Skip to main content Accessibility help

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

  • Yan-Li Zeng (a1), Wen-Jie Wang (a2), Hui-Lin Zhang (a1), Fu-Yi Chen (a3), Song-Jie Huang (a1), Gui-Li Liu (a1), Ya Xi (a1), Xiao-Jing Guo (a1), Wei-Hong Zheng (a2) and Tian-Ci Yang (a1)...



Neurosyphilis (NS) may present with neuropsychiatric disorders characterized by cognitive impairment, personality disorders, and confusion, among others. Very few studies have focused on neuropsychiatric disorders secondary to NS in elderly people.


A retrospective chart review was performed to characterize the psychiatric findings, clinical signs and symptoms, laboratory findings, and brain magnetic resonance imaging results of ten elderly inpatients with NS.


In these ten patients, the most common presenting symptoms included a wide variety of psychiatric manifestations. The serum rapid plasma regain (RPR) and Treponema pallidum particle agglutination assay (TPPA) of the ten patients were positive, with positive CSF TPPA and RPR rates of 100% and 60%, respectively. In addition, 90% of the patients demonstrated abnormal imaging, including cerebral atrophy, infarct ischemic stroke, and hydrocephalus.


Our findings support the importance of serological tests for syphilis as a routine component of the evaluation of patients with clinically evident neurological or psychiatric symptoms. If the serology is positive, all of the patients should be examined with a lumbar puncture. Moreover, psychiatric illnesses secondary to NS in the elderly also deserve medical attention.


Corresponding author

Correspondence should be addressed to: Wei-Hong Zheng, PhD, Department of Neurology, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China. Phone: +86-592-2292022; Fax: +86-592-2992022; Email:
Tian-Ci Yang, PhD, Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China. Phone: +86-592-2993042; Fax: +86-592-2993043. Email:


