HIV-associated dementia is a chronic cognitive deterioration due to brain infection with HIV.
Dementia is a chronic, global, usually irreversible deterioration of cognition. HIV-associated dementia (AIDS dementia complex) may occur in the late stages of HIV infection. Unlike all other forms of dementia it affects more younger people.
HIV-associated dementia is a chronic cognitive deterioration due to brain infection with HIV. Dementia is a chronic, global, usually irreversible deterioration of cognition. HIV-associated dementia (AIDS dementia complex) may occur in the late stages of HIV infection. Unlike all other forms of dementia it affects more younger people. Dementia should not be confused with delirium although the perception is impaired in both. The following helps to distinguish these: Dementia mainly affects the memory is usually caused by anatomical changes in the brain shows a slow start and is usually irreversible. A Dellirbetrifft mainly the attention is usually caused by an acute illness or drug or drug toxicity (sometimes fatal) and is often reversible. Other characteristics contribute to distinguish the two disorders (see Table: Differences Between Delirium and Dementia *). An exclusively HIV-associated dementia is caused by neuronal damage caused by the HIV virus. However, in patients may be the result of another dementia infection with HIV infection, some of which are treatable. These diseases include other infections such. B. a secondary infection with Creutzfeldt-Jakob pathogens that can cause a progressive multifocal leukoencephalopathy, and central nervous system lymphoma. Other opportunistic infections (eg. As cryptococcal meningitis, fungal meningitis others, some bacterial infections, TB meningitis, viral infections, toxoplasmosis) may also help. In the only HIV-associated dementia, subcortical pathology (i.e.,.. Basal ganglia, thalamus) may result when infected macrophages or microglial cells migrate into the deep gray matter and white matter can be affected. The prevalence of dementia in the late stages of HIV infection is 7-27% of patients, 30-40% may have an easier distinct forms. The incidence is inversely proportional to the CD4 + cell counts. Symptoms and signs The symptoms can be similar to those of other dementias. Early symptoms include Slowed thinking and expression difficulty concentrating apathy insight is preserved and manifestations of depression are low. Motor skills are slowing, ataxia and a positive Babinski sign are possible. Abnormal neurological signs may be paraparesis spasticity of the lower limbs ataxia Plantarextensionsreaktion Sometimes a mania or psychosis occur. Diagnosis Clinical examination Measurement of CD4 cells and HIV viral load Immediate clarification, incl. MRI and usually lumbar puncture if an acute deterioration exists HIV-associated dementia should be suspected in patients who have the following symptoms of dementia known HIV infection or symptoms or risk factors that indicate HIV infection when patients have symptoms of HIV infection that may indicate dementia, then a general diagnosis of dementia, based on the usual criteria, including the following: Cognitive or behavioral (neuropsychiatric) symptoms that affect the ability to function at work and perform usual daily activities. These symptoms represent a decline of previous functional levels. These symptoms can be explained not by delirium or major mental disorder. For clarification of cognitive function includes the recording of the patient’s medical history and by a person who knows the patient, plus an examination of the mental state at the bedside or if the investigation at the bedside remains inconclusive, formal neuropsychological examination (dementia: assessment of cognitive function ). If it is not known in patients with symptoms of dementia, that they have HIV infection but have risk factors for this infection, they are tested for HIV. In patients with HIV infection or suspected of having HIV-associated dementia, CD4 counts and HIV viral load to be measured. In patients with suspected or confirmed HIV dementia and these values ??help determine how likely HIV-associated dementia (and CNS lymphoma as well as other HIV-related CNS infections) contributes to dementia. In patients who have HIV infection but no dementia, these values ??help to determine how likely to develop HIV-associated dementia. If patients have dementia and HIV infection, other processes can cause or worsen symptoms of dementia. Thus, the cause of cognitive decline must, especially sudden, severe loss it is due to HIV or any other infection- be identified as soon as possible. MRI with and without contrast agents should be conducted to identify other causes of dementia, and if detected by MRI are no contraindications, a lumbar puncture should take place. Findings in the late stage of HIV-associated dementia may be diffuse, non-contrast-accomodating hyperintensities of the white matter, cerebral atrophy and ventricular enlargement. Prognosis patients with HIV infection and untreated dementia have a worse prognosis (average life expectancy of 6 months) than HIV-infected patients without dementia. Treatment Antiretroviral Therapy The primary treatment of HIV-associated dementia is a antiretroviral therapy that increases the CD4 + cell counts, and improved cognitive function. Support measures are similar to those in other forms of dementia. For example, the environment should be bright, friendly and familiar, and it should be designed so that an orientation is reinforced (eg. As placement of large clocks and calendars in the room). Measures to ensure the safety of the patient (eg., Signal monitoring systems for patients who walk) should be initiated. Symptoms are treated as far as necessary.