Abstract
BackgroundPatients often report neurocognitive difficulties after neuroborreliosis (NB). The frequency and extent of cognitive problems in European patients have been studied incompletely.MethodsSixty patients received a neurological and neuropsychological work-up 6 months or longer after treatment for proven NB. Quality of life, psychiatric symptom load, and brain atrophy were measured. All results were compared with a group of 30 healthy control persons adapted for age, gender and education being serologically negative for Borrelia burgdorferi senso latu. A cognitive sum score and a global sum score including cognitive, psychological results and quality of life data was calculated for both groups.ResultsPatients after NB showed a lower (i.e. more impaired) score on the Scripps Neurological rating scale (SNRS), but the observed neurological deficits were generally mild (mean ± SD: 97.1 ± 4.7 vs. 99.1 ± 2.4, p = 0.02). The mean neuropsychological domain results of the NB group were all within the normal range. However, a lower performance was found for the frontal executive function z-values (mean ± SD –0.29 ± 0.60 vs. 0.09 ± 0.60; p = 0.0059) of NB patients. Comparing the global sum score (mean ± SD 11.3 ± 4.2 NB vs. 14.3 ± 2.9 control, p = 0.001) and the cognitive sum score of the NB group with those of the control group (mean ± SD -0.15 ± 0.42 NB vs. 0.08 ± 0.31 control, p = 0.0079), both differences were statistically different. The frequencies of impaired global sum scores and those of the pathological cognitive sum scores (p = 0.07) did not differ statistically. No significant differences were found for health-related quality of life (hrQoL), sleep, psychiatric symptom load, or brain atrophy.ConclusionThe mean cognitive functions of patients after proven NB were in the normal range. However, we were able to demonstrate a lower performance for the domain of frontal executive functions, for the mean cognitive sum score and the global sum score as a sign of subtle but measurable sequelae of neuroborreliosis. Brain atrophy is not a common consequence of neuroborreliosis.
Highlights
Patients often report neurocognitive difficulties after neuroborreliosis (NB)
Eligible NB patients had to show a documented typical clinical presentation of NB in combination with positive serum antibodies against Borrelia burgdorferi sensu lato and either a cerebrospinal fluid (CSF) pleocytosis with an elevated Borrelia-specific CSF-to-serum antibody index (AI) or a CSF pleocytosis accompanied by an erythema migrans (EM) at the time of presentation
Neurological examination The diagnosis and treatment of the former NB patients dated back 4.5 ± 3.7 years. When they presented with neuroborreliosis, patients were 42.9 ± 14.4 years old; 39 % complained of headaches, 10 % experienced fever, in 20 % signs of meningitis were present, 44 % showed a facial palsy, in 66 % radicular symptoms were predominant, 7 % reported cognitive alterations, and in 7 % an altered mood was observed
Summary
The frequency and extent of cognitive problems in European patients have been studied incompletely. There are only few studies on cognitive symptoms in patients who have had the European form of neuroborreliosis (NB). This gap in our knowledge gives rise to speculations about the clinical course of NB, often leading to the impression that NB inevitably results in severe neurocognitive sequelae. In a study with 20 patients with previously diagnosed NB, Benke et al [2] found significantly poorer verbal learning and memory functions paired with problems concerning the executive functions as residual symptoms after NB. Our study aims to elucidate the extent and frequency of brain atrophy caused by NB as reported by Tarasow et al in 60 % of their patients [5]
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