Dementia of infectious origin

Dementia in AIDS

 For more information see AIDS.

• HIV is a neurotropic virus
• immunity is failing
• occurs relatively long after the primary infection

Prion dementia

• the resulting spongiform encephalopathies are caused by prions

Kuru

• spreads by cannibalism → ingestion of raw brain or liver
• symptoms:
  • progressive, global dementia
  • neurological symptoms – "cerebellar ataxia"

Creutzfeld-Jacobo disease

• CJD is the most common prion dementia in humans
• symptoms:
  • the clinical picture matches the picture of kuru':
    • cerebellar ataxias
    • epileptic seizures
    • myoclonus
• on EEG high sharp waves

Bovine spongiform encephalopathy

• BSE, or the so-called mad cow disease'

Dementia in Lyme boreliosis

• symptoms:
  • mostly just milder dementia, with a secondary neurasthenic syndrome

Progressive paralysis

 For more information see Syphilis.

• = tertiary lues
• at the turn of the 19th and 20th centuries, half of psychiatric patients reportedly suffered from this disease
• it led to death within 3–5 years
• English abbreviation GPI (general paralysis of the insane)
• chronic panencephalitis
• atrophy of the cerebral cortex
• infiltration by plasma cells and proliferation of microglia, neurons degenerate
• is very rare today

Clinical picture

• first stage - picture of neurasthenic syndrome:
  • fatigue
  • distractibility, nervousness, lability
  • changes in character, neglects duties and appearance
  • rude joking, boasting
  • euphoria to mania
• there is rapid memory loss with amnestic disorientation
• antisocial and paraphilic behavior, alcoholism, criminal activity
• neurological symptoms:
  • hearing disorder - pressure sores, hyperreflexia, pronunciation disorders
  • Argyll-Robertson's pupils - preserved convergence, but no reaction to light
• sudden death – ictus paralyticus

Forms

• megalomaniac form – grandiose delusions
• depressive form
• simplex form – a picture of progressive dementia
• Lissauer's form – neurological symptomatology
• CSF paralysis – finding in the CSF, without clinical manifestation

Diagnosis

• seropositivity:
  • it is necessary to do "treponemal reactions" (TPHA, TPI), RRR and VDRL, in the tertiary stage they tend to be negative

Treatment

• year 1917: Wagner – Jeuregg:
  • discovered that "treponemas die at temperatures above 38.5 °C
  • thats how pyrotherapy was developed = treatment of malaria
  • he received a Nobel prize for his discovery
• today only ATB' - penicillin* disease is practically reversible

Links

Related articles

• Dementia

References

• BENEŠ, Jiří. Studijní materiály [online]. [cit. 2020]. <http://jirben.wz.cz>.