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IDEAS, IncPresentation
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clearAIDS Dementia Complex
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AIDS Dementia Complex (ADC) can be a serious problem with a poor prognosis. AIDS dementia complex is a term used to describe cognitive, motor and behavioral neurological impairments that are unrelated to opportunistic infections. These impairments significantly impair activities of daily living, resulting in decreased independence.

A - AIDS - Advanced HIV infection
D - Dementia - Cognitive impairment worsening during late-stage HIV infection
C - Complex - A condition consisting of neuropsychologic disturbances in the areas of cognition, motor function, and behavior

In the central nervous system, HIV penetrates the blood-brain barrier, infecting CD4 + cells in the brain (Kalichman, 1998). HIV dementia is a subcortical dementia (Gabrieli, 1995), affecting structure beneath the cerebral cortex. Because the basal ganglia are affected, HIV-associated cognitive disorders (including dementia) share many features with diseases such as Parkinson's disease and Huntington disease. People with damage or dysfunction in the basal ganglia have slower thought processes (bradyphrenia), and move more slowly (bradykinesia). They are forgetful, but may often recall information if given enough time.

Before the availability of effective anti-HIV treatments, opportunistic infections significantly shortened the lifespan of many individuals with AIDS. With the advent of pharmacological intervention to help prolong the lives of those with HIV infection, the course of the disease is changing. Currently, about 20% of those in the later stages of AIDS exhibit signs of AIDS Dementia Complex, with 10,000 cases occurring annually in the USA (McArthur, Sacktor, & Selnes, 1999). Individuals with ADC exhibit severe cognitive, motor, and neurological impairments that seriously impair day-to-day functioning in the later stages of the disease process.

Diagnosis is difficult, as symptoms may vary. A thorough evaluation is necessary to determine the cause of cognitive impairment and appropriate treatment. Procedures used in the diagnostic process include: neuropsychological testing; mental status examination; neuropsychiatric interview; neurologic examination; and radiologic and laboratory testing.

AREAS IN THE BRAIN IMPACTED BY HIV
FRONTAL: loss of organizational skills; disinhibitionBASAL GANGLIA: involuntary movements
LIMBIC/TEMPORAL: language impairment, memory lossBRAIN STEM: gait, visual disturbances

The American Psychiatric Association provides diagnostic criteria for dementia not otherwise specified (nos) in their publication, the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV, 1994). A condensed version of diagnostic criteria for dementia (nos) is as follows:

  1. Impairment in short- and long-term memory
  2. At least 1 of the following:
    1. Impairment in abstract thinking
    2. Impaired judgment
    3. Other disturbances of higher cortical function
    4. Personality change
  3. Memory impairment and intellectual impairment causing significant social and occupational impairments
  4. Absence of occurrence exclusively during the course of Delirium
  5. Either of the following:
    1. Evidence of an organic factor causing this impaired memory and intellect
    2. Impaired memory and intellect cannot be accounted for by any nonorganic mental disorder
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The DSM-IV associated features of Dementia include:

  • Learning problem
  • Addiction
  • Dysarthria or Involuntary Movement
  • Somatic or Sexual Dysfunction
  • Psychosis
  • Sexually Deviant Behavior
  • Depressed Mood
  • Anxious / Fearful or Dependent Personality
  • Hypo- /Hyperactivity
  • Dramatic / Erratic or Antisocial Personality
  • Odd or Eccentric or Suspicious Personality

It has been established that HIV can have a direct effect on the brain. Reviewing common signs and symptoms of the various forms of impairment associated with ADC is imperative for healthcare professionals as well as caregivers (Van Gorp, Dilley, & Buckingham, 1998).

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Cognitive Symptoms Of AIDS Dementia Complex

Cognition
SymptomExampleInterventions
Severe confusionUnawareness of illness; Difficulty following directions.Talk in a calm, slow manner, using simple information.
Delayed or absent verbal responsesLanguage difficultiesCommunicate to person using non-verbal gestures such as touching and smiling. Simplify questions which require a yes or no answer. Obtain evaluation by a Speech-Language Pathologist for speech and swallowing difficulties.
Global deteriorationDifficulty generating ideas; MutismProvide a board with pictures of common objects to which the person can point when making needs known.
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Before continuing to the post-test, review the following sample scenario.

Scene 1

Assess the photo to the left.

  • Identify 3 risk factors or safety concerns that could pose harm to Jim.
  • Identify 2 positive strategies in the environment to help Jim organize his day-to-day routines.
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Answers

Safety/risk concerns:
  1. Throw rug getting caught under walker
  2. Ashtray/cigarettes on top of magazines - potential fire hazard
  3. Lamp is very close to edge of table / loose electrical cords not concealed and tucked away

Interventions:

  1. Enlarged calendar hung in an easily visible, frequently visited place
  2. Oversized pill box - easy to read - easy to open
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