Dementia- Memory loss could spell danger
Oct 04, 2009
A medical study has revealed that HIV-related dementia (mental disorder) is more common in people with HIV-subtype D. Researchers from Mulago Hospital, the Infectious Disease Institute, and the US-based John Hopkins University School of Medicine conducted
By Rebecca Harshbarger and Frederick Womakuyu
A medical study has revealed that HIV-related dementia (mental disorder) is more common in people with HIV-subtype D. Researchers from Mulago Hospital, the Infectious Disease Institute, and the US-based John Hopkins University School of Medicine conducted neurological assessments of 60 people living with HIV in Kampala who were at risk of dementia and had not begun antiretroviral therapy.
Dr. Noeline Nakasujja, a researcher at Mulago Hospital who participated in the study, says there are two types of HIV: HIV-1 and HIV-2. “But Uganda has HIV-1 infection, characterised by genetic diversity.
This leads to several viral sub-types including A, B, C, D, E, F, G, H, J and K, being predominant in different geographical regions.†Type D and A are the commonest in Uganda.
Nakasujja says although HIV-related dementia has been observed in 30% of patients with other HIV-subtypes rather than D, the latter may have an effect on disease progression.
“HIV sub-type D patients tend to develop AIDS-defining illnesses, especially the late forms, faster and also progress faster to death.â€
Nakasujja says HIV-related dementia starts when the virus enters the brain. The virus attacks cells that are supposed to protect the brain from infection. While attacking these cells, the virus produces neurotoxins, which damage the brain cells.
Opportunistic infections that affect people living with HIV, such as fungal meningitis, can also hurt one’s brain.
Although the World Health Organisation characterises HIV-related dementia as a stage four event, Nakasujja says researchers have observed the disease in patients in the second and third stages of HIV.
“HIV-related dementia used to be neglected because people thought it was a stage four event, where the patient would die,†says Nakasujja. “But even in stage two, HIV can attack the brain.â€
David Basangwa, a psychologist at Butabika Hospital, says dementia is common in people living with HIV. “HIV does well in brain tissue,†he says.
Tuberculosis and other opportunistic
infections, like bacterial and fungal meningitis, can also affect the brain. The first symptom is failing memory, especially for recently learned things.
“The short-term memory keeps deteriorating,†says Basangwa.
As dementia worsens, the patient becomes less able to take care of themselves.
They seem to get lost in their surroundings and tasks like managing their bank account, personal hygiene and schoolwork or job can become difficult.
Relationships also decline — people with dementia can become increasingly suspicious of their partners. Psychotic symptoms may develop, such as visual and auditory hallucinations.
“HIV and mental health problems go hand-in-hand,†says Elly Katabira, a neurophysician at Makerere College of Health Sciences and president of the International AIDS Society. “The virus affects the brain cells much more quickly than we expect.â€
People living with HIV-related dementia are irritable or apathetic, unable to care about things that normally mattered to them. Even though they can do work, they will be slower in executing tasks at their jobs.
Unfortunately, family members and friends that might be sympathetic towards dementia in the elderly are often confused or even angered when they see dementia in younger people, unaware of what is going on.
“Family members and friends are unlikely to think the person is sick,†says Nakasujja.
“The friends will say, we don’t understand this guy anymore; he is forgetting things. If it was an elderly person, they would understand, but not for a young one or someone aged 30 to 40. Their friends and family see things they don’t expect and are confused,†she explains.
In Uganda, dementia has been observed in people with other HIV sub-types other than B. The prevalence/statistics and number of patients attended to in health units is about 30% if not on antiretroviral therapy.
Other forms of therapy
Researchers are making inroads into treatment that may slow down the progress of dementia. Cognitive and behavioural therapies may also be useful.
Several studies have found that music therapy helps patients with dementia. It is important to remember that the patient’s caregiver also needs training and emotional support. Some physicians prescribe these drugs for Alzheimer’s disease to treat vascular dementia.
How common is dementia?
A study published in medical journal The Lancet in 2005, reveals that approximately 24.3 million people worldwide have dementia, with 4.6 new cases every year.
The number of people with dementia is projected to double every two decades and reach 81.1 million by 2040. The rate of increase is expected to be faster in developing countries which have rapidly-growing life expectancies.
Symptoms
Linda, a cashier from Kasubi, used to have a career as a radio journalist before she and her late husband began suffering from HIV-related dementia. She lost her job in radio due to the stress of living with HIV, taking care of her dying husband, and tending their baby.
Her CD4 count has risen from 198 to 419. “I would sometimes lose memory, like count out money and then not remember where I put it,†she said. “I would forget to take breakfast and my husband would forget to take his drugs. Sometimes, I felt like a wave was sweeping through my head.â€
But she says antiretroviral therapy helped restore her memory and health.
If opportunistic infections are causing the dementia, such as meningitis, these will also need to be treated at a clinic.
Other symptoms
Loss of short-term memory
Decline in hygiene
Difficulty in performing tasks at work or school
Being suspicion of other people
Having visual and auditory hallucinations
Being unable to manage a bank account
Forgetting to medication or eating food
HOW IS HIV-RELATED DEMENTIA TREATED?
HIV-related dementia is best treated with antiretroviral therapy. However other thrapies are being tried out in Uganda.
Dr. Noeline Nakasujja, a researcher at Mulago Hospital, says: “Within a period of six months, there is usually a noticeable change in the patients, if treatment is started early.â€
“If patients are started on ARVs, their cognitive functions significantly improve,†she says. “If diagnosed early, the condition is reversible. But if left untreated, a patient’s health deteriorates quickly. â€
She advises that if you are concerned that you or a loved one is suffering from dementia, you can be screened at a health clinic.
