title: Medial temporal lobe atrophy as a predictor of poor cognitive outcomes in general paresis.
abstract: The effect of penicillin therapy on clinical outcomes vary among patients with general paresis (GP). We sought to explore biomarkers that might serve as predictors of clinical outcomes in GP and identify patients requiring early intervention.
  
  
  
  Thirty-five inpatients with GP were recruited. Each GP patient underwent comprehensive neuropsychological, neuroimaging and laboratory assessments before receiving penicillin therapy, and returned for follow-up evaluations after 6 months. The visual rating of medial temporal lobe atrophy (MTA) and the Fazekas scale was used to analyze the neuroimaging abnormalities.
  
  
  
  MTA scores were correlated with the pre-treatment cognitive scores and change in Mini Mental State Examination scores. GP patients with a Clinical Dementia Rating Scale (CDR) ≤1 or MTA scores ≤2 achieved significant improvement in neuropsychological test scores, as compared with patients with CDR >1 or MTA scores >2. Fazekas scale scores correlated with the pre-treatment attention scores. Significant improvements in cognitive test scores were observed in GP patients with normalization of serum rapid plasma regain (RPR) titers, but not those without normalization of RPR titers.
  
  
  
  Severe MTA may serve as a predictor of poor cognitive outcome and an indicator of severe cognitive impairment in GP patients. Thus, early interventions for improving cognitive function may be considered for GP patients with severe MTA. White matter hyperintensities may associated with attention impairment. Serum RPR titer may serve as a sensitive indicator of therapeutic effect in GP.
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital) and Southern Medical University, Guangzhou, China.
authors.forename: Ben
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Haishan
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Le
authors.initials: L
authors.lastname: Hou
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Guangzhou Medical University, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Zhangying
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Peng
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Zheng
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Yuefen
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Ziyan
authors.initials: Z
authors.lastname: Fang
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Xinru
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Xinni
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Radiology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
authors.forename: Sha
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital) and Southern Medical University, Guangzhou, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Yuping
mesh_terms: D000906:Antibodies / Q000097:blood*; D001284:Atrophy / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D060825:Cognitive Dysfunction / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009483:Neuropsychological Tests; D009494:Neurosyphilis / Q000188:drug therapy / Q000523:psychology*; D010406:Penicillins / Q000627:therapeutic use; D013702:Temporal Lobe / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D015415:Biomarkers; D010406:Penicillins
keywords: cognitive impairment; neuroimaging; neuropsychological assessment; neurosyphilis; predictors of cognitive decline; psychiatric symptoms