Qualitative Features Of Neurocognitive Complications

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HIV neurocognitive complications are often described as having "subcortical" features. This means that the pattern of impairment is somewhat reminiscent of that seen in neurological diseases that affect primarily the subcortical structures or white matter and possibly pathology involving frontostriatal circuits (e.g., Huntington's disease, Parkinson's disease, and multiple sclerosis). Persons with this pattern of neuropathology tend to have difficulties in psychomotor abilities, speed of information processing, initiation, divided

Table V

Criteria for Mild Neurocognitive Disorder"

Acquired impairment in cognitive functioning, involving at least two ability domains, documented by performance of at least 1.0 standard deviation below the mean for age-education-appropriate norms on standardized neuropsychological tests. The neuropsychological assessment must survey at least the following abilities: verbal/language, attention/speeded processing, abstraction/executive, memory (learning and recall), complex perceptual-motor performance, and motor skills. The cognitive impairment produces at least mild interference in daily functioning (at least one of the following): Self-report of reduced mental acuity or inefficiency in work, homemaking, or social functioning.

Observation by knowledgeable others that the individual has undergone at least mild decline in mental acuity with resultant inefficiency in work, homemaking, or social functioning.

The cognitive impairment has been present at least 1 month.

The cognitive impairment does not meet criteria for delirium or dementia.

There is no evidence of another preexisting cause for the MND.b

"As defined by Grant and Atkinson (1995).

bIf the individual with suspected mild neurocognitive disorder (MND) also satisfies criteria for a major depressive episode or substance dependence, the diagnosis of MND should be deferred to a subsequent examination conducted at a time when the major depression has remitted or at least 1 month has elapsed following termination of dependent-substance use.

Table VI

Criteria for HIV Dementia"

Marked acquired impairment in cognitive functioning, involving at least two ability domains (e.g., memory and attention): typically, the impairment is in multiple domains, especially in learning of new information, slowed information processing, and defective attention/ concentration. The cognitive impairment can be ascertained by history, mental status examination, or neuropsychological testing.

The cognitive impairment produces marked interference with day-to-day functioning (work, home life, and social activities).

The marked cognitive impairment has been present for at least 1 month.

The pattern of cognitive impairment does not meet criteria for delirium (e.g., clouding of consciousness is not a prominent feature) or, if delirium is present, criteria for dementia need to have been met on a prior examination when delirium was not present.

There is no evidence of another, preexisting etiology that could explain the dementia (e.g., other CNS infection, CNS neoplasm, cerebrovascular disease, preexisting neurological disease, or severe substance abuse compatible with CNS disorder).

"As defined by Grant and Atkinson (1995).

attention, learning difficulties, difficulties in retrieval of information but not accelerated forgetting, and some executive dysfunction. To the extent that there are language problems, these are more in the area of fluency rather than naming. In contrast, the so-called "cortical" dementias (Alzheimer's disease and multi infarct dementia) are characterized by severe memory impairment that includes difficulty in learning new information as well as rapid forgetting, problems in naming and comprehension, and disturbances of praxis.

Thus, HIV-infected persons with asymptomatic neuropsychological impairment or MCMD tend to have mild learning difficulties, some problems with attention, difficulties with speed of information processing, some psychomotor slowing, and occasionally, difficulties with fluency. Although this may be the most typical pattern, it should be noted that since HIV-associated neurological injury can be widespread in the brain, there are some cases that have symptoms that are more cortical in nature, and others that have mixed features.

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