• New York State Department of Health. Cognitive disorders and HIV/AIDS: HIV-associated dementia and delirium. New York (NY): New York State Department of Health; 2007 Sep. 12 p. [6 references]

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Cognitive disorders and HIV/AIDS: HIV-associated dementia and delirium. New York (NY): New York State Department of Health; 2005 Oct. 7 p.

General Recommendation

Key Point:

Early stages of dementia and delirium are often subtle, difficult to recognize, and may resemble primary psychiatric disorders.

Human Immunodeficiency Virus (HIV)-Associated Dementia

Presentation

Diagnosis

Clinicians should exclude other treatable, reversible causes of change in mental status before a diagnosis of HIV-associated dementia (HAD) can be made (see Table 2 in the original guideline).

Clinicians should conduct neuroimaging studies and a lumbar puncture as part of a complete evaluation for HAD.

Key Point:

HAD may be incorrectly diagnosed as Alzheimer's disease. Early HAD differs from Alzheimer's disease in that it is more likely to present with behavioral changes, progresses more rapidly, may be associated with abnormal cerebrospinal fluid (CSF) findings, and is rarely associated with aphasia.

Management of Patients with HAD

Referral

Clinicians should refer patients with HAD who present with accompanying depression, mania, psychosis, behavioral disturbance, or substance use for psychiatric consultation to assist in psychopharmacologic treatment and management.

Clinicians should refer patients who require treatment with multiple psychotropic medications and/or are using illicit substances for psychiatric consultation because of the risk of drug-drug interactions and toxicity.

Treatment

Antiretroviral Drugs

Clinicians should assess the efficacy of the highly active antiretroviral therapy (HAART) regimen when patients receiving HAART present with symptoms of HAD.

Clinicians should initiate HAART when patients not receiving HAART present with symptoms of HAD.

Non-Pharmacologic Management

Clinicians should involve members of the patient's primary support system, such as family or friends, in both medication management and attending appointments and should educate them about HAD and its course.

Clinicians should assess patients' ability to function independently at home and arrange for assistance in the form of family support, nursing case management, and nursing home care services when indicated. Clinicians should refer patients who are unable to be safely cared for at home for placement in a skilled nursing facility.

Clinicians should discuss advance directives such as a living will, healthcare proxy, or durable power of attorney early in the course of illness, while patients have the capacity to make decisions about their treatment. Clinicians should clearly document the content of these discussions in the medical record and include copies of advance directives as part of the medical record.

Clinicians should consult with a psychiatrist if questions exist about a patient's mental capacity to make decisions about his or her treatment.

Refer to the original guideline document for a full discussion of the non-pharmacologic management of patients with HIV-associated dementia.

Delirium Associated with HIV

Clinicians should immediately refer patients who present with signs and symptoms of delirium to the hospital.

Presentation and Diagnosis

Clinicians should assess for delirium when there is a sudden change in a patient's cognitive functioning, consciousness, or behavior.

* Delusions are usually paranoid but more disorganized than those seen in psychoses.

Management of Patients with Delirium

Treatment should be aimed at correcting the underlying conditions that have led to delirium. Refer to the original guideline document for a discussion.

Key Point:

HIV-infected patients may be more sensitive to the side effects of psychotropic medications. Older patients and those with more advanced disease are at highest risk for side effects.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• New York State Department of Health. Cognitive disorders and HIV/AIDS: HIV-associated dementia and delirium. New York (NY): New York State Department of Health; 2007 Sep. 12 p. [6 references]

Not applicable: The guideline was not adapted from another source.

2001 Mar (revised 2007 Sep)

New York State Department of Health - State/Local Government Agency [U.S.]

New York State Department of Health

Mental Health Committee

Chair: Milton L Wainberg, MD, New York State Psychiatric Institute, New York, New York

Members: Bruce D Agins, MD, MPH, New York State Department of Health AIDS Institute, New York, New York; Kalyana Battu, MD, Albany Medical Center, Albany, New York; Barbara A Conanan, RN, MS, Saint Vincent's Manhattan Department of Community Medicine, New York, New York; Joseph Z Lux, MD, Bellevue Hospital, New York, New York; Peter Meacher, MD, AAHIVS, FAAFP, South Bronx Health Center for Children and Families, Bronx, New York; Yiu Kee Warren Ng, MD, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Bella M Schanzer, MD, MPH, Columbia University Medical Center, New York, New York

Liaisons: Francine Cournos, MD, Liaison to the New York/New Jersey AIDS Education and Training Center, Columbia University, New York State Psychiatric Institute, New York, New York; James J Satriano, PhD, Liaison to the New York State Office of Mental Health, Columbia University College of Physicians and Surgeons, New York, New York

AIDS Institute Staff Liaison: L Jeannine Bookhardt-Murray, MD, Harlem United Community AIDS Center, New York, New York

AIDS Institute Representative: Heather A Duell, LMSW, New York State Department of Health AIDS Institute, Bureau of Community and Support Services, Albany, New York

Not stated

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Cognitive disorders and HIV/AIDS: HIV-associated dementia and delirium. New York (NY): New York State Department of Health; 2005 Oct. 7 p.

None available

This NGC summary was completed by ECRI on May 4, 2005. It was updated by ECRI on October 19, 2005 and on June 6, 2008. This summary was updated by ECRI Institute on July 25, 2008, following the U.S. Food and Drug Administration advisory on Antipsychotics.