Information about Aids Dementia Complex

AIDS dementia complex (ADC)
Classification & external resources

ICD-10	B22., F02.4
ICD-9	042

AIDS dementia complex (ADC; also known as HIV dementia, HIV encephalopathy and HIV-associated dementia) has become a common neurological disorder associated with HIV infection and AIDS. It is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of brain macrophages and microglia.^[1] These cells are actively infected with HIV and secrete neurotoxins of both host and viral origin. The essential features of ADC are disabling cognitive impairment accompanied by motor dysfunction, speech problems and behavioral change. Cognitive impairment is characterised by mental slowness, trouble with memory and poor concentration. Motor symptoms include a loss of fine motor control leading to clumsiness, poor balance and tremors. Behavioral changes may include apathy, lethargy and diminished emotional responses and spontaneity. Histopathologically, it is identified by the infiltration of monocytes and macrophages into the central nervous system (CNS), gliosis, pallor of myelin sheaths, abnormalities of dendritic processes and neuronal apoptosis.^[2][1]

ADC typically occurs after years of HIV infection and is associated with low CD4+ T cell levels and high plasma viral loads. It is sometimes seen as the first sign of the onset of AIDS. Prevalence is between 10-20% in Western countries^[4] and has only been seen in 1-2% of India based infections.^[5][6] This has to due to with differences in diets, such as consumption of curcumin (in curry) and EGCG or Theaflavins (in teas), both which can pass the blood brain barrier and have neuroprotective effects. With the advent of highly active antiretroviral therapy (HAART), the frequency of ADC has declined in developed countries. HAART may not only prevent or delay the onset of ADC in people with HIV infection, it can also improve mental function in people who already have ADC.

Dementia only exists when neurocognitive impairment in the patient is severe enough to interfere markedly with day-to-day function. That is, the patient is typically unable to work and may not be able to take care of him or herself. Before this, the patient is said to have a mild neurocognitive disorder.

Diagnostic criteria

1. Marked acquired impairment of at least two ability domains of cognitive function (e.g. memory, attention): typically, the impairment is in multiple domains, especially in learning, information processing and concentration/attention. The cognitive impairment is ascertained by medical history, mental status examination or neuropsychological testing.
2. Cognitive impairments identified in 1. interfere markedly with day-to-day functioning.
3. Cognitive impairments identified in 1. are present for at least one month.
4. Cognitive impairments identified in 1. do not meet the criteria for delirium, or if delirium is present, dementia was diagnosed when delirium was not present.
5. No evidence of another, pre-existing aetiology that could explain the dementia (e.g. another CNS infection, CNS neoplasm, cerebrovascular disease, pre-existing neurological disease, severe substance abuse compatible with CNS disorder.^[7]

While the progression of dysfunction is variable, it is regarded as a serious complication and, untreated, can progress to a fatal outcome. Diagnosis is made by neurologists who carefully rule out alternative diagnoses. This routinely requires a careful neurological examination, brain scans (MRI or CT scan) and a lumbar puncture to evaluate the cerebrospinal fluid. No single test is available to confirm the diagnosis, but the constellation of history, laboratory findings, and examination can reliably establish the diagnosis when performed by experienced clinicians. The amount of virus in the brain does not correlate well with the degree of dementia, suggesting that secondary mechanisms are also important in the manifestation of ADC.

Research

AIDS Dementia Complex (ADC) is not a true opportunistic infection. It is one of the few conditions caused directly by HIV itself. But it is not quite as simple as that because the central nervous system can be damaged by a number of other causes:

• opportunistic infections - there are many
• Primary cerebral lymphoma or metastasis of other AIDS-related cancers
• direct effects of HIV in the brain
• toxic effects of drug treatments
• malnutrition

Many researchers believe that HIV damages the vital brain cells, neurons, indirectly. According to one theory, HIV either infects or activates cells that nurture and maintain the brain, known as macrophages and microglia. These cells then produce toxins that can set off a series of reactions that instruct neurons to kill themselves. The infected macrophages and microglia also appear to produce additional factors chemokines and cytokines - that can affect neurons as well as other brain cells known as astrocytes. The affected astrocytes, which normally nurture and protect neurons, also may now end up harming neurons. The HIV virus protein gp120 inhibits the stem cells in the brain from producing new nerve cells.^[8] Researchers hope that new drugs under investigation will interfere with the detrimental cycle and prevent neuron death.

ADC stage characteristics

• Stage 0 (Normal) Normal Mental and Motor Function
• Stage 0.5 (Subclinical) Minimal symptoms of cognitive or motor dysfunction characteristic of ADC, or mild signs (snout response, slowed extremity movements), but without impairment of work or capacity to perform activities of daily living (ADL). Gait and strength are normal.
• Stage 1 (Mild) Evidence of functional intellectual or motor impairment characteristic of ADC, but able to perform all but the more demanding aspects of work or ADL. Can walk without assistance.
• Stage 2 (Moderate) Cannot work or maintain the more demanding aspects of daily life, but able to perform basic activities of self care. Ambulatory, but may require a single prop.
• Stage 3 (Severe) Major intellectual incapacity - cannot follow news or personal events, cannot sustain complex conversation, considerable slowing of all output. And/or motor disability - cannot walk unassisted, requiring walker or personal support, usually with slowing and clumsiness of arms as well.
• Stage 4 (End Stage) Nearly vegetative. Intellectual and social comprehension and responses are at a rudimentary level. Nearly or absolutely mute. Paraparetic or paraplegic with double incontinence

References and notes

External links

• Price, R.W. (1998). AIDS Dementia Complex. University of California San Francisco. Retrieved on 2006-04-06.

