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AIDS-dementia complex (ADC)
AIDS-dementia complexAbbreviation: ADC
The exact cause of AIDS dementia is unknown, but current theories suggest that it results from HIV infection of macrophages in the brain (microglia) and the destructive release of cytokines that disrupt neurotransmitter function.
AIDS dementia is characterized by slow, progressive memory loss, decreased ability to concentrate, a general slowing of cognitive processes, and mood disorders. Motor dysfunction may also be present, including ataxia, bowel and bladder incontinence, and seizures. Higher levels of HIV RNA in the cerebrospinal fluid (CSF viral load) are correlated with increased problems.
Treatment options may include highly active antiretroviral therapies. Since their introduction the incidence of AIDS-dementia complex has decreased.
The patient's mental status and level of consciousness must be assessed and documented. Clear documentation is essential to track a patient's changes over time. Orientation to person, place, and time; thought processes (cognition); verbal communication skills; and memory losses can be determined through simple conversations that reveal the patient's ability to recall normal details of the day and previous teaching. Particular attention is paid to patients' abilities to comply with their complex medication regimen; inability to do so requires another person to assume responsibility for this task. The patient's affect and mood; the presence of agitated, restless, or lethargic behavior; and the extent to which clothing is clean and appropriate for the weather may reveal progressing dementia when compared with previously documented mental status assessments.
Interventions are based on clear communication. As patients develop dementia, they may become frightened, and a consistently gentle approach with positive feedback is essential. Clocks, calendars, and memory aids help the patient become reoriented. Step-by-step written instructions should be given to augment verbal instructions. Caregivers need to learn how to reorient the patient, how to recognize and treat hallucinations, how to create a safe environment, how to ensure that basic hygiene needs are met, and how to document medication schedules and intake because patients may forget to eat or drink adequately.