Joseph Kamugisha
6 June 2007
opinion
Kigali — Some of the defects that arise due to HIV infection include HIV associated minor cognitive disorder that may occur in patients who are otherwise asymptomatic or mildly (moderately) symptomatic.
The disorder is characterized by sub-cortical deficits of attention, information processing speed, learning and memory, and psychomotor skills. HIV associated minor cognitive disorder may be complicated by the presence of depression and anxiety, but is not caused by psychiatric problems.
Doctor Dirk de Ridder, a neurosurgeon, says that the diagnosis of HIV associated minor cognitive disorder requires comprehensive neuropsychological evaluation.
The doctor says that the cognitive problems are typically spotty and mild; hence they escape detection by short cognitive screening techniques.
Thorough neuropsychological testing can detect mild problems across the spectrum of cognitive and psychomotor functions. The neuropsychological evaluation also includes assessment of personality functioning to help identify possible co-morbid disorders of mood and to dissociate the cognitive effects associated with mood disturbance and HIV associated minor cognitive disorder.
Dr. de Ridder says some studies suggest various antiretroviral medications may improve cognitive function in HIV associated minor cognitive disorder. Treatment of co-existing mood disorders and cognitive behavior intervention for attention training and developing memory compensatory strategies frequently improve mild or moderate cognitive disturbances.
The doctor also highlights that AIDS infection is linked with dementia, which is a progressive disorder that initially presents as apathy, inertia, cognitive slowing, memory loss, and social withdrawal.
He explains that as dementia progresses, multiple cognitive functions become increasingly impaired. The terminal phases are characterized by global cognitive impairment, mutism, and severe psychomotor retardation.
Unlike HIV associated minor cognitive disorder, dementia rarely develops prior to constitutional problems and usually does not develop prior to other Aids defining illnesses. As with HIV associated minor cognitive disorder, thorough neuropsychological evaluation is recommended to assist in differential diagnosis and to identify the presence of any co-existing psychiatric disturbance.
Doctor de Ridder reveals that treatment with azidothymidine (Retrovir, AZT, and DZV) has been associated with improvement in cognitive functioning. However, these findings are tentative. Other promising treatments include the antiretroviral drug didanosine (Videx), cytokine blocker, calcium channel blockers, N-methyl- D-aspartate antagonists, and the synthetic peptide T.
In the symptomatic treatment of co-existing psychiatric disorder, increased susceptibility to certain psychoactive drugs should be considered.
The process by which neuronal death and loss occurs is speculative, although proposed mechanisms include the production of cytokines that interfere with neuronal function, production of abnormal neurotransmitter metabolites that are neurotoxic, and the presence of certain viral fragments that interfere with neurotransmitter transmission.
HIV-1 associated CNS disorders include neurobehavioral disorders, HIV associated minor cognitive disorder and HIV associated dementia, and the neurological disorder of HIV associated myelopathy.
HIV associated myelopathy is characterized by symptoms of weakness, loss of coordination, urinary incontinence and signs of paresis, and plasticity.
This condition affects approximately 20% of adult patient with AIDS, although evidence of myelopathy is found at autopsy in 50% of patients. This condition is often associated with co-existing cognitive dysfunction.
HIV-1 has been found in the spinal cord and CSF of patients with HIV associated myelopathy; however, it is uncertain whether HIV-1 is a direct pathogen. Other conditions such as vitamin B12 deficiencies cause similar disorders, particularly in the immune compromised patient.
The doctor explains that with HIV infection, a number of neurological problems have been associated variously with opportunistic infections, certain treatment drugs, nutritional deficiencies, cytokines produced by the immune system in response to infection, the HIV virus, and psycho-social issues.
Symptoms can also include headache, fever, stiff neck, altered consciousness, seizures, stroke, impairment of speech and/or sight, loss of motor control, change in dream patterns, anxiety, depression, and others.
Physical defects in the brain have indicated cysts, abscesses, lesions, hemorrhage, atrophy and other results. Dementia results when there is a chronic impairment of mental capacity.
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