Test them all; an easily diagnosed and readily treatable cause of dementia with life-threatening consequences if missed

Neurosurgery and human immunodeficiency virus in the era of combination antiretroviral therapy: a review

“…94 However, the misdiagnosis of neurological conditions has been described in cases in which HIV testing has been withheld from individuals who were perceived to be at low risk. 67 Therefore, HIV testing should be performed in all cases in which the neurosurgical presentation is suggestive. 17 Patients should always be informed that HIV testing will be performed, and they are entitled to refuse.…”

Clinical variables related to the diagnostic stability of demential syndromes

“…With this purpose in mind, the last revision by the American Academy of Neurology (Knopman et al, 2001) on the parameters used to diagnose dementia was published in 2001, which instructs that all patients should obtain a Cranial Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI), a depression triage scale such as the "Geriatric Depression Scale" (GDS), dosing of vitamin B12, thyroid-stimulating hormone (TSH), and Venereal Disease Research Laboratory test (VDRL) for those with a risk factor, or residing in an endemic area. In endemic areas, the European guideline also recommends the serology for human immunodeficiency virus (HIV) (British HIV Association, 2008;Nightingale et al, 2013) and, more recently, the systematic sleep analysis, particularly in the search for the Obstructive Sleep Apnea syndrome (OSA) (Waldemar et al, 2007;Verstraeten et al, 2007). The recommendation made by the Brazilian Academy of Neurology is even broader, as it also includes a complete blood count, blood urea concentrations, creatinine, albumin, hepatic enzymes, and calcium, in order to discard misleading clinical and psychiatric causes (Nitrini et al, 2005).…”

Evidence-based perspectives on the implementation of screening for neurocognitive impairment in HIV

“…59 There is a case to be made for HIV testing in individuals with NCI who are not already diagnosed, but that argument has been strongly made elsewhere. 60 If the benefits of ART in treating or preventing HAND or HIVE are uncontroversial, we must consider whether there is a case for screening patients already on ART so that other therapeutic interventions can be offered. Considerations include whether any particular ART drug or regimen affects neurocognitive outcomes in patients with demonstrable NCI, or in PLWH in general; whether additional benefit can be achieved from adjunctive treatments; and whether more general approaches, such as management of comorbidities and psychological and pharmacological therapies can improve outcomes.…”