HIV directly affects the CNS, primarily causing subcortical
neuropathology. Dementia as the initial presentation is rare, but organic
mental changes that mimic many functional disorders can occur during the
course of infection. The mental status examination is not adequately
sensitive to detect noncognitive dysfunction, and subjective complaints,
neurological signs, reduced T4 lymphocytes, CSF abnormalities, diffuse
slowing on ECG, mild cerebral atrophy on brain CT, and nonspecific
hyperdensities on brain magnetic resonance imaging do not correlate
reliably with early and subtle HIV-induced neuropsychological impairment.
Zidovudine (AZT) can delay or reverse mental deficits, and psychostimulants
can reduce apathetic withdrawal, but high-potency neuroleptics can cause
neuroleptic malignant syndrome.