Cognitive impairments in patients with persistent symptoms attributed to Lyme disease

Berende, Anneleen; Rentergem, Joost A. Agelink van; Evers, Andrea W M; Hofstede, H.J.M. ter; Vos, Fidel J.; Kullberg, Bart Jan; Kessels, Roy P. C.

doi:10.1186/s12879-019-4452-y

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…Although some studies find self-reported cognitive problems in a considerable proportion of patients with treated neuroborreliosis [ 2 , 4 ], we were not able to find reduced cognitive function in our cohort. Our results are in line with Dersch et al [ 15 ] and Berende et al [ 14 ], but contrary to studies finding reduced verbal learning/memory and attention/executive function [ 10 , 11 , 38 – 40 ]. There are several possible explanations for the different results.…”

Section: Discussionsupporting

confidence: 92%

“…Since none of the controls were asked to grade subjective memory or concentration problems, and the clinical composite score is unvalidated, we do not know whether mild subjective concentration/ memory problems are frequent in the control group or the general population. A modest association between self-reported cognitive problems and results on neuropsychological test-results has been documented previously, both in patients with neuroborreliosis [ 14 ] and other patient groups [ 44 , 45 ]. We did not include a questionnaire to assess patients’ subjective cognitive problems in detail, nor did we ask them about their expectancy regarding the outcome when included in the acute phase.…”

Section: Discussionmentioning

confidence: 60%

“…Despite the high prevalence of self-reported cognitive problems, studies using cognitive tests show conflicting results. Some find reduced cognitive function, especially in verbal learning and memory [ 10 – 12 ], and processing speed [ 12 , 13 ], while others find no differences between patients and healthy controls [ 14 , 15 ]. Apart from leptomeningeal and cranial nerve enhancement in the acute phase, pathological findings on conventional MRI after treated neuroborreliosis are unusual [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of cognitive function, structural brain changes and fatigue 6 months after treatment of neuroborreliosis

et al. 2022

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Background Complete recovery after adequately treated neuroborreliosis is common, but studies report that some patients experience persistent symptoms like self-reported cognitive problems and fatigue. Persisting symptoms are often termed post-Lyme disease syndrome, of which etiology is not clearly understood. The aim of this study was to investigate cognitive function, possible structural changes in brain regions and level of fatigue. We have not found previous studies on neuroborreliosis that use standardized neuropsychological tests and MRI with advanced image processing to investigate if there are subtle regional changes in cortical thickness and brain volumes after treatment. Methods We examined 68 patients treated for neuroborreliosis 6 months earlier and 66 healthy controls, with a comprehensive neuropsychological test protocol, quantitative structural MRI analysis of the brain and Fatigue Severity Scale. Results We found no differences between the groups in either cognitive function, cortical thickness or brain volumes. The patients had higher score on Fatigue Severity Scale 3.8 vs. 2.9 (p = 0.001), and more patients (25.4%) than controls (5%) had severe fatigue (p = 0.002), but neither mean score nor proportion of patients with severe fatigue differed from findings in the general Norwegian population. Conclusion The prognosis regarding cognitive function, brain MRI findings and fatigue after adequately treated neuroborreliosis is favorable.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Assessment of cognitive function, structural brain changes and fatigue 6 months after treatment of neuroborreliosis

et al. 2022

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“…In line with previous studies, this study indicates that self-reported symptoms are clinically relevant with regard to daily functioning. 34 We recommend that this definition of persistent symptoms is used in future studies into this topic, allowing for comparison of findings between studies. Lastly, the longitudinal assessment of symptoms enabled describing the course and severity of symptoms over time.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of persistent symptoms after treatment for lyme borreliosis: A prospective observational cohort study

