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HIV Cognitive-Motor Disorder and Dementia

Feb 8, 2003

I tested + in 1992. I have been on several drug regimes and overall they have been successful with regard to HIV suppression. Over the years I have noticed problems with memory and concentration. I am taking Risperdal 0.5 mg to see if this will help. Have you any experience using this drug for this problem? I'm also curious about any side effects. My overall concern of course is dementia. What are the signs of progession of HIV in the brain?

Response from Dr. Horwath

HIV infection can cause impairment of cognitive and motor functions, and emotional changes. Cognitive problems may include slowed thinking, memory impairment, decreased attention and concentration. Motor problems may include hand tremor, slowed movements, incoordination, and gait problems. The emotional changes may include apathy and social withdrawal.

The persistent presence of two or more of these symptoms, but with little or no functional impairment, is called HIV-associated cognitive-motor disorder (HCMD).

The presence of two or more of these symptoms (or more serious symptoms) for more than a month, associated with impaired functioning (impaired ability to work, care for oneself, interact socially, etc.) is called HIV-associated dementia (HAD).

The risk of developing HAD is higher in people who are older, have a high viral load, low CD4 count (< 200 copies/ml), or anemia. A history of substance abuse, delirium, central nervous system (CNS) infection (e.g. CNS toxoplasmosis, meningitis, encephalitis) also may increase the risk of HAD.

Certain antiretroviral medications are better at penetrating the blood-brain barrier, and may be more effective at treaqting HAD. These antiretrovirals include zidovudine (AZT, Retrovir), stavudine (d4T, Zerit), indinavir (Crixivan), and nevirapine (Viramune). Clinical trials demonstrating this effect need to be done.

Drugs like risperidone (Risperdal) are sometimes used to manage the symptoms of dementia, such as agitation, behavior problems, hallucinations, delusions, and severe confusion. Risperdal does not cause improvement in memory. It may improve concentration if your concentration is impaired by hallucinations, delusions, or agitation, but is not likely to do so otherwise. The common side effects of Risperdal include sedation, slowed thinking, restlessness (akathisia), muscle spasm (dystonia), tremor, slowed movements, stiffness, and dyskinesia (abnormal involuntary movements). These adverse effects are unlikely to occur at low doses (such as 0.5 mg), but are likely to occur at high doses (above 6 mg/day).

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