neurologic disorders
HIV Associated Dementia
Diagnosis of HIV Associated Dementia
Clinical evaluation Measurement of CD4 count and HIV viral load Prompt evaluation, including MRI and usually lumbar puncture, when deterioration is acute HIV-associated dementia should be suspected in patients who have Symptoms of dementia Known HIV infection or symptoms or risk factors suggesting HIV infection If patients known to have HIV infection have symptoms suggesting dementia, a general Clinical criteria is confirmed based on the usual criteria, including the following: Cognitive or behavioral (neuropsychiatric) symptoms interfere with the ability to function at work or do usual daily activities. These symptoms represent a decline from previous levels of functioning. These symptoms are not explained by delirium or a major psychiatric disorder. Evaluation of cognitive function involves taking a history from the patient and from someone who knows the patient plus doing a bedside How to Assess Mental Status or, if bedside testing is inconclusive, If patients with symptoms of dementia arenotknown to have HIV infection but have risk factors for HIV infection, they are tested for HIV. In patients with HIV infection or suspected HIV-associated dementia, CD4 count and HIV viral load are measured. In patients with suspected or confirmed HIV and dementia, these values help determine how likely HIV-associated dementia (and CNS lymphoma and other HIV-associated CNS infections) is to be contributing to dementia. In patients who have HIV infection but not dementia, these values help determine how likely HIV-associated dementia is to develop. If patients have dementia and HIV infection, other processes can cause or contribute to worsening dementia symptoms. Thus, the cause of cognitive decline, particularly sudden, severe decline—whether due to HIV or another infection—must be identified as soon as possible. MRI, with and without contrast, should be done to identify other causes of dementia, and if MRI does not identify any contraindication to Lumbar Puncture (Spinal Tap) , lumbar puncture should also be done. Late-stage findings of HIV-associated dementia may include diffuse nonenhancing white matter hyperintensities, cerebral atrophy, and ventricular enlargement. 