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

References