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HIV-associated dementia in older adults: clinical and tomographic aspects

Published online by Cambridge University Press:  17 February 2011

Emanuela Torreão Brito e Silva ,
Leonardo Ferreira Caixeta ,
Vânia Lucia Dias Soares  and
Gisele Rodrigues Fonseca Sagawa
Emanuela Torreão Brito e Silva*
Affiliation:
Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiânia, Brazil
Leonardo Ferreira Caixeta
Affiliation:
Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiânia, Brazil
Vânia Lucia Dias Soares
Affiliation:
Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiânia, Brazil
Gisele Rodrigues Fonseca Sagawa
Affiliation:
Goiânia Emergency Hospital, Goiânia, Brazil
*
Correspondence should be addressed to: Emanuela Torreão Brito e Silva, Rua Dr. Pinto Ferraz, N° 97, Apt. 132, Vila Mariana, São Paulo, SP, CEP 04117-040, Brazil. Phone: +55-11-5549-0550; Fax: +55-11-3209-5419. Email: [email protected].
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Abstract

Background: Elderly adults with human immunodeficiency virus (HIV) are at greater risk of developing cognitive impairment. The purpose of this study was to describe clinical and tomographic characteristics of HIV-1 associated dementia (HIVD) in older adults.

Methods: A descriptive study was carried out involving eight HIVD patients. Seven tests were employed for cognitive assessment and transformed to whole number z-scores using appropriate normative sets.

Results: The average age of the patients was 71 years; seven cases described the route of HIV infection as being heterosexual; and mean schooling was 6.5 years. Six subjects were using highly active anti-retroviral therapy (HAART), with an average CD4 count of 407.8 cells/mm3. Mild dementia was detected in most cases (87.5%). Deficits on neuropsychological tests showed results similar to multi-center transversal studies on HIVD. The classic HIVD triad observed in younger adults was also seen in this population: i.e. cognitive changes, psychiatric changes and motor impairment. Cortical injury shown by dyscalculia, visual-spatial change and language deficits were frequent. Brain images showed cortical atrophy in all patients but was restricted to frontal lobes in five cases.

Conclusion: The findings on brain imaging were non-specific, revealing images similar to those of the elderly brain and to HIVD in younger adults. HIVD in the elderly is a challenge and become an increasingly significant differential diagnosis for cognitive loss in old age. This dementia must be clinically suspected and image exams are useful in excluding other central disorders. Prospective studies of HIV-positive elderly people are warranted to better understand HIVD.

Keywords

HIVcognitive impairmentbrain imaging
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 7 , September 2011 , pp. 1061 - 1069
Copyright
Copyright © International Psychogeriatric Association 2011

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