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Despite such growing suspicions, the psychiatric effects of malaria were still considered “more common than are generally known” [4], and a military journal editorial noted that malaria should be considered “associated with protean mental states” [18]. Psychiatric symptoms also remained clearly associated in the literature of the era with even the mild chronic and relapsing forms of disease, with a case report describing psychosis developing weeks prior to the onset of fevers from the generally benign Plasmodium vivax malaria [17].
Reports from among soldiers of the Vietnam War era similarly described mostly transient cases of psychosis, and impaired memory and concentration generally following admission for treatment for malaria [19], often lagging admission by some days, and typically without evidence of such symptoms while previously febrile [20]. Neuropsychological testing of certain of these patients both soon after their acute illness and following their recovery identified common patterns of deficits, particularly in tests of recent memory, visual organization, psychomotor speed, and visual motor integration [21, 22]. Decades later, follow-up of malaria patients from the Vietnam War demonstrated lasting changes in personality, depression, and symptoms of partial seizure [23], as well as deficits on tests of memory, and other evidence of chronic cognitive dysfunction on neuropsychological testing [24].