Alzeheimer’s is the most common cause of dementia, but syphilis can also cause it.
A medical study has revealed that HIV-related dementia (mental disorder) is more common in people with HIV-subtype D. Researchers from Mulago Hospital, the Infectious Disease Institute, and the US-based John Hopkins University School of Medicine conducted neurological assessments of 60 people living with HIV in Kampala who were at risk of dementia and had not begun antiretroviral therapy.
Dr. Noeline Nakasujja, a researcher at Mulago Hospital who participated in the study, says there are two types of HIV: HIV-1 and HIV-2. “But Uganda has HIV-1 infection, characterised by genetic diversity.
This leads to several viral sub-types including A, B, C, D, E, F, G, H, J and K, being predominant in different geographical regions.†Type D and A are the commonest in Uganda.
Nakasujja says although HIV-related dementia has been observed in 30% of patients with other HIV-subtypes rather than D, the latter may have an effect on disease progression.
“HIV sub-type D patients tend to develop AIDS-defining illnesses, especially the late forms, faster and also progress faster to death.â€
Nakasujja says HIV-related dementia starts when the virus enters the brain. The virus attacks cells that are supposed to protect the brain from infection. While attacking these cells, the virus produces neurotoxins, which damage the brain cells.
Opportunistic infections that affect people living with HIV, such as fungal meningitis, can also hurt one’s brain.
Although the World Health Organisation characterises HIV-related dementia as a stage four event, Nakasujja says researchers have observed the disease in patients in the second and third stages of HIV.
“HIV-related dementia used to be neglected because people thought it was a stage four event, where the patient would die,†says Nakasujja. “But even in stage two, HIV can attack the brain.â€
David Basangwa, a psychologist at Butabika Hospital, says dementia is common in people living with HIV. “HIV does well in brain tissue,†he says.
Tuberculosis and other opportunistic
infections, like bacterial and fungal meningitis, can also affect the brain. The first symptom is failing memory, especially for recently learned things.
“The short-term memory keeps deteriorating,†says Basangwa.
As dementia worsens, the patient becomes less able to take care of themselves.
They seem to get lost in their surroundings and tasks like managing their bank account, personal hygiene and schoolwork or job can become difficult.
Relationships also decline — people with dementia can become increasingly suspicious of their partners. Psychotic symptoms may develop, such as visual and auditory hallucinations.
“HIV and mental health problems go hand-in-hand,†says Elly Katabira, a neurophysician at Makerere College of Health Sciences and president of the International AIDS Society. “The virus affects the brain cells much more quickly than we expect.â€
People living with HIV-related dementia are irritable or apathetic, unable to care about things that normally mattered to them. Even though they can do work, they will be slower in executing tasks at their jobs.
Unfortunately, family members and friends that might be sympathetic towards dementia in the elderly are often confused or even angered when they see dementia in younger people, unaware of what is going on.
“Family members and friends are unlikely to think the person is sick,†says Nakasujja.
“The friends will say, we don’t understand this guy anymore; he is forgetting things. If it was an elderly person, they would understand, but not for a young one or someone aged 30 to 40. Their friends and family see things they don’t expect and are confused,†she explains.
In Uganda, dementia has been observed in people with other HIV sub-types other than B. The prevalence/statistics and number of patients attended to in health units is about 30% if not on antiretroviral therapy.
Other forms of therapy
Researchers are making inroads into treatment that may slow down the progress of dementia. Cognitive and behavioural therapies may also be useful.
Several studies have found that music therapy helps patients with dementia. It is important to remember that the patient’s caregiver also needs training and emotional support. Some physicians prescribe these drugs for Alzheimer’s disease to treat vascular dementia.
How common is dementia?
A study published in medical journal The Lancet in 2005, reveals that approximately 24.3 million people worldwide have dementia, with 4.6 new cases every year.
The number of people with dementia is projected to double every two decades and reach 81.1 million by 2040. The rate of increase is expected to be faster in developing countries which have rapidly-growing life expectancies.
Symptoms
Linda, a cashier from Kasubi, used to have a career as a radio journalist before she and her late husband began suffering from HIV-related dementia. She lost her job in radio due to the stress of living with HIV, taking care of her dying husband, and tending their baby.
Her CD4 count has risen from 198 to 419. “I would sometimes lose memory, like count out money and then not remember where I put it,†she said. “I would forget to take breakfast and my husband would forget to take his drugs. Sometimes, I felt like a wave was sweeping through my head.â€
But she says antiretroviral therapy helped restore her memory and health.
If opportunistic infections are causing the dementia, such as meningitis, these will also need to be treated at a clinic.
Other symptoms
Loss of short-term memory
Decline in hygiene
Difficulty in performing tasks at work or school
Being suspicion of other people
Having visual and auditory hallucinations
Being unable to manage a bank account
Forgetting to medication or eating food
HOW IS HIV-RELATED DEMENTIA TREATED?
HIV-related dementia is best treated with antiretroviral therapy. However other thrapies are being tried out in Uganda.
Dr. Noeline Nakasujja, a researcher at Mulago Hospital, says: “Within a period of six months, there is usually a noticeable change in the patients, if treatment is started early.â€
“If patients are started on ARVs, their cognitive functions significantly improve,†she says. “If diagnosed early, the condition is reversible. But if left untreated, a patient’s health deteriorates quickly. â€
She advises that if you are concerned that you or a loved one is suffering from dementia, you can be screened at a health clinic.
Alzeheimer’s is the most common cause of dementia, but syphilis can also cause it.