General paralysis of the insane and AIDS in old age psychiatry: epidemiology, clinical diagnosis, serology and ethics?the way forward

Abstract

While the incidence of general paralysis of the insane (GPI) has declined, AIDS (acquired immune deficiency syndrome) has emerged as a new illness. Today, in England and Wales, as many elderly people die from AIDS as from neurosyphilis, although both diagnoses are rare in this age group. Both are serious medical conditions with psychiatric manifestations. For both, serological tests may identify the disease, and treatment may be of benefit, but there is considerable social stigma attached to the diagnoses. Ethical guidelines for serological testing for HIV (human immunodeficiency virus) have been available for over a decade. In view of the similarities between the diseases, it may be unethical to test patients for syphilis routinely. Epidemiology, risk factors, neurological and neuropsychiatric features and ethics must be considered before testing for both syphilis and HIV. Copyright © 1998 John Wiley & Sons, Ltd.

Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients

“…Several case series have described these symptoms as atypical or "formes frustes" [9][10][11]. Although the incidence of syphilis has decreased significantly in the post-penicillin era, a worldwide resurgence of neurosyphilis has occurred since the advent of the human immunodeficiency virus (HIV) epidemic [12][13][14]. In addition, the precise incidence of neurosyphilis remains unknown because of the similarities in the clinical manifestations of neurosyphilis and other neurological diseases.…”

Clinical and imaging findings in patients with neurosyphilis: a study of a cohort and review of the literature

“…The use of penicillin therapy has significantly reduced the incidence of syphilis over time . However, the emergence of acquired immunodeficiency syndrome (AIDS) has dramatically increased the incidence of syphilis throughout the Western world during the last decade . A high rate of syphilis coinfection has been reported in HIV‐positive patients residing in northern Israel .…”

“…1,2 However, the emergence of acquired immunodeficiency syndrome (AIDS) has dramatically increased the incidence of syphilis throughout the Western world during the last decade. [1][2][3][4] A high rate of syphilis coinfection has been reported in HIV-positive patients residing in northern Israel. 5 Similarly, a syphilis outbreak among men who have sex with men has been reported in Tel-Aviv, Israel, during 2008-2009.…”

Neuropsychiatric disorders secondary to neurosyphilis in elderly people: one theme not to be ignored

“…The incidence of Alzheimer's disease in the older than 65 years age group was approximately 6% and was steeply rising to 20% or more in people older than 80 years (Copeland et al, 1992). Alzheimer's-type dementia has been characterized by temporoparietal neuropsychiatric features such as amnesia for recent events, apraxia, aphasia, and visuospatial difficulties (Hilton, 1998). These cognitive findings differed from patients with NS, which mainly manifested as cognitive impairment and amnesia in the elderly patients.…”