Cerebral toxoplasmosis and alcohol abuse in AIDS: dementia with multiple etiologies

ABSTRACT Major neurocognitive disorder due to multiple etiologies, or dementia due to multiple etiologies (DME), is a term coined by the Diagnostic and Statistical Manual of Mental Disorders to refer to complex cases when multiple pathologies, such as Alzheimer's disease, Lewy Bodies, human immunodeficiency virus (HIV), vascular-related brain damage or frontotemporal lobar degeneration, are identified as contributing to neurocognitive impairment and/or behavioral alterations, based on patient's neuroimaging tests, laboratorial exams, associated symptomatology and medical history. In this study, we report the case of a 63-year-old male patient who presented with parkinsonism symptoms, aphasia and cognitive impairment on multiple domains after cerebral toxoplasmosis related to acquired immunodeficiency syndrome, vascular damage and a history of alcohol abuse. We discuss the neurocognitive and neurobehavioral variables that characterized this diagnosis, as well as the importance of the differential diagnosis of DME on the field of neuropsychology of aging and, especially, for individuals living with HIV infection.

摘要 多重病因所致的重度神经认知障碍，或称多重病因痴呆（DME），是《精神障碍诊断与统计手册》提出的术语，用于指代同时存在多种病理因素（如阿尔茨海默病、路易体病变、人类免疫缺陷病毒（HIV）感染、血管性脑损伤或额颞叶变性）导致神经认知损害和/或行为改变的复杂病例，诊断依据为患者的神经影像学检查、实验室检测、相关症状及病史。本研究报告1例63岁男性患者的临床病例：该患者在罹患获得性免疫缺陷综合征相关脑弓形虫病、合并血管损伤及酗酒史后，出现帕金森综合征症状、失语症及多领域认知障碍。本文探讨了该诊断的特征性神经认知与神经行为变量，以及多重病因痴呆（DME）的鉴别诊断在老年神经心理学领域的重要性，尤其针对人类免疫缺陷病毒（HIV）感染者。