HIV and Dementia

What is HIV-associated dementia?

HIV/AIDS affects many of the body's organ systems, including the brain and nervous system. Most people don't know that the HIV infection actually makes its way to the brain early in the disease process. HIV encephalopathy is an infection that spreads throughout the brain. It is one cause of dementia in people infected with HIV. The greater the spread of infection in the brain, the worse the dementia symptoms become.

AIDS dementia is also called AIDS dementia complex or HIV-associated dementia. It is a serious consequence of HIV infection and is typically seen in advanced stages of the disease.

What causes HIV-associated dementia?

When HIV spreads to the brain, it results in encephalopathy (a disease which affects the brain's function), which causes dementia. The greater the spread of infection in the brain, the worse the dementia symptoms become.

What are the symptoms of HIV-associated dementia?

The following symptoms are among those seen with HIV-associated dementia:

  • Encephalitis, a condition in which the membranes of the brain and spinal column swell
  • Loss of memory
  • Reduced ability to think clearly, a condition called cognitive impairment
  • Difficulty concentrating or staying focused
  • Difficulty speaking clearly or accurately
  • Apathy or lack of interest in previously enjoyable activities
  • Gradual loss of motor skills, or reduced coordination

The symptoms of HIV-associated dementia may resemble other medical conditions or problems. Always consult your health care provider for a diagnosis.

How is HIV-associated dementia diagnosed?

Examination and evaluation are essential in determining the presence and extent of the dementia. In addition to a complete medical history and extensive neurological motor and sensory exam, diagnostic procedures for dementia may include the following:

  • Mental status test. This is a brief and simple test of memory and some other common cognitive or thinking skills; it is usually part of a complete neurological exam.
  • Neuropsychological testing.
  • Basic tests of physical abilities or movement.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Blood tests.
  • Spinal fluid test. A procedure performed by inserting a hollow needle into the lower back (lumbar spine).

How is HIV-associated dementia treated?

Specific treatment for HIV-associated dementia will be determined by your health care provider based on the following:

  • The extent of the problem
  • Your age, overall health, and medical history
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disorder
  • The opinion of the health care providers involved in your care
  • Your opinion and preference

Treatment typically includes:

  • Antiretroviral therapy. This is aggressive medical treatment aimed at reducing the amount of AIDS virus in the body. It also can help ease dementia symptoms.
  • Substance or alcohol abuse counseling. People with HIV who abuse drugs or alcohol can have more severe dementia symptoms.
  • Prescription medications. In addition to other medications you take for AIDS symptoms, your health care provider may recommend antidepressants, antipsychotics, or stimulants. Deciding which one will be prescribed will depend on what may be causing your dementia.
  • Lifestyle changes. Regular exercise and a structured routine will help to manage HIV-associated dementia. Writing lists can help you stay organized and remember important details. A neurologist may recommend working with a special therapist who can help you learn to better manage daily life.
  • Coping strategies. If dementia symptoms become severe, you may need help at home. A skilled caregiver can provide this service.

What are the complications of HIV-associated dementia?

The gradual loss of mental clarity and physical coordination can seriously reduce quality of life. Without treatment, HIV-associated dementia can be fatal.

Can HIV-associated dementia be prevented?

People who are using highly active antiretroviral therapy, known as HAART, are less likely to develop HIV-associated dementia. Experts think this may be because these drugs help maintain the overall immune system. A milder form of cognitive impairment, called HIV-associated neurocognitive disorder, or HAND, may still occur, though. 

Living with HIV-associated dementia?

Depending on your level of dementia, various therapies may be required. HIV-associated dementia is a progressive condition, meaning that it will continue to get worse, and the amount of care needed to manage the disease will increase over time.

When should I call my health care provider?

If you notice changes in your ability to speak, focus, or concentrate, talk with your health care provider. These symptoms are common to other conditions, including other infections, depression, and nutritional deficiencies. Unusual shifts in mood or emotions and changes in social behavior also require a conversation with a health care provider. Best results are achieved with early diagnosis and treatment.

Key points

  • HIV-associated dementia occurs when the HIV virus spreads to the brain.
  • Symptoms of HIV-associated dementia include loss of memory, difficulty thinking, concentrating, and or speaking clearly, lack of interest in activities and gradual loss of motor skills.
  • Medications for treating HIV-associated dementia include antiretrovirals, antidepressants, antipsychotics, or stimulants.
  • People with HIV who abuse drugs or alcohol can have more severe dementia symptoms.
  • Your health care provider may suggest lifestyle changes and coping strategies that can help you manage dementia.


Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.