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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
close this folderCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
View the document11.1 Neurological complications with secondary mental manifestations
View the document11.2 Changes in mental status - Delirium (acute organic brain syndrome)
View the document11.3 Changes in mental status - AIDS related dementia (ADC) (chronic organic brain syndrome)
View the document11.4 Changes in mental status - AIDS Related Mania
Open this folder and view contents11.5 Mental complications
View the document11.6 Crisis and crisis counseling
View the document11.7 Persons with previous mental disorders
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

11.3 Changes in mental status - AIDS related dementia (ADC) (chronic organic brain syndrome)

• More gradual changes in mental health status occur with ADC characterized by:

• Gradual decline in cognitive functioning: Impairments in attention and concentration, verbal memory (e.g. word finding), mental slowing, arithmetic calculations, visuospatial memory, visuomotor coordination, complex task sequencing. Later global cognitive impairment and mutism sets in.

• Specific deficits in the integration of motor functioning: unsteady gait, loss of balance, slowed fine motor speed, tremors, changes in handwriting, weakness. Later seizures decorticate posturing, myoclonus, spastic weakness and frontal release signs are not uncommon.

• Behavioural problems: slowed speech and response time and personality changes earlier on, followed by hallucinations and delusions.

• Affective changes: Apathy, loss of interest and friends and others and irritability.


• ADC causes significant decline in occupational and social functioning similar to other sub-corticol dementias that affect the white matter of the brain that lies underneath the grey matter.

• Patients may not be aware of these changes and they may occur with other mental conditions making diagnosis difficult. It is also a more emotionally difficult diagnosis for patients to accept as while physical ill health is expected, cognitive decline is not, and most patients are relatively young. The profound implications to self-esteem, self-care and legal ramifications have to be considered in a comprehensive management plan.


ADC occurs in 20-30% of patients with CD4 <100 cells/mm3. Where available, brain imaging will show atrophy and non-specific white matter changes. ART medication slows the progression to ADC, and other drug treatment is often symptomatic (e.g. small doses of sedatives, for sleep disturbances). There are few treatment options for ADC, and clinical improvement is not usually maintained for long periods of time.

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