AIDS Dementia Complex and the SLP

world_logo1

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
  • Forgetfulness
  • 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
  • Confusion
  • Word-finding deficits
  • Withdrawal from hobbies or social activities
  • Depression

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.

 

References

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.

Voyzey, G. A. (2015). Meeting the Cultural, Therapeutic, and Individual Needs of the Lesbian, Gay, Bisexual or Transgendered Patient. Perspect Gerontol, 20(3), 85-103. doi: 10.1044/gero20.3.85.

Skilled Nursing & Long-Term Care Sessions at #ASHA15

asha_15_snf_sessions

By Heather Jeng

The 2015 ASHA Convention has sessions devoted specifically to the skilled nursing/long-term care setting! Of course, there are many, many other relevant courses in tracks such as Swallowing and Swallowing Disorders, Motor Speech Disorders, Language Disorders, etc. However, if you want to direct some of your professional development to setting-specific issues, you’ll want to check out the following courses. The information below has been copied from the Program Planner.

Continue reading

“Feeling Fulfilled as a Therapist”: Starting the CFY in Skilled Nursing

seattle_new_beginningsby Sara Savaglio & Heather Jeng

A warm welcome to our new co-blogger, Sara S.! Our first non-Case Western alum to join SLPs in the SNF, Sara is celebrating some major SLP career milestones this year. She graduated from the University of Washington this summer, and is starting her Clinical Fellowship Year in skilled nursing/long-term care near Olympia, WA. (Check out the rest of her bio.) We chatted with her about why she chose speech-language pathology as a career, and what drew her to the SNF setting.

Continue reading

Where Do I Go From Here? Practice-Based Evidence Provides Direction

elderly_hands_map

 

By Heather Jeng

Sept 21st is World Alzheimer’s Day. Treating a person with a degenerative disease process requires focusing more on intact strengths and environmental factors than deficits. This is referred to as habilitative (vs rehabilitative) intervention. A common treatment challenge is making sound evidence-based decisions when designing and modifying the treatment plan. But evidence does not come only from research studies. In honor of all of our patients with Alzheimer’s, this post explores how evidence is generated every day in treatment sessions, and how clinicians can harness it to provide effective treatment with confidence.

Continue reading

Dementia & Spousal Caregiver Health

elderly-couple

by Heather Jeng

Earlier this month, I had a long conversation with a client’s wife. She was struggling with guilt and sadness about having moved her husband into long-term care after his needs became too great for her to manage at home. At the same time, though, she admitted that she felt “healthier than I have in years.” It makes intuitive sense that caregiver burden, especially for elderly caregivers, affects one’s own health. But I wondered about the specifics of how this plays out. So for Research Tuesday this month, I did some digging about the health impact of being a spousal caregiver to a person with dementia.

Continue reading

Cognitive Impairment and Pain: Enhancing Communication

iStock_000012625418Small_0_PAIN

By Heather Jeng

September is Pain Awareness Month. SLPs in skilled nursing/long-term care frequently work with patients who have acute and/or chronic pain. Yet we receive little training on characteristics of pain and how cognitively intact patients express it, let alone those with cognitive-communication disorders! Please comment below to share any experiences helping a patient with cognitive impairment communicate their pain.    

Continue reading