DEMENTIA DUE TO HIV DISEASE - DEMENTIA DUE TO HIV DISEASE...

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DEMENTIA DUE TO HIV DISEASE DSM-IV DEMENTIAS DUE TO OTHER MEDICAL CONDITIONS 294.1 DEMENTIA DUE TO HIV DISEASE (CODE 042 ON AXIS III) Dementia is impairment of short- and long-term memory, abstract  thinking, and judgment with  personality changes, severe enough to interfere with work, normal social activities, and relationships. Human immunodeficiency virus (HIV) has been shown to affect the brain directly by crossing the  blood-brain barrier on two types of immune cells—monocytes and macrophages. Cells within the central  nervous system (CNS) have been found to have express CD4 receptor sites for HIV entry into cells.  Although several hypotheses have been proposed, it is not known exactly by what mechanism neurological  dysfunction occurs. Neuropsychiatric symptoms may range from barely perceptible changes in a person’s  normal psychological presentation to acute delirium to profound dementia. Because of the associated  immune dysfunction, secondary brain infections may cause further damage. Studies have shown CNS abnormalities in a large percentage of clients, with 3 people in 10 who are  HIV-symptomatic exhibiting symptoms of dementia. Recent studies suggest symptoms can occur prior to  an acquired immunodeficiency syndrome (AIDS) diagnosis, as they are the first clinical symptoms of  progression. CLIENT ASSESSMENT DATA BASE Activity/Rest Low energy level, constant fatigue Insomnia, change in sleep patterns Yawning frequently Wakefulness at night Ego Integrity Emotional lability (e.g., irritability, anxiety, agitation, combativeness, and panic attacks) Reports feeling like he or she is losing his or her mind Feelings of powerlessness, worthlessness Elimination Constipation/diarrhea Increasing frequency of incontinence Food/Fluid Decreased interest in food Apraxia (inability to carry out motor functions of chewing and swallowing despite intact sensory function) Agnosia (failure to recognize foods despite intact sensory function); may report change in taste/smell Weight loss Hygiene Unable to do simple/difficult tasks of activities of daily living (ADL) Deficits in many/all personal care areas No concern for hygiene; disheleved, unkempt appearance
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Neurosensory Changes in mental status, forgetfulness, poor concentration/decreased alertness, apathy; impaired impulse  control (loss of mental acuity/ability to problem-solve) Unrealistic expectations, free-floating anxiety, paranoid ideation Organic psychosis (hallucinations, delusions) Psychomotor retardation/slowed responses, decreased grip strength, decreased pinprick sensation, ataxic  gait Impaired sensation or sense of position Numbness, tingling of feet (paresthesias)
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DEMENTIA DUE TO HIV DISEASE - DEMENTIA DUE TO HIV DISEASE...

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