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 ProblemsMinor Cognitive-Motor Disorder (MCMD)Minor cognitive-motor disorder (MCMD) is also a diagnosis of exclusion, according to the criteriaset out26inpicasTable 10-9. 16 Patients failing to meet these criteria yet who manifest functionalimpairments or related anxiety and fear warrant attention as well. MCMD may result from manyof the same risk factors as dementia. It is important to distinguish between progressive dementiaand MCMD because the latter is a less severe disorder and does not progress necessarily tofull dementia. This information may ameliorate a patient’s fear of a continuing decline.Table 10-9:Defined Criteria for HIV-Associated Minor Cognitive-Motor DisorderProbable Diagnosis(must meet all four criteria)*1. Acquired cognitive/motor/behavioral abnormalities verified by both areliable history and by neuropsychological tests2. Mild impairment of work or activities of daily living3. Does not meet criteria for HIV dementia or HIV myelopathy4. No other etiology presentX* A possible diagnosis of minor cognitive-motor disorder can be given if criteria 1, 2 and 3 are present and either (1) an alternativeetiology is present and the cause of criterion 1 is not certain, or (2) the etiology of criterion 1 cannot be determined because ofincomplete evaluation.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.Subclinical Neurocognitive ImpairmentThe impact of HIV in the CNS may show up in neurocognitive testing in the absence of significantor consistent clinical complaints, signs or symptoms. A patient may have a very mild problemwith memory, for instance, which might show up on testing but does not affect the person’sability to function in his or her work or home life. Since such neurocognitive testing would showevidence of cognitive deficits in patients without HIV as well, the long-term implications of suchfindings are not yet clear. Whether such patients are more likely to progress to MCMD or HAD astheir viral loads increase and immune systems decline needs to be determined.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 215