Page 173 - AIDSBK23C

Page 173

HIV-1-Associated Minor Cognitive/Motor Disorder

Does not meet criteria for HIV-1-associated dementia complex and meets 1 and 2
of the following:

1. Deficit in at least two of the following:

Mental slowing: digit symbol at least 1 standard deviation below
age- and education-adjusted norms.

Memory: Rey Auditory Verbal learning test (total) of at least
1 standard deviation below norms.

Motor dysfunction: any impairment in finger tapping or
pronation/supination.

Incoordination: mild impairment in gait or clumsiness.

Emotional lability or apathy/withdrawal.

AND

2. Deficit in at least one of the role function measures attributed in part to
cognitive function:

Need for frequent rests.
Cut down on amount of time in activities.
Accomplish less than desired.
Cannot perform activities as carefully as one would like.
Limited in work or activities.
Difficulty performing activities.
Requires special assistance to perform activities.

AIDS DEMENTIA COMPLEX.-- In only 3% of adults with HIV infection is ADC the
first manifestation of AIDS. During the late stages of AIDS, when CD4 lymphocyte counts drop
and HIV-1 RNA levels increase, more patients may be affected with frank dementia. In patients
receiving antiretroviral therapy (ART) the incidence declines. The disease often progresses
insidiously, particularly in patients receiving antiretroviral therapy, but the onset can be more
rapid over weeks in patients who have never received antiretroviral therapy. Persons with CD4
counts below 100/µL progress more rapidly. The mean survival in untreated persons is about 6
months. Other significant predictors of progression to dementia are the presence of an anemia,
weight loss, and constitutional symptoms.[745,746,747]
The diagnosis is one of exclusion. Opportunistic infections involving the CNS in AIDS
tend to have a more rapid onset and course. Clinical features of ADC suggest early and