ABSTRACT
OBJECTIVE: Older patients have a high prevalence of neurological and psychiatric disorders. They also have a baseline prevalence of late latent syphilis or positive syphilis serology. Thus the clinical question arises as to whether a neuropsychiatric disorder in a geriatric patient is neurosyphilis or if the positive serology is incidental. METHOD: An illustrative case example is used to illustrate this dilemma. The relevant literature is reviewed. RESULTS: The cerebrospinal fluid (CSF) protein is an important indicator of inflammatory activity in the central nervous system and is used as a clinical guide in the diagnosis. Elderly patients have higher values of normal CSF protein than younger patients. CONCLUSIONS: Given the importance of CSF protein in the diagnosis of neurosyphilis, physicians must include this knowledge, that elderly patients have higher CSF protein values, in their clinical decision making in the differentiation between neurosyphilis and late latent syphilis in the elderly patient.
Subject(s)
Dementia/diagnosis , Neurosyphilis/diagnosis , Aged , Cerebrospinal Fluid Proteins/cerebrospinal fluid , Dementia/psychology , Diagnosis, Differential , Female , Humans , Neurosyphilis/psychology , Patient Care Team , Syphilis SerodiagnosisABSTRACT
Standard antipsychotics are ineffective in some geriatric patients. In addition, they are not helpful for apathy and withdrawal. Studies have demonstrated that 5HT2 antagonists improve affective symptoms and anxiety; therefore, the efficacy of risperidone on agitation and withdrawal was considered. The literature on risperidone was reviewed, and the efficacy and limitations of risperidone observed in two geriatric patients, one with agitation and another with apathy and withdrawal. Risperidone proved to be effective in controlling disruptive behavior in geriatric patients. Combined antagonism of D2 and 5HT2 receptors might be effective in improving agitation and withdrawal. Risperidone, with both D2 and 5HT2 antagonistic properties, seems to have potential as an alternative agent in controlling agitation and withdrawal in geriatric patients. Caution and need for further observation is recommended.
