Diagnosing and treating HIV dementia.

Many studies have shown that brain infections occur early in HIV infection, usually within weeks of seroconversion. Asymptomatic seropositive persons frequently show HIV in the brain and spinal fluid. The most common presenting symptoms are memory loss, walking difficulties, mental slowing, and depressive symptoms. In patients with localized abnormalities, such as weakness, another opportunistic infection should be suspected. Most patients with HIV dementia have clear psychomotor slowing, greater than normal reflexes, and signs indicating widespread brain dysfunction. As the dementia progresses, patients develop language and attention problems, apathy, severe psychomotor slowing, and lack of insight. Delirium is a frequent side effect of the medicines used to treat dementia. Diagnosis is fairly simple, with MRI being used to rule out CMV, progressive multifocal leukoencephalopathy, and herpes. AZT and antiretrovirals offer protective effects to delay the onset and progression of AIDS dementia. The AIDS Clinical Trials Group has completed a study showing that nimodipine, a calcium-channel blocker, can lessen damage to the brain, and is safe and generally well tolerated. Combination therapies, such as antiretrovirals with cytokine blockers, will probably emerge as the treatment of choice for dementia.