Dementia in AIDS patients

Abstract

We determined incidence and future projections of dementia after AIDS onset in 492 homosexual men with AIDS in the Baltimore/Los Angeles sites of the Multicenter AIDS Cohort Study, 64 of whom developed dementia. We studied various risk factors for dementia, including demographic and clinical features, medical history, markers of immune status before AIDS, and zidovudine use. During the first 2 years after AIDS, HIV dementia developed at an annual rate of 7%. Overall, 15% of the cohort followed through death developed dementia. The median survival after dementia was 6.0 months. Using a proportional hazards model, risk factors for more rapid development of dementia were lower hemoglobin (relative hazard, 0.59 per additional 2 g/dl; p = 0.0005) and body mass index (relative hazard, 0.64 per additional 5 kg/m2; p = 0.05) 1 to 6 months before AIDS, more constitutional symptoms 7 to 12 months before AIDS (relative hazard, 1.68 per additional symptom, p = 0.005), and older age at AIDS onset (relative hazard, 1.60 per decade older; p = 0.009). In a multivariate model, pre-AIDS hemoglobin remained the most significant predictor of dementia. There were no significant risks defined from demographic characteristics, specific AIDS-defining illnesses, zidovudine use before AIDS, or CD4+ lymphocyte count before AIDS. We project that 12 months after the first AIDS diagnosis, 7.1% of survivors will have dementia. The observed association between anemia, low weight, constitutional symptoms, and dementia suggests a role for cytokines inducing both systemic and neurologic disease.

A Longitudinal Analysis of the Impact of Physical Activity on Neurocognitive Functioning Among HIV-Infected Adults

“…Even mild NCI can lead to problems with everyday functioning, including medication adherence, driving, and financial management [4][5][6][7]. Moreover, HIV infection and aging may have additive or synergistic negative effects on the central nervous system (CNS), leading to increased rates of NCI among older HIV-infected cohorts [8,9]. Thus, as the population of HIV-infected adults lives longer, the need to address the longer-term impact of NCI is increasing.…”

HIV-1-assoziierte neurokognitive Störung

“…Daher bleibt die zerebrale Manifestation der HIV-Infektion mit der Störung von kognitiven, motorischen, Verhaltensund vegetativen Funktionen [3, 65,76,102] ein Alltagsproblem in der HIV-Medizin. Für dieses Krankheitsbild wurden verschiedene Begriffe geprägt wie HIVEnzephalopathie, AIDS-Demenz-Komplex und HIV-assoziierter kognitiv-motorischer Komplex.…”

Human Immunodeficiency Virus and the Central Nervous System

“…The American Academy of Neurology and the World Health Organization (WHO) (1991,1996) recommend the terms "HIVassociated dementia" and "HIV-1 associated minor cognitive- motor complex" to designate the major and minor forms of cognitive impairment in HIV infection [67]. The latter does not involve impairment in daily life activities.…”

“…Occasionally, however, chronic use of medications, such as narcotic analgesics, anticholinergics, and antipsychotics, can result in an insidious cognitive deterioration that may mimic dementia. An attempt should be made to remove or reduce the dose of any potentially offending agents [24,67,81,82].…”