neuropathology prior to initiation of therapy portends worse outcome
- antiretroviral therapy is likely to improve dementia
- zidovudine (AZT)
- may be helpful in preventing occurrence
- may partially reverse symptoms in patients with established dementia
- high dose
More general terms
References
- ↑ Jump up to: 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Jump up to: 2.0 2.1 Kaul et al. Pathways to neuronal injury and apoptosis in HIV-associated dementia. Nature 410:988-94 2001 [review]
- ↑ Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ Jump up to: 4.0 4.1 4.2 Heaton RK, Clifford DB, Franklin DR Jr et al HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology. 2010 Dec 7;75(23):2087-96. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21135382 Free PMC article.