Neurocognitive Changes in Tertiary Neurosyphilis: A Retrospective Chart Review

Context: Since the beginning of the new millennium, prevalence of syphilis has re-increased and is once again, a major public health problem. Neurosyphilis is the extension of syphilitic infection to the nervous system. It is considered by many as a cause of reversible dementia, when treated early. However, scarce data exist on the evolution of cognitive and behavioral impairments in patients affected by tertiary neurosyphilis. Objectives: The aim of this study was to explore the cognitive and behavioral changes in a cohort of patients diagnosed with neurosyphilis. Design: A retrospective study based on systematized chart review between 2000 and 2012 in a large neurological tertiary care facility. Outcome measure: Clinical evaluations by treating physicians. Results: Eighteen patients were identified with tertiary neurosyphilis. Out of this group. only two had systematic neuropsychological follow-up despite physician reports of significant and persistent cognitive and psychiatric changes. For these two cases, only slight improvements were noted in memory and executive skills while improvements in attention were marked. None of our patients had previous psychiatric history yet a large proportion developed symptoms after the infection. Conclusion: Although neurosyphilis is traditionally considered a reversible form of dementia, we found limited support for this claim in our two patients with close follow-up. Quality data on the cognitive and psychiatric changes in the rest of our cohort was dramatically lacking, and this could not be explained by absence of symptoms at presentation. Given the recrudescence of syphilis, we propose a systematic approach to the evaluation and follow-up of this disorder.