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Gray, F, Adle-Biassette, H, Chrétien, F, Lorin de la Grandmaison, G, Force, G, Keohane, C
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Neuropathology and neurodegeneration in human immunodeficiency virus infection Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments
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Clin Neuropathol year=2001 pages=146-155 volume=20 issue=4
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Adle-Biassette, H, Lévy, Y, Colombel, M, Poron, F, Natchev, S, Keohane, C and Gray, F title=Neuronal apoptosis in HIV infection in adults journal=Neuropathol Appl Neurobiol year=1995 pages=218-227 volume=21 issue=3 id=
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Gray, F, Adle-Biassette, H, Chrétien, F, Lorin de la Grandmaison, G, Force, G, Keohane, C
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Neuropathology and neurodegeneration in human immunodeficiency virus infection Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments
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Clin Neuropathol year=2001 pages=146-155 volume=20 issue=4
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Grant, I, Sacktor, H, and McArthur, J
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2005
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The Neurology of AIDS
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HIV neurocognitive disorders
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http://wwwhnrcucsdedu/publications_pdf/2005grant1pdf
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H E Gendelman, I Grant, I Everall, S A Lipton, and S Swindells (ed)
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2nd
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357-373
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Oxford University Press
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London, UK
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ISBN 0198526105
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Satishchandra, P, Nalini, A, Gourie-Devi, M, Khanna, N, Santosh, V, Ravi, V, Desai, A, Chandramuki, A, Jayakumar, P N, and Shankar, S K
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Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96)
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Indian J Med Res year=2000 pages=14-23 volume=11 issue=
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Wadia, R S, Pujari, S N, Kothari, S, Udhar, M, Kulkarni, S, Bhagat, S, and Nanivadekar, A
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Neurological manifestations of HIV disease
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J Assoc Physicians India year=2001 pages=343-348 volume=49 issue=
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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.
#Marked acquired impairement 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 neuropyschological testing.
#Cognitive impairments identified in 1. interfere markedly with day-to-day functioning.
#Cognitive impairments identified in 1. are present for at least one month.
#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.
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Grant, I, Atkinson, J
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1995
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Comprehensive textbook of psychiatry
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Psychiatric aspects of acquired immune deficiency syndrome
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http://wwwhnrcucsdedu/publications_pdf/2161995pdf
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Kaplan, HI and Sadock, BJ (ed)
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VI
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(Vol2, Sect 292) 1644-1669
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Williams and Wilkins
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Baltimore, MD
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ISBN 0683045326
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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
Neurologist s 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 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.
AIDS Dementia Complex (ADC) is not a true
Opportunistic Infection . It is one of the few conditions caused directly by the HIV virus. 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
- 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
Chemokine s and
Cytokine s - that can affect neurons as well as other brain cells known as
Astrocyte s. The affected astrocytes, which normally nurture and protect neurons, also may now end up harming neurons. Researchers hope that new drugs under investigation will interfere with the detrimental cycle and prevent neuron death.
- ''(Normal)'' Normal Mental and Motor Function
- ''(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.
- ''(Mild)'' Evidence of functional intellectual or motor impairment characteristic of ADC, but able to perform all but he more demanding aspects of work or ADL. Can walk without assistance.
- ''(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.
- ''(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.
- ''(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
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Price, RW publisher=University of California San Francisco
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1998
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http://hivinsiteucsfedu/InSitepage=kb-04&doc=kb-04-01-03
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AIDS Dementia Complex
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2006-04-06
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