Facts about AIDS Related Dementia (ARD)

[Guest guest]

Dear Mark;

Thank you for your email. Below are some facts about Dementia. You can get

more information about AIDS Related Dementia FROM THIS WEBLINK:

http://www.thebody.com/treat/neuro_dementia.html

Hope this is useful. Sincerely...S

*********

AIDS RELATED DEMENTIA:

Dementia is a brain disorder that affects a person's ability to think clearly

and can impact his or her daily activities. AIDS dementia complex (ADC) --

dementia caused by HIV infection -- is a complicated syndrome made up of

different nervous system and mental symptoms. These symptoms are somewhat

common in people with HIV disease.

The frequency of ADC increases with advancing HIV disease and as CD4+ cell

counts decrease. It is fairly uncommon in people with early HIV disease, but

it's more common in people with severely weakened immune systems and symptoms

of advanced disease. Severe ADC is almost exclusively seen only in people with

advanced HIV disease.

ADC consists of many conditions that can be of varying degrees and may

progressively worsen. These conditions can easily be mistaken for symptoms of

other common HIV-associated problems including depression, drug side effects

or opportunistic infections that affect the brain like toxoplasmosis or

lymphoma. Symptoms of ADC may include poor concentration, forgetfulness, loss

of short- or long-term memory, social withdrawal, slowed thinking, short

attention span, irritability, apathy (lack of caring or concern for oneself or

others), weakness, poor coordination, impaired judgment, problems with vision

and personality change.

Because ADC varies so much from person to person, it is poorly understood and

has been reported and described in many conflicting ways. There are possibly

three stages of Dementia

Possible Symptoms of Early Stage ADC

• Difficulty concentrating

• Difficulty remembering phone numbers or appointments

• Slowed thinking

• Longer time needed to complete complicated tasks

• Reliance on list keeping to help track daily activities

• Mental status tests and other mental capabilities may be normal

• Irritability

• Unsteady gait (walk) or difficulty keeping balance

• Poor hand coordination and change in writing

• Depression

Possible Symptoms of Middle Stage ADC

• Symptoms of motor dysfunction, like muscle weakness

• Poor performance on regular tasks

• More concentration and attention required

• Slow responses and frequently dropping objects

• General feelings of indifference or apathy

• Slowness in normal activities, like eating and writing

• Walking, balance and coordination requires a great deal of effort

Possible Symptoms of Late Stage ADC

• Loss of bladder or bowel control

• Spastic gait, making walking more difficult

• Loss of initiative or interest

• Withdrawing from life

• Psychosis or mania

• Confinement to bed

What Is ADC?

ADC is characterized by severe changes in four areas: a person's ability to

understand, process and remember information (cognition); behavior; ability to

coordinate muscles and movement (motor coordination); or emotions (mood).

These changes are called ADC when they're believed to be related to HIV itself

rather than other factors that might cause them, like other brain infections,

drug side effects, etc.

In ADC, cognitive impairment is often characterized by memory loss, speech

problems, inability to concentrate and poor judgment. Cognitive problems are

often the first symptoms a person with ADC will notice. These include the need

to make lists in order to remember routine tasks or forgetting, in mid-

sentence, what one was talking about.

Behavioral changes in ADC are the least understood and defined. They can be

described as impairments in one's ability to perform common tasks and

activities of daily living. These changes are found in 30-40% of people with

early ADC.

Motor impairment is often characterized by a loss of control of the bladder;

loss of feeling in and loss of control of the legs; and stiff, awkward or

obviously slowed movements. Motor impairment is not common in early ADC. Early

symptoms may include a change in handwriting. Mood impairments are defined as

changes in emotional responses. In ADC, this impairment is associated with

conditions, such as severe depression, severe personality changes (psychosis)

and, less commonly, intense excitability (mania).

The Symptoms of ADC

Properly diagnosing ADC is heavily dependent on the keen judgment of doctors,

often together with specialists like psychiatric, brain or neurology experts.

It's easy to imagine how difficult it is to determine impairments in mood and

behavior since there's no standard or common course of ADC. In one person it

may be very mild with periods of varying severity of symptoms. In another it

can be abrupt, severe and progressive. Currently, there is no way to tell how

a person will progress with ADC.