Ursinus

Vrijmoeth

Harms

et al. 2021

The Lancet Regional Health - Europe

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Summary Background Concerns about long-lasting symptoms attributed to Lyme borreliosis (LB) are widespread in the Western world, while such symptoms are highly prevalent in the general population. Methods In the largest prospective study to date, adults with physician-confirmed LB were included at the start of antibiotic treatment. Primary outcomes, prevalence of persistent symptoms and symptom severity, were assessed using three-monthly standardised questionnaires during one year. Persistent symptoms were defined as impaired scores for fatigue (CIS, subscale fatigue), cognitive impairment (CFQ) or pain (SF-36, subscale bodily pain) ≥6 months, with onset <6 months. Outcomes were compared with a longitudinal general population and a tick-bite cohort without LB as a reference. Findings Of 1135 LB patients (94•8% erythema migrans, 5•2% disseminated LB), 1084 fulfilled primary analysis criteria, as well as 1942 population and 1887 tick-bite controls. Overall prevalence of persistent symptoms in LB patients was 27•2% (95%CI, 24•7%-29•7%); 6•0% and 3•9% higher than in population (21•2%, 95%CI, 19•3%-23•1%; p < 0•0001) and tick-bite (23•3%, 95%CI 21•3%-25•3%; p = 0•016) cohorts, respectively. At 12 months, fatigue, cognitive impairment, and pain were significantly more severe in erythema migrans patients than in reference cohorts, while in disseminated LB patients, only pain was more severe. Interpretation In treated LB patients, persistent symptoms were significantly more prevalent and symptoms were more severe than in individuals without LB, although the background prevalence was substantial. This suggests an association, either direct or indirect, between persistent symptoms and LB in a relatively small subset of patients. Funding ZonMw; Dutch Ministry of Health, Welfare and Sport.

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“…However, self-reported cognitive deficits do not always correlate with performance on neuropsychological tests. Berende et al found no association between self-reported cognitive difficulties in over two hundred LB patients and performance on objective tests of episodic memory, working memory / attention, verbal fluency, information-processing speed, and executive function ( 73 ). Less than 3% of participants had cognitive deficits based on neuropsychological testing, a rate comparable to the general population.…”

Section: Discussionmentioning

confidence: 99%

Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis

et al. 2020

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Context: Persistent fatigue, pain, and neurocognitive impairment are common in individuals following treatment for Lyme borreliosis (LB). Poor sleep, depression, visual disturbance, and sensory neuropathies have also been reported. The cause of these symptoms is unclear, and widely accepted effective treatment strategies are lacking. Objectives: To identify symptom clusters in people with persistent symptoms previously treated for LB and to examine the relationship between symptom severity and perceived disability. Methods: This was a retrospective chart review of individuals with a history of treatment of LB referred to The Dean Center for Tick-Borne Illness at Spaulding Rehabilitation Hospital between 2015 and 2018 (n = 270) because of persistent symptoms. Symptoms and functional impairment were collected using the General Symptom Questionnaire-30 (GSQ-30), and the Sheehan Disability Scale. Clinical tests were conducted to evaluate for tick-borne co-infections and to rule out medical disorders that could mimic LB symptomatology. Exploratory factor analysis was performed to identify symptom clusters. Results: Five symptom clusters were identified. Each cluster was assigned a name to reflect the possible underlying etiology and was based on the majority of the symptoms in the cluster: the neuropathy symptom cluster, sleep-fatigue symptom cluster, migraine symptom cluster, cognitive symptom cluster, and mood symptom cluster. Symptom severity for each symptom cluster was positively associated with global functional impairment (p < 0.001). Conclusion: Identifying the interrelationship between symptoms in post-treatment LB in a cluster can aid in the identification of the etiological basis of these symptoms and could lead to more effective symptom management strategies. Zubcevik et al. Symptom Clusters in Lyme Borreliosis Key Message: This article describes symptom clusters in individuals with a history of Lyme borreliosis. Five clusters were identified: sleep-fatigue, neuropathy, migrainelike, cognition, and mood clusters. Identifying the interrelationship between symptoms in each of the identified clusters could aid in more effective symptom management through identifying triggering symptoms or an underlying etiology.

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Cognitive impairments in patients with persistent symptoms attributed to Lyme disease

Cited by 9 publications

References 29 publications

Assessment of cognitive function, structural brain changes and fatigue 6 months after treatment of neuroborreliosis

Assessment of cognitive function, structural brain changes and fatigue 6 months after treatment of neuroborreliosis

Prevalence of persistent symptoms after treatment for lyme borreliosis: A prospective observational cohort study

Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis

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