sailor girlAIDS Dementia Complex
by Mark Bowers

Dementia and its Symptoms

The term dementia is used by neurologists to describe a clinical syndrome composed of memory loss, decreased mental concentration and the loss of other intellectual functions because of progressive disease in the brain. There may be motor signs, such as weakness, lack of coordination and unsteady gait. Behavioral changes are most likely to be noticed by friends or family members, and may include apathy, personality changes and loss of libido. ADC (AIDS Dementia Complex) is often characterized by depression, but depression alone is not enough to establish a diagnosis of ADC. Depression has a profound effect on survival and should be treated, whether it appears as part of the of symptoms called ADC or alone.

The clinical course of ADC is variable. Some people experience only mild symptoms, while others progress rapidly. A scale that allows clinicians to stage ADC is provided below. The first symptoms to appear are often the most difficult to quantify: short-term memory loss and poor concentration may be attributed to stress, to prescription or recreational drug use, or to fatigue, but may also be early manifestations of ADC.

AIDS Dementia Complex Classification

  • Stage 0: Normal
  • Stage 0.5: Subclinical or Equivocal
  • Minimal symptoms
  • Mild neurological signs
  • No impairment of work or activities of daily living (ADL)
  • Stage 1: Mild
  • Certain intellectual or motor impairment
  • Able to do all but the most demanding work or ADL
  • Stage 2: Moderate
  • Cannot work or perform demanding ADL
  • Capable of self-care
  • Ambulatory, but may need cane or walker
  • Stage 3: Severe
  • Major intellectual disability or
  • Cannot walk unassisted
  • Stage 4: End-Stage
  • Nearly vegetative
  • No cognition
  • Para-or-quadriplegic
  • Adapted from J Worley and R Price, Management of neurologic complications of HIV-1 infection and AIDS. In The Medical Management of AIDS, 3rd Edition. M Sande and P Volberding, editors. WB Saunders Company, Philadelphia, 1992.

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