In 1981, a mysterious disease was discovered to be infecting men—the disease leading to odd patterns of deadly infections and diseases. The diseases that ultimately killed the patients were known, but usually only afflicted those whose immune systems were compromised for some reason. Blood testing revealed that these patients had low levels of T4 cells (T helper lymphocytes). These cells help fight off disease-causing microorganisms. Researchers discovered that a retrovirus was killing these T4 cells—the human immunodeficiency virus (HIV). The virus manufactures its DNA in host cells. AIDS is diagnosed when a patient has HIV, has an opportunistic infection (or Kaposi’s sarcoma), and has a low number of T4 cells or low ratio of T4 cells to T8 cells (T helper cells to T suppressor cells or CD4+ cells to CD8+ cells) (Flanders et al.). Short Case Study (I) In 2004, a young boy of middle-school age was admitted to the hospital, his mother complaining that his cognitive function and academic ability had been declining in the past year. Both legs had become weak months before his admission
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In 1981, a mysterious disease was discovered to be infecting men—the
disease leading to odd patterns of deadly infections and diseases. The diseases
that ultimately killed the patients were known, but usually only afflicted those
whose immune systems were compromised for some reason. Blood testing
revealed that these patients had low levels of T4 cells (T helper lymphocytes).
These cells help fight off disease-causing microorganisms. Researchers
discovered that a retrovirus was killing these T4 cells—the human
immunodeficiency virus (HIV). The virus manufactures its DNA in host cells.
AIDS is diagnosed when a patient has HIV, has an opportunistic infection (or
Kaposi’s sarcoma), and has a low number of T4 cells or low ratio of T4 cells to
T8 cells (T helper cells to T suppressor cells or CD4+ cells to CD8+ cells)
(Flanders et al.).
Short Case Study (I)
In 2004, a young boy of middle-school age was admitted to the hospital,
his mother complaining that his cognitive function and academic ability had been
declining in the past year. Both legs had become weak months before his
admission to the facility, and the boy had been bedridden for eight weeks. His
short-term memory capacity was declining. Diagnostic tests led to many possible
diagnoses, but during his hospitalization his cognitive abilities declined even
further. The child’s father had died at a young age, from tuberculosis; upon
finding this out, the doctors added HIV to their possible diagnoses. Through a
battery of testing, it was determined that the boy had antibodies to HIV, and also
determined that his mother (who showed no symptoms) also had HIV (John et
al.).
By early January of 1985, there were scientific studies showing that the
AIDS virus resided in brain tissue of AIDS patients who suffered from dementia
and cognitive impairment. Macrophages get infected by HIV, making them
unable to fight infection, even if T4 cells give them the signal to do so. The
infection of macrophages is believed to contribute to symptoms of dementia due
to brain cells being destroyed (Flanders et al.).
The purpose of this paper is to explore and explain AIDS Dementia
Complex (ADC).
Symptoms of ADC and Stages of Progression
The most common cause of dementia in adults (adults forty years of age
or less) is HIV infection. In those patients with dementia, the untreated condition
worsens quickly in just months. The incidences of ADC would more than likely
be rising now, because of improved rates of survival of HIV patients; some data
shows that 20% of AIDS patients still develop some level of ADC today (Mattson
et al.). The number of ADC incidences was as high as 40-70% in AIDS patients
just a decade ago, when patients had no treatment before dementia set in (which
may prevent the dementia from even beginning) (Bartlett).
The stages of ADC and its progress range from normal functioning to very
severe/end stages. The earliest complaints of patients suffering from ADC are
difficulty thinking and paying attention. Their motor and cognitive skills
progressively decline; they become slow mentally, forgetful, physically weak and
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unsteady. They may also develop tremors. Their behavior may change to
become agitated and hallucinatory, and they cannot move their limbs and eyes
rapidly. They also have a “loss of will” (Portegies et al.).
As the dementia progresses to later stages, patients may be
unresponsive, unaware, severely confused, unable to be coordinated, and
involuntarily jerking and convulsing (DeVita et al.). (Table 1 outlines major
symptoms of all stages.)
Uncommon occurrences in ADC are agnosia, aphasia, and mania in late
stages.
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Figure 1 (bottom of previous page): Deficiencies in areas of ability of AIDS
patients that had neurological impairment, indicating a “subcortical pattern.”
Source: Gendelman, Howard E. et al., eds. The Neurology of AIDS. London:
Oxford University Press, 2005.
The system used to clinically determine the progression of dementia in
patients ranges from Stage 0 to Stage 4 (see table below). (Fanning)
Table 1: Staging Scheme for the AIDS Dementia Complex (ADC)
Stage Characteristics
Stage 0 (normal) ▪ Normal mental and motor function
Stage 0.5 (Equivocal/Subclinical) ▪ Either minimal or equivocal symptoms of cognitive or motor dysfunction characteristic of ADC, or mild signs (snout response, slowed extremity movements), but without impairment of work or capacity to perform activities of daily living (ADL). ▪Gait and strength are normal
Stage 1 (Mild) ▪ Unequivocal evidence (symptoms, signs, neuropsychological test performance) of functional intellectual or motor impairment characteristic of ADC, but able to perform all but the more demanding aspects of work or ADL▪ Can walk without assistance
Stage 2 (Moderate) ▪ Cannot work or maintain the more demanding aspects of work or ADL, but able to perform basic activities of self-care▪ Ambulatory, but may require a single prop
Stage 3 (Severe) ▪ Major intellectual incapacity (cannot follow news or personal events, cannot
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sustain complex conversation, considerable slowing of all output) or motor disability (cannot walk unassisted, requires walker or personal support, usually with slowing and clumsiness of arms as well)
Stage 4 (End Stage) ▪ Almost vegetative▪ Intellectual and social comprehension and responses are at a rudimentary level. ▪ Mute or almost mute▪ Paraparetic or paraplegic with double incontinence
Source: DeVita Jr., Vincent T. et al. AIDS: Etiology, Diagnosis, Treatment and