Diagnosing Aids Dementia
Jan 16, 1997
We presently have a patient with CD4 below 100, Desiminated MAC (intestinal) , Rx's of AZT & 3TC, Rifibutin, Azythromax, Multi-Vit etc., , hx of stroke self limiting mild within 2 months only mild weakness left on the left side. He is presently displaying confusion, not oriented to person, place or time on occassion, verbalizing he is seeing things, no evidence of any auditory hallucinations, what complicates this case is the patient has a long standing history of extreme manipulative behavior and a psych history of the same. He in the past when his disease process was "under control" would cry wolf as it were to gain attention and use his HIV+ status to manipulate the system to gain certain advantages from the system, he has played one Clinician off the other and one nurse off the other until it is very difficult to determine if this behavior is something new physiologically or mentally. I spoke to my Medical Director and he reviewed his case and ordered either an MRI or a CT for this week, However, if these come up negative, what do we look for next, and how do you diagnosis Aids Dementia???
Response from Dr. Cohen
I can't give advice on this specific case, but I'll make a few general comments on evaluating someone with AIDS and an altered mental status. An MRI is a good idea to rule out mass lesions (toxoplasmosis, lymphoma, etc) or other processes such as PML or CMV encephalitis. But it is also important to determine whether the patient is delirious or demented. The best way to distinguish the two is to conduct neuropsychiatric testing, which can be done at the bedside by neuropsychologists, psychiatrist, or neurologists. Neuropsychiatric testing is a very good way to distinguish between dementia, depression, and delirium.
In addition to an MRI, it is important to rule out easily correctable causes of abnormal mental status, including hypoxia, hypoglycemia, electrolyte abnormalities, thyroid dysfunction, syphilis, B12 deficiency, drug intoxication, and cryptococcal meningitis. These can be ruled out with simple blood tests.
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