AIDS Dementia Complex and the SLP

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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.

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

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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.

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Dementia & Spousal Caregiver Health

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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.

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Cognitive Impairment and Pain: Enhancing Communication

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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.    

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Cognitive Intervention with Individuals with Dementia: Linking Strategies to Targets

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By Nikki Kneale

It is estimated that by 2050 up to 16 million Americans will be living with dementia. This does not mean that this is solely a problem for the future. In a 2013 survey by ASHA, cognitive communication ranked second in percentage of caseload make-up; specifically, cognitive communication for dementia ranked 3rd (ASHA, 2013). There are a number of strategies SLPs working with residents who have dementia can use, each with their own small but growing body of evidence. So, which treatment strategy is a therapist to use? How do we know which one is best?  Continue reading

Cognitive Screens for People with Parkinson’s: All Are Not Created Equal

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By Heather Jeng

Do you know what cognitive screening tool is used in your local healthcare community to screen for cognitive deficits in individuals with Parkinson’s disease (IWPD)? Chances are, it’s the MMSE. This tool was suggested for physician office visit screenings for this population by the Task Force on Dementia in Parkinson’s Disease (part of Movement Disorders Society) back in 2007. The general guideline for physicians was not to pursue further cognitive assessment if the patient scored at least 26 on the MMSE.

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