Sometimes symptoms of ADC are overlooked or dismissed by caregivers, who may

believe the symptoms are due to advanced HIV disease. In fact, people with

advanced disease generally do not have symptoms of ADC but do have fairly

normal mental functioning as long as they also have no other neurological

problems. At the other end of the spectrum, ADC should be carefully

distinguished from severe depression -- common among people with HIV that may

result in symptoms similar to ADC.

ADC occurs more commonly in children with HIV than with adults. It presents

similarly and is often more severe and progressive

How Does HIV Cause ADC?

While it is clear that HIV can cause serious nervous system disease, how it

causes ADC is unclear. In general, nervous system and mental disorders are

caused by the death of nerve cells. While HIV does not directly infect nerve

cells, it's thought that HIV can somehow kill them indirectly.

Macrophages -- white cells that are prevalent in the brain and act as large

reservoirs for HIV -- appear to be HIV's first target in the central nervous

system. HIV-infected macrophages can carry HIV into the brain from the

bloodstream. Test tube studies offer these hypotheses about how macrophages

may help destroy nerve cells:

• An infected macrophage in the brain may shed a particle on HIV's outer

coat (called gp120), causing damage to nerve cells.

• HIV's TAT gene, which helps produce new virus, detaches from HIV and

circulates in the blood, causing toxic effects in nerve cells.

• The macrophage itself releases a number of substances that, in excess,

can be toxic to the brain. Some examples are quinolinic acid and nitric oxide,

among an array of other signal molecules. These can bind to nerve cells and

cause cell dysfunction or death. Research has found higher levels of

quinolinic acid and other markers of cell activation in the CSF of people with

ADC.

• HIV infection of other brain cells, including astrocytes.

Incidence Anecdotal reports indicate that there are fewer people with ADC

since anti-HIV therapy became standard. People who develop ADC today tend to

be " sicker " than those who developed it before the use of anti-HIV therapy.

One early study from England supports this theory.

The British study found that only 2% of people with AIDS taking AZT developed

ADC from 1982-1988, compared to 20% of those not on AZT. The incidence of ADC

dropped from 53% in 1987 (before the arrival of AZT) to 3% in 1988 (after the

arrival of AZT).

Early in the epidemic, many new AIDS cases were attributed to ADC. These newly-

diagnosed people often had ADC but no other AIDS-related condition. Many

doctors report that they are no longer seeing people who have just ADC. It has

increasingly become a disease of late-stage AIDS when people suffer from

multiple infections.

Diagnosing ADC

Three tests are required to diagnose ADC accurately: a mental status exam, one

of the standard scans (CT and/or MRI) and a spinal tap. These may also help

tell ADC apart from other brain disorders like toxoplasmosis, PML (progressive

multifocal leukoencephalopathy) or lymphoma. Care should be taken, however, as

ADC may occur along with the symptoms of other brain disorders. Diagnosing

both conditions at the same time can be more difficult.

The main way to detect and evaluate ADC is through a mental status exam. The

examination is designed to reveal problems like short- or long-term memory

loss, problems with orientation, concentration and abstract thinking as well

as swings in mood. Imaging of the brain with scans (like an x-ray) is also

used. Certain lab tests can also be useful like examining cerebrospinal fund

(CSF), obtained by a spinal tap (also called lumbar puncture).

CT and MRI scans are routinely used in the detection of ADC. CT scans are x-

rays that use special beams to produce detailed images of organs and

structures within the body. In people with ADC these scans usually show signs

of destroyed brain tissue. MRI, or Magnetic Resonance Imaging, is a sensitive

brain scan that is used when CT findings are not conclusive. Results from both

of these tests are helpful in ruling out other causes for the symptoms.

Tests of CSF may help determine if someone has ADC, but they are not

conclusive. Mostly they're used to rule out other causes of the symptoms of

ADC, and that's why they're important. Many people with ADC have higher levels

of certain proteins or white blood cells in their CSF. However, not everyone

with these levels turn out to have ADC. Also, people with advanced ADC are

generally more likely to have higher HIV levels in their CSF, although people

with no symptoms of brain disorders sometimes have high HIV levels in their

CSF.