•  • [ e] HIV/AIDS related topics
HIV	HIV AIDS HIV structure and genome HIV test CDC Classification System for HIV Infection HIV disease progression rates HIV vaccine WHO Disease Staging System for HIV Infection and Disease AIDS dementia complex Antiretroviral drug
History	AIDS origin AIDS pandemic AIDS Museum Timeline of AIDS Oral polio vaccine AIDS hypothesis Reappraisal of HIV–AIDS Hypothesis Duesberg hypothesis
Culture	International AIDS Conference International AIDS Society World AIDS Day Treatment Action Campaign UNAIDS PEPFAR NAMES Project AIDS Memorial Quilt HIV and AIDS misconceptions List of HIV-positive people People With AIDS Self-Empowerment Movement
AIDS pandemic in	Sub-Saharan Africa (in South Africa) Asia (in China • India • Myanmar • Pakistan • Taiwan • Japan) in Latin America (in Brazil) Caribbean Eastern Europe and Central Asia (in Russia) Western Europe United States List of countries by HIV/AIDS adult prevalence rate

•  • [ e] Viral diseases (A80-B34, )
Viral infections of the CNS	Poliomyelitis (Post-polio syndrome) - Subacute sclerosing panencephalitis - Progressive multifocal leukoencephalopathy - Rabies - Encephalitis lethargica - Lymphocytic choriomeningitis - Tick-borne meningoencephalitis - Tropical spastic paraparesis
Arthropod-borne viral fevers and viral haemorrhagic fevers	Dengue fever - Chikungunya - Rift Valley fever - Yellow fever - Argentine hemorrhagic fever - Bolivian hemorrhagic fever - Lassa fever - Crimean-Congo hemorrhagic fever - Omsk hemorrhagic fever - Kyasanur forest disease - Marburg hemorrhagic fever - Ebola
Viral infections characterized by skin and mucous membrane lesions	Herpes simplex - Chickenpox - Herpes zoster - Smallpox - Monkeypox - Measles - Rubella - Plantar wart - Cowpox - Vaccinia - Molluscum contagiosum - Roseola - Fifth disease - Hand, foot and mouth disease - Foot-and-mouth disease
Viral hepatitis	Hepatitis A - Hepatitis B - Hepatitis C - Hepatitis E
Viral infections of the respiratory system	Avian flu - Acute viral nasopharyngitis - Infectious mononucleosis - Influenza - Viral pneumonia
Other viral diseases	Cytomegalovirus - Mumps - Bornholm disease
Sexually transmitted	HIV (AIDS, AIDS dementia complex) - Genital warts

•  • [ e] WHO ICD-10 Mental and behavioural disorders (, )
Neurological/symptomatic	Dementia (Alzheimer's disease, Multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex) - Delirium - Post-concussion syndrome
Psychoactive substance	Intoxication (Drunkenness) - Physical dependence (Alcohol dependence, Opioid dependency) - Withdrawal (Benzodiazepine withdrawal, Delirium tremens) - Amnesic (Korsakoff's syndrome)
Psychotic disorder	Schizophrenia (Disorganized schizophrenia) - Schizotypal personality disorder - Delusional disorder - Folie deux - Schizoaffective disorder
Mood (affective)	Mania - Bipolar disorder - Clinical depression - Cyclothymia - Dysthymia
Neurotic, stress-related and somatoform	Agoraphobia - Anxiety disorder - Panic disorder - Generalized anxiety disorder - Social Anxiety Disorder - OCD - Acute stress reaction - PTSD - Adjustment disorder - Conversion disorder (Ganser syndrome) - Somatoform disorder - Somatization disorder - Neurasthenia
Physiological/physical behavioural	Eating disorder (Anorexia nervosa, Bulimia nervosa) - Sleep disorder (Dyssomnia, Insomnia, Hypersomnia, Parasomnia, Night terror, Nightmare) - Sexual dysfunction (Erectile dysfunction, Premature ejaculation, Vaginismus, Dyspareunia, Hypersexuality) - Postpartum depression
Adult personality and behaviour	Personality disorder - Passive-aggressive behavior - Kleptomania - Trichotillomania - Voyeurism - Factitious disorder - Munchausen syndrome
Mental retardation	Mental retardation
Psychological development (developmental disorder)	Specific: speech and language (Expressive language disorder, Aphasia, Expressive aphasia, Receptive aphasia, Landau-Kleffner syndrome, Lisp) - scholastic skills (Dyslexia, Dysgraphia, Gerstmann syndrome) - motor function (Developmental Dyspraxia) Pervasive: Autism - Rett syndrome - Asperger syndrome
Behavioural and emotional, childhood and adolescence onset	ADHD - Conduct disorder - Oppositional defiant disorder - Separation anxiety disorder - Selective mutism - Reactive attachment disorder - Tic disorder - Tourette syndrome - speech (Stuttering, Cluttering)