Wu Yi-Shan, Lane Hsien-Yuan, Lin Chieh-Hsin
*Department of Psychiatry, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung; †Department of Psychiatry, China Medical University Hospital; and ‡Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Clin Neuropharmacol. 2015 Jul-Aug;38(4):156-7. doi: 10.1097/WNF.0000000000000094.
A large number of patients with neurosyphilis present dementia with a progressive course and psychiatric symptoms such as depression, mania, and psychosis. Despite prompt and proper antibiotic treatment, the recovery is often incomplete, especially when tissue damage has occurred. We reported a patient with persisted cognitive decline associated with neurosyphilis that improved substantially after donepezil therapy. A 43-year-old man manifested significant psychiatric symptoms such as mania, psychosis, and cognitive impairment due to neurosyphilis. Subsequently, the patient was treated with antipsychotics and donepezil concurrent with an adequate antibiotic treatment for neurosyphilis. During the 1-year follow-up, his rapid plasma reagin titer approached from 1:256 to 1:64. His Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale scores improved from 12 to 25 and 42.3 to 6.3, respectively, after a 6-month donepezil treatment. Donepezil was discontinued. Three months later, worsening of cognitive impairment (MMSE score, 23) was noted. After donepezil was started again for 3 months, his MMSE score improved to 26. Persistent cognitive impairment is commonly associated with neurosyphilis despite adequate penicillin treatment. Treatment of the cognitive impairment is important but difficult. Cholinergic pathways are considered as involving in the cognitive deficit induced by neurosyphilis and donepezil, a cholinesterase inhibitor, which may be useful for the improvement of cognition. In this case report, we described for the first time the successful use of donepezil in treating cognitive impairment associated with neurosyphilis. The role of cholinesterase inhibitors in the treatment of cognitive impairments caused by neurosyphilis needs further studies.
大量神经梅毒患者表现为进行性病程的痴呆以及抑郁、躁狂和精神病等精神症状。尽管进行了及时且恰当的抗生素治疗，但恢复往往不完全，尤其是在已经发生组织损伤的情况下。我们报告了一名与神经梅毒相关的持续性认知功能下降患者，在使用多奈哌齐治疗后有显著改善。一名43岁男性因神经梅毒出现了如躁狂、精神病和认知障碍等明显的精神症状。随后，该患者在接受治疗神经梅毒的足量抗生素治疗的同时，接受了抗精神病药物和多奈哌齐治疗。在1年的随访期间，他的快速血浆反应素滴度从1:256降至1:64。经过6个月的多奈哌齐治疗后，他的简易精神状态检查表（MMSE）评分和阿尔茨海默病评估量表认知分量表评分分别从12分提高到25分以及从42.3分提高到6.3分。多奈哌齐停药。3个月后，发现认知障碍恶化（MMSE评分，23分）。在再次开始使用多奈哌齐3个月后，他的MMSE评分提高到26分。尽管进行了足量青霉素治疗，但持续性认知障碍通常与神经梅毒相关。认知障碍的治疗很重要但也很困难。胆碱能通路被认为与神经梅毒引起的认知缺陷有关，而胆碱酯酶抑制剂多奈哌齐可能有助于改善认知。在本病例报告中，我们首次描述了多奈哌齐成功用于治疗与神经梅毒相关的认知障碍。胆碱酯酶抑制剂在治疗神经梅毒所致认知障碍中的作用需要进一步研究。
