By Davangere Devaband MD & Richard Mayeux MD MSE
The human immunodeficiency virus (HIV) responsible for acquired immune deficiency syndrome (AIDS) also causes dementia in many victims.
The dementia may start with subtle changes in personality, memory, and behavior, but at first these alterations are usually attributed to the dramatic emotional impact of the disease, In some AIDS patients, however, episodes of depression and psychosis start to occur regularly --- often at about the same time that opportunistic infections, such as pneumonia, strike --- and considerable memory loss becomes apparent to others. Eventually the victims of AIDS-related dementia themselves acknowledge having serious problems with mental activity and complain of overall lethargy and lack of interest in once-important parts of their lives.
In AIDS victims, dementia symptoms regularly stabilize for months on end, and sometimes for years, before once again continuing a generally downhill course.
While there is no known cure for the disease itself, many symptoms of AIDS dementia (and other psychological problems associated with the illness) often respond to medications. Stimulant drugs such as methylphenidate (Ritalin) and dextroamphetamine improve attention span and overall mental ability for brief periods. Psychotic episodes can be treated with small doses of antipsychotic drugs, and depression responds to small doses of antidepressant drugs.
The use of
drugs to treat AIDS dementia is complicated by potential interaction with
other drugs already being taken to deal with infections or various AIDS-related
problems. In general, the smallest effective doses should be prescribed
to minimize interactions, and some compounds should be avoided altogether
(such as antidepressants with high anticholinergic side effects).
Source: J. Am. Geriatric Soc (1998) 46:597
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