周全性老年評估個案報告：神經性梅毒與認知功能障礙

Comprehensive Geriatric Assessment of a 66 Year-old Patient with Neurosyphilis: A Case Report

陳宜慶(Yi-Ching Chen) ； 許凱倫(Kai-Lun Sheu) ； 顏啟華(Chi-Hua Yen)

《台灣老年醫學暨老年學雜誌》 12卷4期 (2017/11) Pp. 274-287

https://doi.org/10.29461/TGG.201711_12(4).0005

摘要

梅毒的症狀多變，一直以來都是難以診斷的疾病。老年人口梅毒感染的盛行率相對較高，但這些患者常合併多重慢性疾病的問題而使得診斷更加困難與複雜。在梅毒的眾多型態中，神經性梅毒的潛伏期長，且為認知功能改變的原因之一，但能經由抗生素治療而改善。若能針對認知功能改變的老年患者進行梅毒的篩檢，並及早給予感染者治療，便能降低病患對照護的需求。本個案為一名66歲男性神經性梅毒患者，團隊應用周全性老年評估提供適當的醫療建議，以增進病患的疾病控制與生活品質。

關鍵字

周全性老年評估 ； 神經性梅毒 ； 次發性躁症

並列摘要

A 66-year old male without any known psychiatric disease started to demonstrate easy irritability, poor impulse control, decreased sleep need, grandiosity and hypertalkativeness three weeks prior to his visit at our hospital. The patient neither had any physical illness nor recent conflict with his family. Mania was initially suspected when the patient was sent to our emergency department; a psychiatric consultation was accordingly requested and the patient was subsequently admitted to the acute psychiatric ward for diagnostic evaluation. Comprehensive geriatric assessment (CGA) showed mild cognitive disorder (MMSE: 26/30), no obvious depression (GDS: 0/15), and good activities of daily living (ADL: 100/100; IADL: 6/8). Elevated RPR/VDRL (1:32) was noted during his hospitalization, and active syphilis infection was confirmed by serum TPPA/TPHA (1:20480). An infectious disease specialist was consulted, and the patient was highly suspected of having neurosyphilis. CSF sampling was then performed. The lab results were compatible with diagnostic criteria for neurosyphilis. The psychotic symptoms improved gradually with intravenous ceftriaxone treatment. We also corrected newly diagnosed hypertension and chronic renal disease and gave instructions on daily diet. After discharge, his symptoms continued to improve under oral medication, and was followed up regularly until total recovery.

並列關鍵字

comprehensive geriatric assessment ； neurosyphilis ； secondary mania