HIV and Dementia

HIV/AIDS affects many of the body's organ systems, including the brain and nervous system. Most people don' know that 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. It develops in about one in 10 people with AIDS.

People who have HIV are at risk for developing AIDS dementia if they:

  • Are older

  • Are female

  • Have a CD4 count of less than 100

  • Have high levels of virus in the blood, called viral load

  • Have other infections or chronic diseases

  • Have injected drugs, particularly cocaine

  • Have had previous periods of delirium

Symptoms

The following symptoms are among those seen with AIDS-related dementia:

  • Encephalitis, a condition in which the membranes of the brain and spinal column swell

  • Loss of memory

  • Reduced ability to think clearly, a condition called cognitive impairment

  • Difficulty concentrating or staying focused

  • Difficulty speaking clearly or accurately

  • Apathy or lack of interest in previously enjoyable activities

  • Gradual loss of motor skills, or reduced coordination

Complications

The gradual loss of mental clarity and physical coordination can seriously reduce quality of life. Without treatment, AIDS-related dementia can be fatal.

When to call a doctor

If you notice changes in your ability to speak, focus, or concentrate, talk with your health care 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 doctor. Best results are achieved with early diagnosis and treatment.

Diagnosis

An exam may include:

  • Discussion of symptoms

  • Discussion of lifestyle choices, such as alcohol or drug use

  • Neuropsychological testing

  • Basic tests of physical abilities or movement

  • Imaging tests

  • Blood tests

  • Spinal fluid test

Treatment

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 medications. In addition to other medications you take for AIDS symptoms, your doctor may recommend antidepressants, antipsychotics, or stimulants. Which one prescribed will depend on what may be causing your dementia.

  • Lifestyle changes. Regular exercise and a structured routine will help to manage AIDS dementia. Writing lists can help you stay organized and remember important details. A neurologist may recommend working with a special therapist who can help improve daily life.

  • Coping strategies. If dementia symptoms become severe, you may need help at home. A skilled caregiver can provide this service.

Prevention

People who are using highly active antiretroviral therapy, known as HAART, are less likely to develop AIDS-related dementia. Experts think this may be because these drugs help maintain the overall immune system. A milder form of cognitive impairment, called HIV-associated neurocognitive disorder, or HAND, may still occur, though. 


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