HIV and Dementia
What is HIV-associated dementia?
HIV/AIDS affects many of the body's organ systems, including the brain and nervous system. Most people don't know that the HIV infection actually makes its way to the brain early in the disease process. HIV encephalopathy is an infection that spreads throughout the brain. It is one cause of dementia in people infected with HIV. The greater the spread of infection in the brain, the worse the dementia symptoms become.
AIDS dementia is also called AIDS dementia complex or HIV-associated dementia. It is a serious consequence of HIV infection and is typically seen in advanced stages of the disease.
What causes HIV-associated dementia?
When HIV spreads to the brain, it results in encephalopathy (a disease which affects the brain's function), which causes dementia. The greater the spread of infection in the brain, the worse the dementia symptoms become. People with HIV may also become infected with other organisms (such as cytomegalovirus, Cryptococcus, and toxoplasmosis, and with cancer such as CNS lymphoma). Each of these infections or conditions can 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
- Reduced ability to think clearly, a condition called cognitive impairment
- Trouble concentrating or staying focused
- Trouble speaking clearly or accurately
- Apathy or 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 medical conditions or problems. Always see your healthcare provider for a diagnosis.
How is HIV-associated dementia diagnosed?
Examination and evaluation are essential in determining the presence and extent of the dementia. Your healthcare provider will take your full medical history. You will also have an extensive neurological motor and sensory exam. Diagnostic tests for dementia may also include the following:
- Mental status test. This is a brief and simple test of memory and some other common cognitive or thinking skills. It is usually part of a complete neurological exam.
- Neuropsychological testing.
- Basic tests of physical abilities or movement.
- MRI. An imaging test that uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body.
- CT scan. An imaging test that uses a combination of X-rays and computer technology to make horizontal (axial) images, often called slices, 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 procedure performed by inserting a hollow needle into the lower back (lumbar spine).
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 medical 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 aggressive medical treatment aimed at reducing the amount of AIDS virus in the body. It also can help 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 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.
- 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 are using highly active antiretroviral therapy, known as HAART, are less likely to develop HIV-associated dementia. Experts think this may be because these medicines help maintain the overall immune system. A milder form of cognitive impairment, called HIV-associated neurocognitive disorder, or HAND, may still occur, though.
Living with HIV-associated dementia?
Depending on your level of dementia, different therapies may be required. HIV-associated dementia is a progressive condition. This means that it will continue to get worse, and the amount of care needed to manage the disease will increase 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.
April 07, 2017
Lentnek, Arnold, MD,Sather, Rita, RN