The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 10: Psychiatric ProblemsThe diagnosis of HIV-associated dementia (HAD) is made by excluding all potential causes for achange in mental state according to criteria set out by the American Academy of Neurology, 16shown in Table 10-7. Risk factors for dementia are listed in Table 10-8.26 picasTable 10-7: Definitional Criteria for HIV-Associated Dementia (HAD)CriterionDescription1. Acquired abnormality in Cognitive decline verified by history and mentalat least two of the followingstatus examination. When possible, history shouldcognitive abilities (presentbe obtained from an informant and examinationfor more than or equalshould be supplemented by neuropsychologicalto one month):testing. The cognitive dysfunction must causeAttention/concentrationimpairment of work or in activities of daily living,Speed of processingwith impairment not attributable solelyAbstraction/reasoningto severe systemic illness.Visuospatial skillsMemory learningSpeech/language2. At least one of the following:Acquired abnormality in motor Abnormality verified by physcial examination,function or performance.neuropsychological tests, or both.Decline in motivation or emotional Change characterized by any of the following:control or change in social behavior. apathy, inertia, irritability, emotional lability, ornew-onset impaired judgment characterized bysocially inappropriate behavior or disinhibition.3. Absence of clouding of consciousnessduring a period long enough toestablish the presence of criterion 1.4. Exclusion of another etiology by Alternate possible etiologies include activehistory, physical, and psychiatric central nervous system opportunistic infectionsexamination and appropriate or malignancy, psychiatric disorders (e.g.,laboratory and radiologic tests. depressive disorders), active substance abuse, oracute or chronic substance withdrawal.Source: American Academy of Neurology AIDS Task Force. Nomenclature and research case definitions for neurological manifestationsof human immunodeficiency virus type 1 (HIV-1) infection: report of a working group of the American Academy of Neurology AIDS TaskForce. Neurology 41:778-85, 1991.Table 10-8: Risk Factors for HIV Dementia• High plasma HIV RNA (may not correlate in significant % of cases)• Low CD4 count• Anemia• Low body mass index• Older age• Intravenous drug use• Constitutional symptoms prior to diagnosis of AIDS• Co-morbidity with chronic encephalopathy or vacuolar myelopathy214U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau