by Heather Jeng
December 1st is World AIDS Day. Usually in its later stages, HIV/AIDS can cause degenerative cognitive impairment. Fortunately, antiretroviral therapy has prevented many individuals with HIV/AIDS from acquiring AIDS Dementia Complex (ADC). However, speech-language pathologists may still encounter patients with this condition. Here are some basics on this disorder.
What is AIDS Dementia Complex?
ADC is thought to be caused by HIV itself, not a related opportunistic infection. The term “complex” was used to indicate that ADC affects not only intellectual function, but also motor and behavioral function. Generally, ADC is linked to advanced stages of the disease and low CD4 counts (<200 cells/mm3).
Prior to full-blown ADC, individuals may present with Minor Cognitive Motor Disorder, which is characterized by:
- Difficulty concentrating
- Slowed movements
- Changes in personality
- Lack of coordination
Individuals with ADC may present with varying symptoms, which may include:
- Poor concentration
- Decreased processing speed
- Difficulty learning new things
- Changes in behavior
- Forgetfulness/Memory loss
- Word-finding deficits
- Withdrawal from hobbies or social activities
As the dementia progresses, people with ADC may experience weakness, speech-language impairmentsvisual deficits, balance problems, and incontinence of bowel and bladder (AIDS.gov, 2010).
Stages of ADC
Stage 0: Normal functioning.
Stage .5: Symptoms are absent or minimal, mild neurologic signs; no impairment of work or capacity to perform activities of daily living (ADLs). Gait and strength are normal.
Stage 1: Mild. The patient can perform all but the most demanding work or ADL functions and is able to walk without assistance.
Stage 2: Moderate. The patient cannot perform demanding ADLs or work but is capable of basic activities of self-care. The patient is ambulatory but may require a support.
Stage 3: Severe. The patient exhibits major intellectual incapacity and motor disability.
Stage 4: End-stage. The patient is nearly vegetative, mute, with rudimentary intellectual and social comprehension and output. The patient may be paraplegic or quadriplegic with bladder and bowel incontinence.
(Price & Brew, 1988)
Responsibility of the Speech-Language Pathologist
As with any dementia, treating individuals with ADC is within the scope of practice for SLPs. According to the ASHA Practice Portal’s Clinical Topic: Dementia, one of our primary roles when working with people with dementia is “developing treatment plans for maintaining cognitive-communication and functional abilities at the highest level throughout the underlying disease course.” Education and developing effective compensatory strategies play the central role in treatment of ADC (Voyzey, 2015).
George Voyzey wrote an excellent article for the ASHA SIG 15 (Gerontology) Perspectives recently that includes a helpful section on ADC (aka HIV-associated dementia). Check it out!
For more information about HIV/AIDS in general, AIDS.gov offers a useful HIV/AIDS 101.
AIDS.gov. (2010) Staying healthy with HIV/AIDS: potential related health problems: dementia. Retrieved from https://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potential-related-health-problems/dementia/
Price, R. W. (1998). AIDS dementia complex. Retrieved from http://hivinsite.ucsf.edu/InSite?page=kb-04-01-03
Price, R. W., & Brew, B. J. (1988). The AIDS dementia complex. Journal of Infectious Disease, 158, 1079–1083.