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Infections of the Nervous System

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Which of the following pathological features correlates best with the severity of AIDS dementia?

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(A) The number of nodules containing macrophages, lymphocytes, and microglia

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(B) Multinucleated giant cells

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(C) Cortical atrophy

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(D) Neuronal loss

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(E) Macrophage activation

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(E) Cerebral atrophy involving the frontotemporal areas is a common finding in patients with HIV dementia. It does not correlate with the severity of the dementia. Multiple microglial nodules containing macrophages, lymphocytes, and microglia may be seen in HIV dementia. Scattered in the gray and white matter of the brain, they are more common in the white matter, subcortical gray of the thalamus, basal ganglia, and brainstem. They are not specific to HIV dementia and do not correlate with its severity. Other neuropathological findings include neuronal loss, dendritic changes, myelin pallor (which corresponds to changes of the blood–brain barrier), and multinucleated giant cells. The presence of these cells correlates with the degree of dementia and the detection of HIV-1 DNA. However, the intensity of macrophage activation does appear to correlate best with the severity of dementia. (Glass, 2230–2237; Glass, 755–762)

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A 40-year-old man diagnosed with HIV-associated dementia is able to perform basic activities of self-care but cannot work or maintain the more demanding aspects of daily life. He is able to ambulate. In which stage of HIV-associated dementia Memorial Sloan Kettering (MSK clinical staging system) can the patient be classified?

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(A) Stage 0

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(B) Stage 1

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(C) Stage 2

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(D) Stage 3

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(E) Stage 4

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(C) In 1988, Price and colleagues developed the following clinical staging of the severity of HIV-associated dementia:

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  • Stage 0: normal mental and motor function.

  • Stage 0.5 (equivocal subclinical): absent, minimal, or equivocal symptoms without impairment of work or capacity to perform activities of daily life. Mild signs such as snout response, slowed ocular, or extremity movements may be present. Gait and strength are normal.

  • Stage 1 (mild severity): ability to perform all but the most demanding activities of daily life with unequivocal evidence of functional intellectual or motor impairment. The patient can walk without assistance.

  • Stage 2 (moderate severity): ability to perform basic activities of self-care but cannot work or maintain the more demanding aspects of daily life. The patient may ambulate independently.

  • Stage 3 (severe disability): major intellectual or motor incapacity.

  • Stage 4: nearly vegetative status. (Price and Brew, 1079–1083)

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