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Diagnosis and Management of HIV Primary Dementia

  • Francisco Fernandez
  • Joel K. Levy

Abstract

Dementia is generally recognized as an acquired intellectual impairment characterized by persistent deficit in multiple areas including memory, language, cognition, visuospatial skills, personality or emotional functioning.1 The acquired nature of dementia distinguishes it from mental retardation, whereas its persistence differentiates it from delirium. Dementia is largely a problem of elderly individuals, with approximately 20% of individuals over age 65 suffering from dementia.2 The clinical syndrome of dementia may have multiple etiologies which may be either reversible or irreversible.3 Table 1 presents the differential diagnosis of dementia and Table 2 lists the formal evaluation of a demented patient. In rare cases, the syndrome of dementia can occur in young individuals; however, this is the exception rather than the rule.

Keywords

Human Immunodeficiency Virus Human Immunodeficiency Virus Infection Acquire Immune Deficiency Syndrome Human Immunodeficiency Virus Patient Human Immunodeficiency Virus Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Diagnostic and Statistical Manual of Mental Disorders, ed 3 revised. Washington, DC, American Psychiatric Association, 1987.Google Scholar
  2. 2.
    Cummings JL, Benson DF: Dementia: A Clinical Approach. Boston, Butterworths, 1983.Google Scholar
  3. 3.
    Cummings JL: Treatable Dementias. Adv Neural 38: 165–183, 1983.Google Scholar
  4. 3a.
    Reisberg B, Ferris SH, DeLeon MJ, et al: The Global Deterioration Scale (GDS): An instrument for the assessment of primary degenerative dementia (PPD). Am J Psychiatry 139: 1136–1139, 1982.PubMedGoogle Scholar
  5. 4.
    Fauci AS, Masur H, Gelmann EP, et al: The acquired immunodeficiency syndrome: An update. Ann Intern Med 102: 800–813, 1985.PubMedCrossRefGoogle Scholar
  6. 5.
    Sande MA, Volberding PA: The Medical Management of AIDS. Philadelphia, WB Saunders Co., 1988.Google Scholar
  7. 6.
    Navia BA, Jordan BD, Price RW: The AIDS dementia complex. I. Clinical features. Ann Neural 19: 517–524, 1986.CrossRefGoogle Scholar
  8. 7.
    Gabuzda DH, Hirsch MS: Neurologic manifestations of infection with human immunodeficiency virus: Clinical features and pathogenesis. Ann Intern Med 107: 383–391, 1987.PubMedCrossRefGoogle Scholar
  9. 8.
    Navia BA, Price RW: The acquired immunodeficiency syndrome dementia complex as the presenting or sole manifestation of human immunodeficiency virus infection. Arch Neural 44: 65–69, 1987.CrossRefGoogle Scholar
  10. 9.
    McArthur JC: Neurologic manifestations of AIDS. Medicine (Baltimore) 66: 407–437, 1987.Google Scholar
  11. 10.
    Tross S, Price RW, Navia B, et al: Neuropsychological characterization of the AIDS dementia complex: A preliminary report. AIDS 2: 81–88, 1988.PubMedCrossRefGoogle Scholar
  12. 11.
    Price RW, Brew B, Sidtis J, et al: The brain in AIDS: Central nervous system HIV-1 infection and AIDS dementia complex. Science 239: 586–592, 1988.PubMedCrossRefGoogle Scholar
  13. 12.
    Perry SW, Tross S: Psychiatric problems of AIDS inpatients in the New York Hospital: Preliminary report. Public Health Rep 99: 200–205, 1984.PubMedGoogle Scholar
  14. 12a.
    Bredesen DE, Levy RM, Rosenblum ML: The neurology of human immunodeficiency virus infection. Quart J Med 68: 665–667, 1988.PubMedGoogle Scholar
  15. 13.
    Grant I, Atkinson JH, Hesselink JR, et al: Evidence for early central nervous system involvement in the acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections: Studies with neuropsychologic testing and magnetic resonance imaging. Ann Intern Med 107: 828–836, 1987.PubMedCrossRefGoogle Scholar
