Cognitive function in post-treatment Lyme disease Do additional antibiotics help?

Kaplan, Richard F.; Trevino, Richard P.; Johnson, Gary M.; Levy, Lois; Dornbush, Rhea L.; Hu, Linden T.; Evans, Jane DeRose; Weinstein, Arthur; Schmid, Christopher H.; Klempner, Mark S.

doi:10.1212/01.wnl.0000068030.26992.25

Cited by 172 publications

(158 citation statements)

References 25 publications

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“…5 By contrast, although the baseline BDI showed mild to moderate depression, there was no significant difference in neuropsychological test measurements in the combined patient group vs age-matched norms. 7 There was also no significant difference in baseline SF-36, BDI, or neuropsychological test measurements in seropositive vs seronegative patients.…”

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confidence: 81%

“…At 6 months, there was no significant difference in the SF-36, 5 neuropsychological test, and BDI measurements 7 between patients who had received placebo vs antibiotic therapy. Notably, about 40% of patients in each group (i.e., placebo and antibiotic) improved in the total SF-36 summary score at 6 months, while about 30% were unchanged and 30% were worse.…”

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confidence: 84%

“…The latter typically consist of perceived memory or cognitive difficulty, irritability, sleep disturbance, depression, headache, limb or other paresthesias-all in the absence of clinical or laboratory evidence of focal or inflammatory central or peripheral nervous system involvement. [5][6][7] Thus, this entity is often included in discussions of neuroborreliosis, even though there is no evidence of CNS infection in such individuals. Although only three published studies have addressed this disorder, all have been Class I.…”

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confidence: 99%

“…Treatment response, reported in each group as a separate trial, was measured using the physical and mental healthrelated quality of life components of the Medical Outcomes Study 36-item short form general health survey (SF-36) as the primary outcome measure. 5 A second article 7 assessed whether neurocognitive changes occurred in the same population, measuring attention, memory, and executive functioning using a battery of neuropsychological tests as one set of primary outcome measures. Mood and other psychiatric symptoms were assessed using the Beck Depression Inventory (BDI) and the Minnesota Multiphasic Personality Inventory (MMPI-2) as an additional set of primary outcome measures.…”

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confidence: 99%

“…7 In contrast to individuals with PLS, patients with prior untreated or partially treated Lyme disease with late cognitive symptoms (which typically are milder than in PLS) often have abnormalities on neuropsychological testing, CSF, or imaging studies. The latter patients may well have active infection (e.g., Lyme encephalopathy), and often respond to IV ceftriaxone with resolution of symptoms.…”

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confidence: 99%

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Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology [RETIRED]

Halperin¹,

Shapiro²,

Logigian³

et al. 2007

Neurology

303

142

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Objective: To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed? Methods: The authors analyzed published studies ) using a structured review process to classify the evidence related to the questions posed. Results: The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis. Conclusions:There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (Ն8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A). NEUROLOGY 2007;69:91-102

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confidence: 81%

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confidence: 84%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology [RETIRED]

Halperin¹,

Shapiro²,

Logigian³

et al. 2007

Neurology

303

142

View full text Add to dashboard Cite

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Prevention and Treatment of Lyme Disease

Nguyen

Cifu

Pitrak

2022

JAMA

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Association of Seropositivity to Borrelia burgdorferi With the Risk of Neuropsychiatric Disorders and Functional Decline in Older Adults

et al. 2020

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IMPORTANCE Exposure to Borrelia burgdorferi (Bb) has been reported to be associated with certain neuropsychiatric disorders. OBJECTIVE To establish the association between seropositivity to Bb and incidental neuropsychiatric disorders (eg, cognitive decline, incident dementia, and depressive symptoms) as well as functional decline. DESIGN, SETTING, AND PARTICIPANTS This prospective, 6-year follow-up cohort study was conducted in a rural southwestern region of France and included 689 retired farmers 65 years or older randomly recruited from the Farmer Health Insurance System who agreed to submit a blood sample and were participants in the Aging Multidisciplinary Investigation study, an ongoing epidemiological prospective study of aging initiated in 2007. The data were analyzed from April to May 2019. EXPOSURES Borrelia burgdorferi serology testing was performed in a 2-tiered approach. During the follow-up period, cognitive decline, incident dementia, depressive symptoms, and functional decline were repeatedly assessed. MAIN OUTCOMES AND MEASURES Diagnosis of dementia relied on a 3-step procedure; cognitive decline was determined using the Mini-Mental State Examination and depressive symptomatology was assessed using the Center for Epidemiologic Studies Depression scale. For disability, scores on instrumental and basic activities of daily living were investigated. RESULTS Of 689 participants, 432 (62.2%) were men and the mean (SD) age was 75.8 (6.4) years. The seroprevalence rate of Bb was 6.5%. At baseline, compared with Bb− participants, those who were Bb+ were older, predominantly men, and had lower depressive symptoms. No association between seropositivity and any of the studied outcomes (ie, cognitive decline, depressive symptoms, or functional decline) was found in the crude analysis and after adjusting for confounding variables. Regarding incident dementia, no increased risk was found among Bb+ participants (hazard ratio, 0.42; 95% CI, 0.1-1.17; adjusted for diverse confounders). CONCLUSIONS AND RELEVANCE To our knowledge, this is one of the few longitudinal studies exploring the risk of neuropsychiatric disorders and functional decline associated with exposure to Bb. Despite its limitations (eg, a lack of information if clinical manifestations of Lyme borreliosis existed, date of exposure, or treatment received), this study suggests that seropositivity to Bb is not a risk factor for incidental neuropsychiatric disorders and functional decline.

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Cognitive function in post-treatment Lyme disease Do additional antibiotics help?

Abstract: Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.

Cited by 172 publications

References 25 publications

Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology [RETIRED]

Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology [RETIRED]

Prevention and Treatment of Lyme Disease

Association of Seropositivity to Borrelia burgdorferi With the Risk of Neuropsychiatric Disorders and Functional Decline in Older Adults

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