Page 172 - AIDSBK23C

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persons with AIDS are affected, with an annual incidence of 7%. It is rare to have both cognitive
and functional impairment without associated neurologic and/or behavioral deficits. Functional
impairment in isolation is also rare. The American Academy of Neurology algorithm for HIV-1-
associated cognitive/motor disorder is as follows:[745]

HIV-1-Associated Dementia Complex (ADC)

Criteria for 1 and 2 must be met:

1. Scores 1 standard deviation (SD) below age- and education-adjusted norms on
two of eight neuropsychological test or 2 SDs below norms on one of eight tests.

2. Requires assistance or has difficulty (due to either physical or cognitive deficit)
in one of the following instrumental activities of daily living (IADLs):

Using the telephone.
Handling money.
Taking medication.
Performing light housekeeping.
Doing laundry.
Preparing meals.
Shopping for groceries.
Getting to places out of walking distance.
AND

Must meet either 1 or 2 of the following:

1. Any impairment in the following: lower extremity strength, coordination, finger
tapping, alternating hand movements, leg agility, or performance on grooved
pegboard 2 standard deviations below mean (dominant hand).

2. Self-reported frequent depression that interferes with function, loss of interest in
usual activities or emotional lability, or irritability.

Staging of ADC

Mild: must attribute IADL to a cognitive source.

Moderate: satisfies neurologic and psychiatric criteria for mild ADC plus functional
impairment in either telephone use, medication taking, or money handling plus two or
three other IADLs or activities of daily living (indoor mobility, eating, dressing,
grooming, toileting, getting in and out of bed, bathing) attributed to a cognitive source.

Severe: satisfies neurologic and psychiatric criteria for moderate ADC and has in
addition to impairment in telephone use, medication taking, or money handling at
least four IADLs or ADLs attributed to a cognitive source.