  16. 14.
    Janssen RS, Saykin AJ, Kaplan JE, et al: Neurological complications of human immunodeficiency virus infection in patients with lymphadenopathy syndrome. Ann Neural 23: 49–55, 1988.CrossRefGoogle Scholar
  17. 14a.
    Brew BJ, Sidtis JJ, Petito CK, Price RW: The neurologic complications of AIDS and human immunodeficiency virus infection, in Plum F (ed), Advances in Contemporary Neurology. Philadelphia, F.A. Davis Company, 1988, pp. 1–49.Google Scholar
  18. 15.
    Catalan J: Psychosocial and neuropsychiatrie aspects of HIV infection: review of their extent and implications for psychiatry. Psychosom Res 32: 237–248, 1988.CrossRefGoogle Scholar
  19. 16.
    Navia BA, Cho ES, Petito CK, et al: The AIDS dementia complex. II. Neuropathology. Ann Neural 19: 525–535, 1986.CrossRefGoogle Scholar
  20. 17.
    Hill JM, Farrar WL, Pert CB: Localization of the T4 antigen-monkey and rat brain: Prominence in cortical regions. Psychopharm Bull 22: 689–694, 1986.Google Scholar
  21. 18.
    Pumarola-Sune T, Navia BA, Cordon-Cado C, et al: HIV antigen in the brains of patients with the AIDS dementia complex. Ann Neural 21: 490–496, 1987.CrossRefGoogle Scholar
  22. 19.
    Rotterberg DA, Moeller JR, Strother SC, et al: The metabolic pathology of the AIDS dementia complex. Ann Neural 22: 700–706, 1987.CrossRefGoogle Scholar
  23. 20.
    Parisi A, Di Perri G, Strosselli M, et al: Testing for neurological involvement in HIV infection. Lancet 2: 1531–1532, 1987.CrossRefGoogle Scholar
  24. 21.
    Parisi A, Di Perri G, Strosselli M, et al: Usefulness of computerized electroencephalography in diagnosing, staging and monitoring AIDS-dementia complex. AIDS 3: 209–213, 1989.PubMedCrossRefGoogle Scholar
  25. 22.
    Yarchoan R, Brouwers P, Spitzer AR, et al: Response of human immunodeficiency virus associated neurological disease to 3’-azido-3’-deoxythymidine. Lancet 1: 132–135, 1987.PubMedCrossRefGoogle Scholar
  26. 23.
    Brunetti A, Berg G, Di Chiro G, et al: Reversal of brain metabolic abnormalities following treatment of AIDS dementia complex with 3’-azido-2’,3’-dideoxythymidine (AZT, zidovudine): A PET-FDG study. J Nucl Med 30: 581–590, 1989.PubMedGoogle Scholar
  27. 23a.
    Fernandez F, Levy JK, Pirozzolo FJ: Neuropsychological and immunological abnormalities in advanced HIV infection, Abstracts of the WHO Fifth International Conference on AIDS, Montreal, Quebec, Canada, International Development Research Center, 1989.Google Scholar
  28. 24.
    McArthur JC, Sipos E, Chupp M, et al: Immunocytochemical straining of blood and cerebrospinal fluid mononuclear cells in AIDS-spectrum disorders. Neurology (NY) 37:319, 1987 (abst).Google Scholar
  29. 25.
    Brew BJ, Bhalla RB, Fleischer M, et al: Cerebrospinal fluid ß-2 microglobulin in patients infected with human immunodeficiency virus. Neurology (NY) 39: 830–834, 1989.CrossRefGoogle Scholar
  30. 26.
    Albert ML: Subcortical dementia, in Katzman R, Terry RD, Sick KL (eds): Alzheimer’s Disease: Senile Dementia and Related Disorders. New York, Raven Press, 1978, pp. 173–180.Google Scholar
  31. 27.
    Van Gorp WG, Mitrushina M, Cummings JL, et al: Normal aging and the subcortical encephalopathy of AIDS. Neuropsychiatry Neuropsychol Behav Neurol 2: 5–20, 1989.Google Scholar
  32. 27a.
    Fernandez F: Anxiety and the neuropsychiatry of AIDS. J. Clin Psychiatry 50 (11, suppl): 9–14, 1989.PubMedGoogle Scholar
  33. 28.
    Fernandez F, Levy JK, Mansell PWA: Management of delirium in terminally ill AIDS patients. Int J Psychiatr Med 19: 165–172, 1989.CrossRefGoogle Scholar
  34. 29.
    Fernandez F: Pharmacotherapy of HIV related dementia, in American Psychiatric Association’ s AIDS Primer. Washington, DC, American Psychiatric Association, 1987, pp. 5–27.Google Scholar
  35. 30.
    Cassem NH: Critical care psychiatry. in Shoemaker WC, Thompson WL, Holbrook PR (eds): Textbook of Critical Care. Philadelphia, WB Sanders, 1984, pp 981–989.Google Scholar
  36. 31.
    Adams F, Fernandez F, Anderson B: Emergency pharmacotherapy of delirium in the critically ill cancer patient: Intravenous combination drug approach. Psychosomatics 27 (suppl): 33–38, 1986.PubMedCrossRefGoogle Scholar
  37. 32.
    Adams F: Delirium: An optimal treatment approach. Hosp Ther January:29–42, 1987.Google Scholar
  38. 33.
    Fernandez F, Adams F, Levy JK, et al: Cognitive impairment in AIDS related complex and its response to psychostimulants. Psychosomatics 29: 38–46, 1988.PubMedCrossRefGoogle Scholar
  39. 34.
    Fernandez F, Levy JK, Galizzi H: Response of HIV related depression to psychostimulants: Case reports. Hosp Community Psychol 39: 628–631, 1988.Google Scholar
  40. 35.
    Holmes VF, Fernandez F, Levy JK: Psychostimulant response in ARC/AIDS patients. J Clin Psychol 50: 58, 1989.Google Scholar
  41. 36.
    Fernandez F, Adams F, Levy JK, et al: Depression and cancer: An update. Texas Med 82: 46–49, 1986.Google Scholar
  42. 37.
    Woods AM, Niederehe G and Fruge E: Dementia: A family systems perspective, in Zarit SH (ed): Generations: Quarterly of the American Society on Aging. San Francisco, 1985.Google Scholar
  43. 38.
    Fernandez F, Levy JK, Holmes VF, et al: Critical care issues in HIV spectrum disorders, in Wise MG (eds): Problems in Critical Care. Philadelphia, JB Lippincott, 1988, pp 159–170.Google Scholar
  44. 39.
    Folstein MF, Folstein SE, McHugh PR: “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198, 1975.PubMedCrossRefGoogle Scholar
  45. 40.
    Levin HS: Learning and memory, in Hannay HI (ed): Experimental Techniques in Human Neuropsychology. New York, Oxford University Press, 1986.Google Scholar
  46. 41.
    Benton AL: Revised Visual Retention Test, ed 4. New York: The Psychological Corporation, 1974.Google Scholar
  47. 42.
    Lezak MD: Neuropsychological Assessment, ed 2. New York, Oxford University Press, 1983.Google Scholar
  48. 43.
    Benton AL, des Hamsher K: Multilingual Aphasia Examination. Iowa City, The University of Iowa, 1983.Google Scholar
  49. 44.
    Pfeiffer E: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23: 433, 1975.PubMedGoogle Scholar
  50. 45.
    Benton AL, des Hamsher K, Varney NR, Spreen O: Contributions to Neuropsychological Assessment: A Clinical Manual. New York, Oxford University Press, 1983.Google Scholar
  51. 46.
    Lacks P: Bender Gestalt Screening for Brain Dysfunction. New York, John Wiley and Sons-Interscience, 1984.Google Scholar
  52. 47.
    Raven JC, Court JH, Raven J: Manual for Raven’s Progressive Matrices and Vocabulary Scales. Section 3: Standard Progressive Matrices. London, H.K. Lewis and Co., Ltd., 1983.Google Scholar
  53. 48.
    Golden CJ: WAIS-R Manual. New York, The Psychological Corporation, 1981.Google Scholar
  54. 49.
    Golden CJ, Osmon DC, Moses JA Jr, et al: Interpretation of the Halstead-Reitan Neuropsychological Test Battery: A Casebook Approach. New York, Grune and Stratton, 1981.Google Scholar
  55. 50.
    Pirozzolo FJ, Christensen KJ, Ogle KM, et al: Simple and choice reaction time in dementia: Clinical implications. Neurobiol Aging 2: 113, 1981.PubMedCrossRefGoogle Scholar
  56. 51.
    Golden CJ: Stroop Color and Word Test: A Manual for Clinical and Experimental Uses. Chicago: Stoelting Company, 1978.Google Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Francisco Fernandez
    • 1
    • 2
  • Joel K. Levy
    • 2
  1. 1.St Luke’s Episcopal HospitalHoustonUSA
  2. 2.Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA

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