title: HIV-associated dementia in older adults: clinical and tomographic aspects.
abstract: BACKGROUND
  Elderly adults with human immunodeficiency virus (HIV) are at greater risk of developing cognitive impairment. The purpose of this study was to describe clinical and tomographic characteristics of HIV-1 associated dementia (HIVD) in older adults.
  
  
  METHODS
  A descriptive study was carried out involving eight HIVD patients. Seven tests were employed for cognitive assessment and transformed to whole number z-scores using appropriate normative sets.
  
  
  RESULTS
  The average age of the patients was 71 years; seven cases described the route of HIV infection as being heterosexual; and mean schooling was 6.5 years. Six subjects were using highly active anti-retroviral therapy (HAART), with an average CD4 count of 407.8 cells/mm3. Mild dementia was detected in most cases (87.5%). Deficits on neuropsychological tests showed results similar to multi-center transversal studies on HIVD. The classic HIVD triad observed in younger adults was also seen in this population: i.e. cognitive changes, psychiatric changes and motor impairment. Cortical injury shown by dyscalculia, visual-spatial change and language deficits were frequent. Brain images showed cortical atrophy in all patients but was restricted to frontal lobes in five cases.
  
  
  CONCLUSIONS
  The findings on brain imaging were non-specific, revealing images similar to those of the elderly brain and to HIVD in younger adults. HIVD in the elderly is a challenge and become an increasingly significant differential diagnosis for cognitive loss in old age. This dementia must be clinically suspected and image exams are useful in excluding other central disorders. Prospective studies of HIV-positive elderly people are warranted to better understand HIVD.
authors.affiliation: Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiânia, Brazil. emanuelatorreao@gmail.com
authors.forename: Emanuela Torreão
authors.initials: ET
authors.lastname: Brito e Silva
authors.forename: Leonardo Ferreira
authors.initials: LF
authors.lastname: Caixeta
authors.forename: Vânia Lucia Dias
authors.initials: VL
authors.lastname: Soares
authors.forename: Gisele Rodrigues Fonseca
authors.initials: GR
authors.lastname: Sagawa
mesh_terms: D015526:AIDS Dementia Complex / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D000368:Aged; D000377:Agnosia / Q000175:diagnosis / Q000209:etiology; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D060705:Dyscalculia / Q000175:diagnosis / Q000209:etiology; D004411:Dyslexia, Acquired / Q000175:diagnosis / Q000209:etiology; D005625:Frontal Lobe / Q000473:pathology*; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007361:Intelligence Tests; D059906:Neuroimaging / Q000379:methods*; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed