Correlation analysis of psychiatric and behavioral symptoms with cognitive impairment and prognosis in patients with general paresis

Objective: To investigate the characteristics of neuropsychiatric symptoms (NPS) in patients with general paresis (GP) and analyze their correlation with cognitive impairment and prognosis. Methods: Clinical data from 100 GP patients admitted between January 2022 and June 2024 were retrospectively analyzed. Neuropsychiatric Inventory (NPI) assessed neuropsychiatric symptoms, while Mini-Mental State Examination (MMSE) evaluated cognitive function. All patients received standardized anti-syphilis treatment and completed 12-month follow-up. Based on cerebrospinal fluid test results at the final follow-up, patients were categorized into good and poor prognosis groups. Spearman correlation analysis explored the relationship between NPS and cognitive impairment, while multivariate logistic regression identified independent risk factors for poor prognosis. Results: All 100 patients exhibited varying degrees of NPS. The mean NPI total score was (42.38 ± 29.96) points, with depression (6.20 ± 3.83) and apathy (5.75 ± 3.78) scoring highest, while aberrant motor behavior (0.62 ± 1.08) scored lowest. All patients exhibited cognitive impairment, with a mean MMSE score of (13.78 ± 2.92). Impaired recall ability (0.94 ± 0.69) was the most significant deficit. Spearman correlation analysis revealed a significant negative correlation between NPI total scores and MMSE total scores (r = -0.583, P < 0.001). Additionally, all NPI subscales (e.g., delusions r = -0.573, appetite and eating changes r = -0.556) showed significant negative correlations with MMSE total scores (all P < 0.001). At the 12-month follow-up, 38 patients (38.00%) had a good prognosis, while 62 patients (62.00%) had a poor prognosis. Multivariate logistic regression analysis indicated that lower educational attainment (OR = 0.191, 95% CI: 0.052-0.709, P = 0.013), elevated baseline cerebrospinal fluid white blood cell count (OR = 3.194, 95% CI: 1.628-6.268, P<0.001), higher NPI total scores (OR = 1.073, 95% CI: 1.029-1.119, P<0.001), and lower MMSE scores (OR = 0.493, 95% CI: 0.338-0.720, P<0.001) were independent risk factors for poor prognosis in GP patients. Conclusion: The severity of psychiatric and behavioral symptoms showed a significant negative correlation with the degree of cognitive impairment. GP patients with low educational attainment, high baseline cerebrospinal fluid white blood cell counts, severe psychiatric and behavioral symptoms, and poor cognitive function had a higher risk of poor prognosis. Clinicians should develop targeted interventions addressing these high-risk factors to improve patient outcomes.