Lyme neuroborreliosis and dementia.
Level 4 - case-series / case-control
Prospective case series without an uninfected control group
PubMed 24762944 · doi:10.3233/JAD-130446
What was done
Among 1,594 patients evaluated for dementia, researchers prospectively identified and studied 20 patients (1.25%) with dementia and a positive intrathecal anti-Borrelia antibody index. Patients underwent neuropsychological testing, brain MRI, FDG-PET, and cerebrospinal fluid analysis including tau, p-tau, and Aβ42. Etiological diagnoses were determined over a follow-up period of 5.0 ± 2.9 years after antibiotic treatment.
What was found
Two distinct patient groups were observed after antibiotic therapy. The first group (n = 7, 0.44%) had certain neuroborreliosis, showed stability or mild improvement of dementia after antibiotics, and had normal CSF tau, p-tau, and Aβ42. The second group (n = 13, 0.81%) showed progressive worsening of dementia despite antibiotics, with final diagnoses of Alzheimer's disease (n = 4), Alzheimer's disease plus Lewy body disease (n = 3), Lewy body disease (n = 1), frontotemporal lobar degeneration (n = 3), hippocampal sclerosis (n = 1), and vascular dementia (n = 1), alongside coherent abnormal CSF markers. Baseline cognitive tests showed no difference between groups. Brain MRI showed more focal atrophy and FDG-PET showed more frontal hypometabolism in the worsening group.
Why it matters
Pure Lyme dementia is a treatable condition that can stabilize or improve after antibiotics, whereas positive Borrelia antibodies may also coincide with progressive, irreversible neurodegenerative diseases.
Limits
The study is limited by a small sample size (n = 20), an uncontrolled observational design, and lack of a comparison cohort. The abstract reports no baseline or follow-up numerical cognitive test scores, test score differences, or confidence intervals.
Cited by
- supports Advanced and severe Lyme disease can present with dementia-like symptoms and neurological manifestations resembling cerebral palsy.