Advice about management

At the present state of knowledge, patients with HIV-associated dementia should be treated with zidovudine. Although there is uncertainty about the most appropriate dosage, the standard doses of 500 to 600 mg/day should be tried first. If the patient does not respond, the dosage should be increased to 1500 or 2000 mg/day.

Psychosocial interventions should include maintenance of a structured daily schedule, titration of external stimuli, restriction to familiar environments, frequent orienting interactions with significant others, and monitoring of personal and financial affairs.

The care of patients with HlV-associated dementia will make increasing demands on health services, as well as on volunteer and community support systems. It is uncertain, at present, whether such care is best provided in specialized units (e.g. inpatient AIDS units), or within general psychiatric or medical services. Special management problems may arise when the behavioural disturbance (e.g. poor impulse control, sexual acting-out behaviour) is such as to constitute a risk for other patients or staff members. Placement of patients in the terminal stage of the disease may also represent a problem: the lack of appropriate options in the community may obstruct their timely and humane discharge from the hospital.

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