• 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.