Cognitive impairments in patients with persistent symptoms attributed to Lyme disease

Abstract

Background Persistent symptoms attributed to Lyme borreliosis often include self-reported cognitive impairment. However, it remains unclear whether these symptoms can be substantiated by objective cognitive testing. Methods For this observational study, cognitive performance was assessed in 280 adults with persistent symptoms attributed to Lyme borreliosis (as part of baseline data collected for the Dutch PLEASE study). Cognitive testing covered the five major domains: episodic memory, working memory / attention, verbal fluency, information-processing speed and executive function. Patients’ profiles of test scores were compared to a large age-, education- and sex-adjusted normative sample using multivariate normative comparison. Performance validity was assessed to detect suboptimal effort, and questionnaires were administered to measure self-reported cognitive complaints, fatigue, anxiety, depressive symptoms and several other psychological factors. Results Of 280 patients, one was excluded as the test battery could not be completed. Of the remaining 279 patients, 239 (85.4%) displayed sufficient performance validity. Patients with insufficient performance validity felt significantly more helpless and physically fatigued, and less orientated. Furthermore, they had a lower education level and less often paid work. Of the total study cohort 5.7% (n = 16) performed in the impaired range. Among the 239 patients who displayed sufficient performance validity, 2.9% (n = 7) were classified as cognitively impaired. No association between subjective cognitive symptoms and objective impairment was found. Conclusions Only a small percentage of patients with borreliosis-attributed persistent symptoms have objective cognitive impairment. Performance validity should be taken into account in neuropsychological examinations of these patients. Self-report questionnaires are insufficiently valid to diagnose cognitive impairment. Trial registration ClinicalTrials.gov NCT01207739. Registered 23 September 2010.

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

“…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.…”

“…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.…”

“…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 ].…”

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

“…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.…”

Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis

“…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.…”