Neuropsychological characterization of the AIDS dementia complex: a preliminary report.
Neuropsychological characterization of the AIDS dementia complex: a preliminary report.
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艾滋病痴呆症的神经心理学特征：初步报告。
DOI：
10.1097/00002030-198804000-00002
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Sidtis,JJ
中科院分区：
文献类型：
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作者：
Tross,S;Price,RW;Navia,B;Thaler,HT;Gold,J;Hirsch,DA;Sidtis,JJ
进行性痴呆是艾滋病逆转录病毒感染的最常见和最具破坏性的表现之一。与目前定义疾病控制中心诊断标准的其他艾滋病心脏表现不同[1]，被称为艾滋病痴呆综合征（ADC）的痴呆疾病[2-4]不仅仅是免疫抑制的继发性并发症，而是似乎是艾滋病病毒（现在称为HIV）感染大脑的直接结果[5-11]。虽然需要更精确的流行病学和自然史定义，但ADC最终可能会影响大多数艾滋病患者[3，4]，并且是其发病率的最大来源之一。它也可能是艾滋病毒感染的表现，甚至是唯一的临床表现||12]。ADC的影响范围从早期认知丧失（此时全身性疾病可使患者完全活动）所造成的功能损害，到严重形式的严重发病率，其中患者几乎成为植物人，需要全职机构护理。从神经学上讲，ADC会引起认知、运动功能和行为的改变[3] ADC的发病通常是隐性的，尽管可能发生亚急性发作或突然加速。常见的早期症状包括健忘、注意力不集中和思维迟钝。患者经常注意到他们“失去了”对话或想法，在执行更复杂的日常任务时遇到更多困难，这些任务也需要更长的时间才能完成，并且难以关注书籍或电视的内容或情节。早期运动功能障碍会导致平衡差和协调差的抱怨。患者可能会更频繁地报告掉落物体，笔迹可能会改变，步态可能会出现问题。在检查中，四肢和眼睛的快速运动减慢以及“病理性反射”，如鼻部反应是最早的症状。行为上，社交退缩，自发性降低和冷漠是常见的，尽管显著的抑郁似乎并不常见，但早期ADC和反应性抑郁之间的临床区分是困难的
A progressive dementing illness is among the most common and devastating manifestations of infection by the retrovirus that causes AIDS. Unlike the other cardi-nal manifestations of AIDS, which currently define the Center for Disease Control's diagnostic criteria [1], the dementing illness referred to as the AIDS dementia complex (ADC)[2–4], is not simply a secondary complication of immunosuppression, but rather appears to be a direct result of infection of the brain by the AIDS virus (now referred to as HIV)[5-11]. Although more precise definitions of the epidemiology and natural history are needed, the ADC may eventually afflict the majority of AIDS patients [3, 4], and is one of the greatest sources of their morbidity. It may also be the presenting or even the sole clinical manifestation of HIV infection|| 12]. The impact of the ADC ranges from the functional impairment conferred by early cognitive loss at a time when systemic disease would otherwise allow the patient a full level of activity, to the profound morbidity of its severe form in which patients are rendered nearly vegetative and require full-time institutional care. Neurologically, the ADC produces changes in cogni-tion, motor function, and behavior [3] The onset of the ADC is usually insidious, although subacute onset or abrupt acceleration may occur. Common early complaints include forgetfulness, poor concentration, and mental slowing. Patients frequently note that they" lose track'of conversations or thoughts, experience increased difficulty in the performance of more complex daily tasks, which also take longer to complete, and have difficulty attending to the content or plot of books or television. Early motor dysfunction leads to complaints of poor balance and poor coordination. Patients may report dropping objects more frequently, handwriting may change and problems with gait may be noted. On examination, slowing of rapid movements of the extremities and eyes and'pathological reflexes' such as a snout response are among the earliest signs. Behaviorally, social withdrawal, reduced spontaniety, and apathy are common, and although significant depression does not appear to be common, the clinical differentiation between early ADC and reactive depression is difficult