Use Gerstmann–Sträussler–Scheinker (GSS) disease and its course, clinical features of GSS, and characterizes the HIV-associated dementia complex to frame the working diagnosis and next step; treat it as a safety constraint before prescribing or reassuring. Make clinical features of GSS the checkpoint that determines whether you escalate testing, narrow the differential, or change treatment.

Prominent ataxia, with cognitive impairment developing later on; Unlike other prion conditions, it features a much slower, more protracted course, spanning over three to eight years; Rare, inherited prion disease that typically shows up earlier, in a person's thirties or forties; You will also see a mix of pyramidal and extrapyramidal signs, alongside a cognitive profile that shows both cortical and subcortical deficits; You will see a slowed mental processing speed—or bradyphrenia—along with apathy and significant impairments in working memory, attention, and concentration