The elderly psychiatric patient with positive syphilis serology: The problem of neurosyphilis

Objective: Older patients have a high prevalence of neurological and psychi atric disorders. They also have a baseline prevalence of late latent syphil is or positive syphilis serology. Thus the clinical question arises as to w hether a neuropsychiatric disorder in a geriatric patient is neurosyphilis or if the positive serology is incidental. Method: An illustrative case exa mple is used to illustrate this dilemma. The relevant literature is reviewe d. Results: The cerebrospinal fluid (CSF) protein is an important indicator of inflammatory activity in the central nervous system and is used as a cl inical guide in the diagnosis. Elderly patients have higher values of norma l CSF protein than younger patients. Conclusions: Given the importance of C SF protein in the diagnosis of neurosyphilis, physicians must include this knowledge, that elderly patients have higher CSF protein values, in their c linical decision making in the differentiation between neurosyphilis and la te latent syphilis in the elderly patient.