HIV and Dementia
What is HIV-associated dementia?
HIV/AIDS affects many of the body's organ systems, including the brain and nervous system. HIV makes its way to the brain early in the disease process. HIV encephalopathy is a condition that can result from the infection spreading in the brain and damaging it. It is one cause of dementia in people infected with HIV. The greater the damage from HIV infection in the brain, the worse the dementia symptoms can become.
AIDS dementia is also called AIDS dementia complex or HIV-associated dementia. It is a serious result of HIV infection. It is typically seen in advanced stages of the disease.
What causes HIV-associated dementia?
When HIV spreads to the brain, it results in encephalopathy. This is a disease that affects how the brain works. Encephalopathy causes dementia. The greater the spread of infection in the brain, the worse the damage and dementia symptoms become. People with HIV may also become infected with other germs such as cytomegalovirus, Cryptococcus, and toxoplasmosis. They can also develop cancer such as CNS lymphoma. Each of these infections or conditions can sometimes cause a decline in mental function very similar to that caused by HIV.
What are the symptoms of HIV-associated dementia?
The following symptoms are among those seen with HIV-associated dementia:
- Memory loss
- Less ability to think clearly (cognitive impairment)
- Trouble concentrating or staying focused
- Trouble speaking clearly or accurately
- Lack of interest in previously enjoyable activities
- Slow loss of motor skills, or reduced coordination
The symptoms of HIV-associated dementia may look like other health conditions or problems. Always see your healthcare provider for a diagnosis.
How is HIV-associated dementia diagnosed?
You will need an exam and evaluation to find out if you have dementia and how serious it is. Your healthcare provider will take your health history. You will also have an exam to look at your muscles, nerves, and senses. You may also need some of these tests:
- Mental status test. This is a brief, simple test of memory and other common thinking skills. It is usually part of a complete neurological exam.
- Neuropsychological testing
- Basic tests of physical movement
- MRI. An imaging test that uses large magnets, radio waves, and a computer to make detailed pictures of organs and body structures.
- CT scan. An imaging test that uses X-rays and computers to make pictures of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
- Blood tests
- Spinal fluid test. A healthcare provider does this test by putting a hollow needle into the lower back (lumbar spine). The provider tests the fluid.
How is HIV-associated dementia treated?
Your healthcare provider will figure out the best treatment plan for you based on:
- Your age, overall health, and health history
- How sick you are
- How well you handle certain medicines, treatments, or therapies
- If your condition is expected to get worse
- The opinion of the healthcare providers involved in your care
- Your opinion and preference
Treatment typically includes:
- Antiretroviral therapy. This is medical treatment aimed at reducing the amount of AIDS virus in your body. It can prevent or sometimes ease dementia symptoms.
- Substance or alcohol abuse counseling. People with HIV who abuse drugs or alcohol can have more severe dementia symptoms.
- Prescription medicines. In addition to other medicines you take for AIDS/AIDS and related symptoms, your healthcare provider may recommend antidepressants, antipsychotics, or stimulants. Deciding which one will be prescribed will depend on what may be causing your dementia and what symptoms you are having.
- Lifestyle changes. Regular exercise and a structured routine will help to manage HIV-associated dementia. Writing lists can help you stay organized and remember important details. A neurologist may recommend working with a special therapist who can help you learn to better manage daily life.
- Coping strategies. If dementia symptoms become severe, you may need help at home. A skilled caregiver can provide this service.
What are the complications of HIV-associated dementia?
The slow loss of mental clarity and physical coordination can seriously reduce quality of life. Without treatment, HIV-associated dementia can be fatal.
What can I do to prevent HIV-associated dementia?
People who take antiretroviral therapy are less likely to develop HIV-associated dementia. This is because the therapy helps control the virus and causes less damage to the brain. A milder form of cognitive impairment, called HIV-associated neurocognitive disorder (HAND), may still occur.
Living with HIV-associated dementia?
Depending on your level of dementia, you may need different therapies. HIV-associated dementia can gradually get worse. This is especially true if you are not taking antiretroviral therapy. If this happens, you will need more care to manage the disease over time.
When should I call my healthcare provider?
If you notice changes in your ability to speak, focus, or concentrate, talk with your healthcare provider. These symptoms are common to other conditions, including other infections, depression, and nutritional deficiencies. Unusual shifts in mood or emotions and changes in social behavior also require a conversation with a healthcare provider. Best results are achieved with early diagnosis and treatment.
- HIV-associated dementia occurs when the HIV virus spreads to the brain.
- Symptoms of HIV-associated dementia include memory loss, trouble thinking, difficulty concentrating or speaking clearly, lack of interest in activities, and slow loss of motor skills.
- Medicines for treating HIV-associated dementia include antiretrovirals, antidepressants, antipsychotics, or stimulants.
- People with HIV who abuse drugs or alcohol can have more severe dementia symptoms.
- Your healthcare provider may suggest lifestyle changes and coping strategies that can help you manage dementia.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
May 10, 2018
HIV-associated neurocognitive disorders: Epidemiology, clinical manifestations, and diagnosis. UpToDate.
Watson, L Renee, MSN, RN,Zingman, Barry, MD