AIDS dementia complex
3250177
223301715
2008-07-03T13:42:27Z
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{{DiseaseDisorder infobox |
Name = AIDS dementia complex (ADC) |
ICD10 = {{ICD10|B|22||b|20}}, {{ICD10|F|02|4|f|00}} |
ICD9 = {{ICD9|042}} |
}}
{{Technical}}
'''AIDS dementia complex''' ('''ADC'''; also known as '''HIV dementia''', '''HIV encephalopathy''' and '''HIV-associated dementia''') is 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]] [[macrophage]]s and [[microglia]].<ref name=Gray>{{
cite journal
| author=Gray, F., Adle-Biassette, H., Chrétien, F., Lorin de la Grandmaison, G., Force, G., Keohane, C.
| title=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
| journal=Clin. Neuropathol. | year=2001 | pages=146-155 | volume=20 | issue=4
| pmid=11495003
}}</ref> These cells are actively infected with HIV and secrete [[neurotoxin]]s 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. [[histopathology|Histopathologically]], it is identified by the infiltration of [[monocyte]]s and [[macrophage]]s into the [[central nervous system]] (CNS), [[gliosis]], pallor of [[myelin sheath]]s, abnormalities of [[dendritic cell|dendritic]] processes and [[neuron]]al [[apoptosis]].<ref name=Adle>{{
cite journal
| author=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 | pmid=7477730
}}</ref><ref name=Gray>{{
cite journal
| author=Gray, F., Adle-Biassette, H., Chrétien, F., Lorin de la Grandmaison, G., Force, G., Keohane, C.
| title=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
| journal=Clin. Neuropathol. | year=2001 | pages=146-155 | volume=20 | issue=4
| pmid=11495003
}}</ref>
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<ref name=Grant>{{
cite book
| author = Grant, I., Sacktor, H., and McArthur, J.
| year = 2005
| title = The Neurology of AIDS
| chapter = HIV neurocognitive disorders
| chapterurl = http://www.hnrc.ucsd.edu/publications_pdf/2005grant1.pdf
| editor = H. E. Gendelman, I. Grant, I. Everall, S. A. Lipton, and S. Swindells. (ed.)
| edition = 2nd
| pages = 357-373
| publisher = Oxford University Press
| location = London, UK
| id = ISBN 0-19-852610-5
}}</ref> and has only been seen in 1-2% of India based infections.<ref name=Satischandra>{{
cite journal
| author=Satishchandra, P., Nalini, A., Gourie-Devi, M., Khanna, N., Santosh, V., Ravi, V., Desai, A., Chandramuki, A., Jayakumar, P. N., and Shankar, S. K.
| title=Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96)
| journal=Indian J. Med. Res. | year=2000 | pages=14-23 | volume=11 | issue=
| pmid=10793489
}}</ref><ref name=Wadia>{{
cite journal
| author=Wadia, R. S., Pujari, S. N., Kothari, S., Udhar, M., Kulkarni, S., Bhagat, S., and Nanivadekar, A.
| title=Neurological manifestations of HIV disease
| journal=J. Assoc. Physicians India | year=2001 | pages=343-348 | volume=49 | issue=
| pmid=11291974
}}</ref> This may have to do with differences in diets, such as consumption of [[curcumin]] (in curry) and [[EGCG]] or [[Theaflavin]]s (in teas), both which can pass the blood brain barrier and have neuroprotective effects.{{Fact|date=January 2008}} With the advent of [[highly active antiretroviral therapy]] (HAART), the frequency of ADC has declined in [[Developed country|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==
#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.
#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.
#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.<ref name=Atkinson>{{
cite book
| author = Grant, I., Atkinson, J.
| year = 1995
| title = Comprehensive textbook of psychiatry
| chapter = Psychiatric aspects of acquired immune deficiency syndrome.
| chapterurl = http://www.hnrc.ucsd.edu/publications_pdf/2161995.pdf
| editor = Kaplan, H.I. and Sadock, B.J. (ed.)
| edition = VI
| pages = (Vol.2, Sect. 29.2) 1644-1669
| publisher = Williams and Wilkins
| location = Baltimore, MD
| id = ISBN 0-683-04532-6
}}</ref>
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 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
*[[AIDS-related lymphoma|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 [[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. The HIV virus protein [[gp120]] inhibits the stem cells in the brain from producing new nerve cells.<ref>{{cite journal | last =Okamoto | first =Shu-ichi | coauthors =Y.Kang, C. W.Brechtel, E.Siviglia, R.Russo, A.Clemente, A.Harrop, S.McKercher, M.Kaul, and S.A.Lipton | title =HIV/gp120 decreases adult neural progenitor cell proliferation via checkpoint kinase-mediated cell-cycle withdrawal and G1 arrest | journal =Cell Stem Cell | volume =1 | pages =230–236 | date =[[16 August]] [[2007]] | url =http://www.cellstemcell.com/content/article/fulltext?uid=PIIS1934590907000768 | accessdate =2007-09-24 | doi =10.1016/j.stem.2007.07.010}}</ref> 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 skill|Motor Function]]
*'''Stage 0.5''' ''(Subclinical)'' Minimal symptoms of cognitive or motor dysfunction characteristic of ADC, or mild signs ([[snout reflex|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. [[paraparesis|Paraparetic]] or [[paraplegic]] with [[urinary incontinence]] and [[fecal incontinence]].
==References and notes==
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==External links==
*{{
cite web
| author=Price, R.W. | publisher=University of California San Francisco
| year= 1998
| url=http://hivinsite.ucsf.edu/InSite?page=kb-04&doc=kb-04-01-03
| title=AIDS Dementia Complex
| accessdate=2006-04-06
}}
{{AIDS}}
{{Viral diseases}}
{{Mental and behavioural disorders}}
[[Category:HIV/AIDS]]
[[Category:Cognitive disorders]]
[[Category:Diseases]]
[[id:Kompleks demensia AIDS]]
*[http://dictionary-psychology.com Dictionary of psychology]