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 and HIV encephalopathy) 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 (ADC) 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%-15%.
What Is AIDS Dementia Complex?
ADC is one of the most common and clinically important nervous system complications of late stage
. 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 since the rate varies greatly from person to person.
ADC is marked by severe changes in three areas:
Cognition—the ability to understand, process, and remember information
Behavior—emotions (mood, personality) as well as the ability to perform tasks of daily living
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 remembering phone numbers or appointments
Longer time needed to complete complicated tasks
Reliance on list keeping to track daily activities
Unsteady gait, tremor, or difficulty keeping balance
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
Withdrawing from life
Psychosis or mania
Confinement to bed
How Is ADC Diagnosed and Treated?
Three tests are used to diagnose ADC:
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.
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
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:
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
Consideration of anti-HIV therapy used previously
Use of anti-HIV drugs that cross the blood-brain barrier as part of a combination therapy regimen
(Retrovir) 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 this medication. 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
, a monoamine oxidase b inhibitor, or treatment with
, 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, talk to your doctor. 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
as possible from friends and family.
What If Someone I Care for Was Diagnosed With ADC?
If someone you know was diagnosed with ADC, help him 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.
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