NEWS

Ask the Doctor: What Is HIV-Associated Dementia?


Every month, HIV specialist Theresa Mack, M.D., M.P.H.--an associate medical director at St. Luke's Medical Group in Harlem, N.Y.--will answer your most pressing HIV/AIDS questions.

HIV can affect our mental and emotional health. One way that it can do so is through HIV-associated dementia. Also known as AIDS dementia complex and HIV encephalopathy, HIV-associated dementia is no different from non-HIV-associated dementia when it comes to symptoms. However, dementia in people with HIV typically begins earlier than dementia in those who does not have HIV.

Even though HIV-associated dementia has declined in frequency since the introduction of effective ARV medications, it is still a major complication of HIV today. Here are some risk factors:

  • Older age
  • Female gender
  • High viral load
  • Previous AIDS diagnosis
  • Use of injection drugs
  • Comorbid conditions like cytomegalovirus (CMV), herpes and the John Cunningham (JC) virus

You're also more likely to suffer from HIV-associated dementia if you haven't stayed consistently on medication for HIV. For example, a person who is doing well and stops taking medication could be increasing his or her risk of acquiring HIV-associated dementia at a later time. Some researchers are also looking into whether ARV agents that penetrate directly into the brain may do a better job of preventing people from getting HIV-associated dementia.

Identifying the Symptoms

Not everyone with HIV-associated dementia experiences the same symptoms. People may experience any of the following:

  • No symptoms.
  • Mild symptoms. Those with mild symptoms may complain that it's difficult to work or that they have problems with their memories. Others might have trouble finding the right word to say, or need to make lists in order to remember things that they didn't have trouble remembering before. Sleep disturbances and depression may also occur.
  • Severe symptoms. Those with severe symptoms may suffer seizures or psychosis or require placement in a rehabilitation home.

If you have mild symptoms of HIV-related dementia, that doesn't necessarily mean the disease will progress. If you start taking medicines before you experience extreme agitation or suffer symptoms like psychosis, you can slow down or stop the progression.

Often family members first notice that a person living with HIV has become more forgetful or is acting strangely. If you or your family members notice a change in your concentration level or any of the earlier symptoms mentioned, talk about it with your doctor.

Making the Diagnosis

To diagnose HIV-associated dementia, your doctor will eliminate other causes that have the same symptoms, such as these:

In addition, your doctor will do the following:

  • Do a complete physical and neurological exam.
  • Obtain imaging studies of your brain, such as CT scans or MRI scans.
  • Obtain a sample of your brain fluid, called cerebral spinal fluid, to eliminate infections and cancers.
  • Test your memory and cognitive ability by asking you questions or having you perform certain tasks. For example, you might be asked to recall four things your doctor talked to you about, or to draw a cube to check your motor skills and thinking skills. All of these different types of tests are used to diagnose HIV-related dementia.

Just as there is no cure for AIDS, there is no cure for HIV-associated dementia. However, it can be controlled in some people with the appropriate treatment.

You will need a good support system if you have advanced dementia. In cases of severe dementia, family members remind patients to take their medications and assist with activities of daily living (ADLs). Support groups can also help people fare better with the disease.

You can take steps to prevent HIV-associated dementia by starting ARV therapy earlier (regardless of a high CD4 count) and adhering to the ARVs consistently. But even if you do acquire HIV-associated dementia, with early treatment it may be controlled, allowing you to live a very comfortable and productive life.

Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about health and wellness.