TY - JOUR
T1 - The effect of penicillin therapy on cognitive outcomes in neurosyphilis
T2 - A systematic review of the literature
AU - Moulton, Calum D.
AU - Koychev, Ivan
PY - 2015
Y1 - 2015
N2 - Objective: Neurosyphilis commonly presents with cognitive impairment, and penicillin remains the treatment of choice. However, despite a rapid increase in syphilis incidence, the effect of penicillin on long-term cognitive outcomes has not previously been evaluated. We therefore aimed to assess the effect of penicillin on cognitive function in neurosyphilis. Methods: We performed a systematic review of all studies of neurosyphilis, where cognitive function was assessed objectively both before and after penicillin therapy for at least one patient. Where Mini-Mental State Examination (MMSE) scores were taken, we performed a paired-samples t test to assess the change in cognitive function and aimed to correlate this with change in serological titers. Results: Nine studies met inclusion criteria. The one cohort study reported a nonsignificant overall improvement in MMSE, while amalgamation of case reports produced a significant improvement (. P=. .02) in MMSE after treatment. However, follow-up duration was inadequate, and data were insufficient to correlate changes in cognitive function with serological markers. Conclusions: Despite evidence of short-term improvement, there are insufficient data to support the long-term benefit of penicillin therapy on cognitive function in neurosyphilis.
AB - Objective: Neurosyphilis commonly presents with cognitive impairment, and penicillin remains the treatment of choice. However, despite a rapid increase in syphilis incidence, the effect of penicillin on long-term cognitive outcomes has not previously been evaluated. We therefore aimed to assess the effect of penicillin on cognitive function in neurosyphilis. Methods: We performed a systematic review of all studies of neurosyphilis, where cognitive function was assessed objectively both before and after penicillin therapy for at least one patient. Where Mini-Mental State Examination (MMSE) scores were taken, we performed a paired-samples t test to assess the change in cognitive function and aimed to correlate this with change in serological titers. Results: Nine studies met inclusion criteria. The one cohort study reported a nonsignificant overall improvement in MMSE, while amalgamation of case reports produced a significant improvement (. P=. .02) in MMSE after treatment. However, follow-up duration was inadequate, and data were insufficient to correlate changes in cognitive function with serological markers. Conclusions: Despite evidence of short-term improvement, there are insufficient data to support the long-term benefit of penicillin therapy on cognitive function in neurosyphilis.
KW - Cognition
KW - Mini-Mental State Examination
KW - Neurosyphilis
KW - Penicillin
UR - http://www.scopus.com/inward/record.url?scp=84922647721&partnerID=8YFLogxK
U2 - 10.1016/j.genhosppsych.2014.10.008
DO - 10.1016/j.genhosppsych.2014.10.008
M3 - Article
AN - SCOPUS:84922647721
SN - 0163-8343
VL - 37
SP - 49
EP - 52
JO - GENERAL HOSPITAL PSYCHIATRY
JF - GENERAL HOSPITAL PSYCHIATRY
IS - 1
ER -