Clinical characteristics of neurosyphilis patients with prominent mental symptoms and their impact on activities of daily living

Objective To analyze the clinical data of patients with prominent psychiatric symptoms in neurospyhilis (NS) , and explore the risk factors affecting activities of daily living (ADL) . Methods A retrospective analysis was conducted on the clinical data of hospitalized NS patients in the Department of Neurology, the Second Hospital of Nanjing from November 2018 to November 2023. Based on ADL scores, patients were divided into a mild or no impairment group (Group A, ADL score≤60, n=27) and a moderate to severe impairment group (Group B, ADL score＞60, n=28) . Clinical and laboratory indicators were compared between the two groups, and risk factors affecting ADL were explored.The predictive value of the regression equation was evaluated using receiver operating characteristic (ROC) curve analysis. Results A total of 55 cases were included, with an age of (53.93±11.59) years, and 50 male patients (90.91%) . Thirty.eight patients (69.09%) had comorbidities, with hypertension, cerebral infarction, and diabetes being the top three. MRI showed bilateral brain involvement in 36 cases (65.45%) . All patients had positive serum syphilis antibodies［treponema pallidum particle agglutination (TPPA) and tolulized red unheated serum test (TRUST) ］, and positive cerebrospinal fluid (CSF) TPPA. Fifty-three patients (96.36%) had positive CSF TRUST. Clinical manifestations varied: psychiatric symptoms mainly included delusions and hallucinations; cognitive impairment was characterized by memory loss and speech difficulties; mood disorders were mainly irritability and mental excitement; behavioral symp.toms included incoherent speech and abnormal behavior; 3 patients (5.45%) presented with impaired consciousness; other symptoms included sleep disturbances and motor dysfunction, with 7 cases (12.73%) and 3 cases (5.45%) respectively. Compared with Group A, Group B was older［ (58.18±10.35) years vs 49.52±11.33) years, t=2.962,P=0.005］, had a higher proportion of comorbidities (85.71% vs 51.85%, χ 2=5.880,P=0.015) and bilateral brain lesions (78.57% vs 51.85%, χ 2=4.340,P=0.037) ; Group B also had higher levels of D-dimer (Z=3.360,P=0.001) and CSF protein (Z=2.694,P=0.005) , and lower hemoglobin levels (Z=2.249,P=0.024) . Multivariate logistic regression analysis indicated that comorbidities, high D-dimer levels, and high CSF protein concentrations were independent risk fac. tors for impaired ADL (OR=15.301,P=0.030; OR=1.902,P=0.021; OR=1.050,P=0.024) , while high hemoglobin concentration was a protective factor (OR=0.924,P=0.030) . The area under the curve (AUC) for the multivariate regression equation predicting ADL impairment was 0.896 (95%CI: 0.814-0.977) , with a sensitivity of 75.0% and specificity of 92.6%. Conclusion Some NS patients have prominent psychiatric symptoms and severe ADL impairment. Comorbidities, anemia, high D-dimer levels, and high CSF protein concentrations are indicative of disease severity. Timely syphilis treatment, anemia correction, reduction of CSF protein concentration, and strict management of comorbidities can improve patient prognosis.