Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiânia, Brazil.
Int Psychogeriatr. 2011 Sep;23(7):1061-9. doi: 10.1017/S1041610210002474. Epub 2011 Feb 17.
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.
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.
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.
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.
感染人类免疫缺陷病毒（HIV）的老年人发生认知障碍的风险更高。本研究旨在描述老年 HIV 相关痴呆症（HIVD）患者的临床和影像学特征。
进行了一项描述性研究，共纳入 8 例 HIVD 患者。采用 7 种测试进行认知评估，并使用适当的正常量表转换为整数 z 分数。
患者的平均年龄为 71 岁；7 例患者描述的 HIV 感染途径为异性性传播；平均受教育年限为 6.5 年。6 例患者正在使用高效抗逆转录病毒治疗（HAART），平均 CD4 计数为 407.8 个细胞/mm3。大多数患者（87.5%）存在轻度痴呆。神经心理学测试结果显示存在缺陷，与 HIVD 的多中心横断面研究结果相似。在年轻成人中观察到的经典 HIVD 三联征在该人群中也可见：即认知改变、精神改变和运动障碍。计算障碍、视觉空间变化和语言缺陷等皮质损伤较为常见。脑图像显示所有患者均存在皮质萎缩，但 5 例患者仅局限于额叶。
脑影像学检查结果无特异性，显示的图像与老年大脑和年轻成人 HIVD 相似。老年 HIVD 是一个挑战，并且成为老年认知功能下降的一个越来越重要的鉴别诊断。这种痴呆症必须在临床上进行怀疑，并且影像学检查有助于排除其他中枢疾病。有必要对 HIV 阳性的老年人进行前瞻性研究，以更好地了解 HIVD。
