Classification

The World Health Organization (WHO) criteria for HIV-associated dementia(3) are as follows.

1. The research criteria for dementia of the ICD-10(7) are met, with some modifications:

a. decline in memory may not be severe enough to impair activities of daily living;

b. decline in motor function may be present, and is verified by clinical examination and, when possible, formal neuropsychological testing;

c. the minimum requested duration of symptoms is 1 month;

d. aphasia, agnosia and apraxia are unusual.

2. Laboratory evidence for systemic HIV infection is present.

3. No evidence of another aetiology from history, physical examination, or laboratory tests should be present (specifically, cerebrospinal fluid analysis and either CT or magnetic resonance imaging (MRI) should be done to exclude active central nervous system opportunistic processes).

The American Academy of Neurology criteria(4) require the following.

1. Laboratory evidence for systemic HIV infection.

2. Acquired abnormality in at least two of the following cognitive abilities (present for at least 1 month): attention/concentration, speed of processing of information, abstraction/reasoning, visuospatial skills, memory/learning, and speech/language.

3. At least one of the following:

a. acquired abnormality in motor function or performance;

b. decline in motivation or emotional control or change in social behaviour.

4. Absence of clouding of consciouness during a period long enough to establish the presence of (2).

5. Absence of evidence of another aetiology.

Both WHO and American Academy of Neurology criteria distinguish three levels of severity of the dementia syndrome (mild, moderate, and severe), on the basis of the degree of the impairment in activities of daily living.

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