Hide All
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Publishing.
Berbel-Garcia, al. (2004). Magnetic resonance image-reversible findings in a patient with general paresis. Sexually Transmitted Diseases, 31, 350352.
Broadway, J. and Mintzer, J. (2007). The many faces of psychosis in the elderly. Current Opinion in Psychiatry, 20, 551558.
Centers for Disease Control and Prevention. (1998). Guidelines for treatment of sexually transmitted diseases. MMWR Recommendations and Reports, 47 (RR-1), 1111.
Cleare, A. J., Jacoby, R., Tovey, S. J. and Bergmann, K. (1993). Syphilis, neither dead nor buried – A survey of psychogeriatric inpatients. International Journal of Geriatric Psychiatry, 8, 661664.
Copeland, al. (1992). Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool. The British Journal of Psychiatry, 161, 230239.
Fadil, H., Gonzalez-Toledo, E., Kelley, B. J. and Kelley, R. E. (2006). Neuroimaging findings in neurosyphilis. Journal of Neuroimaging, 16, 286289.
French, P., Gomberg, M., Janier, M., Schmidt, B., van Voorst Vader, P. and Young, H. (2009). IUSTI: 2008 European guidelines on the management of syphilis. International Journal of STD and AIDS, 20, 300309.
Friedrich, F., Geusau, A., Greisenegger, S., Ossege, M. and Aigner, M. (2009). Manifest psychosis in neurosyphilis. General Hospital Psychiatry, 31, 379381.
Hilton, C. (1998). General paralysis of the insane and AIDS in old age psychiatry: epidemiology, clinical diagnosis, serology and ethics – the way forward. International Journal of Geriatric Psychiatry, 13, 875885.
Hooshmand, H., Escobar, M. R. and Kopf, S. W. (1972). Neurosyphilis: a study of 241 patients. JAMA, 219, 726729.
Ide, M., Mizukami, K., Fujita, T., Ashizawa, Y. and Asada, T. (2004). A case of neurosyphilis showing a marked improvement of clinical symptoms and cerebral blood flow on single photon emission computed tomography with quantitative penicillin treatment. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 28, 417420.
Kearney, H., Mallon, P., Kavanagh, E., Lawler, L., Kelly, P. and O’Rourke, K. (2010). Amnestic syndrome due to meningovascular neurosyphilis. Journal of Neurology, 257, 669671.
Kent, M. E. and Romanelli, F. (2008). Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Annals of Pharmacotherapy, 42, 226236.
Kodama, al. (2000). Relationship between MRI findings and prognosis for patients with general paresis. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 246250.
Larsen, E. B. and Schultz, V. (1993). Severe consequences of delayed diagnosis and treatment of neurosyphilis[in Danish]. Ugeskr Laeger, 155, 3932.
Lin, L. al. (2010). Development of a colloidal gold-immunochromatography assay to detect immunoglobulin G antibodies to Treponema pallidum with TPN17 and TPN47. Diagnostic Microbiology and Infectious Disease, 68, 193200.
Lin, L. al. (2011). Evaluation of a colloidal gold immunochromatography assay in the detection of Treponema pallidum specific IgM antibody in syphilis serofast reaction patients: a serologic marker for the relapse and infection of syphilis. Diagnostic Microbiology and Infectious Disease, 70, 1016.
Liu, L. al. (2012). Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. Journal of the Neurological Sciences, 317, 3539.
Long, D. and Mulley, G. (2001). Dilemmas in the management of neurosyphilis in elderly patients. Reviews in Clinical Gerontology, 11, 215227.
Luger, A. F., Schmidt, B. L. and Kaulich, M. (2000). Significance of laboratory findings for the diagnosis of neurosyphilis. International Journal of STD and AIDS, 11, 224234.
Luo, W., Ouyang, Z., Xu, H., Chen, J., Ding, M. and Zhang, B. (2008). The clinical analysis of general paresis with 5 cases. Journal of Neuropsychiatry and Clinical Neurosciences, 20, 490493.
Marra, C. M. (2009). Update on neurosyphilis. Current Infectious Disease Reports, 11, 127134.
Mitsonis, C. al. (2008). Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. International Journal of Neuroscience, 118, 12511257.
Omer, T. A., Fitzgerald, D. E., Sheehy, N. and Doherty, C. P. (2012). Neurosyphilis presenting with unusual hippocampal abnormalities on magnetic resonance imaging and positron emission tomography scans: a case report. Journal of Medical Case Reports, 6, 14.
Russouw, H. G., Roberts, M. C., Emsley, R. A. and Truter, R. (1997). Psychiatric manifestations and magnetic resonance imaging in HIV-negative neurosyphilis. Biological Psychiatry, 41, 467473.
Shah, B. B. and Lang, A. E. (2012). Acquired neurosyphilis presenting as movement disorders. Movement Disorders, 27, 690695.
Sun, X.-D., Cheng, F., Shi, X., Xu, G.-X. and Liu, C.-F. (2010). Neurosyphilis presenting as diplopia: a literature review. The Chinese Journal of Dermatovenereology, 6, 021.
Tong, al. (2013a). Laboratory findings in neurosyphilis patients with epileptic seizures alone as the initial presenting symptom. Diagnostic Microbiology and Infectious Disease, 75, 377380.
Tong, al. (2013b). Spectrum and characterization of movement disorders secondary to neurosyphilis. Parkinsonism and Related Disorders, 19, 441445.
Yu, al. (2010). Clinical presentation and imaging of general paresis due to neurosyphilis in patients negative for human immunodeficiency virus. Journal of Clinical Neuroscience, 17, 308310.
Zheng, al. (2011). The clinical presentation and imaging manifestation of psychosis and dementia in general paresis: a retrospective study of 116 cases. Journal of Neuropsychiatry and Clinical Neurosciences, 23, 300307.


Related content

Powered by UNSILO

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

  • Yan-Li Zeng (a1), Wen-Jie Wang (a2), Hui-Lin Zhang (a1), Fu-Yi Chen (a3), Song-Jie Huang (a1), Gui-Li Liu (a1), Ya Xi (a1), Xiao-Jing Guo (a1), Wei-Hong Zheng (a2) and Tian-Ci Yang (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.