Can Lyme disease cause cognitive dysfunction or dementia?

The question of whether Lyme disease could cause dementia was addressed by Wormser and colleagues in an article entitled “Lack of Convincing Evidence That Borrelia burgdorferi Infection Causes Either Alzheimer Disease or Lewy Body Dementia,” published in the journal Clinical Infectious Diseases.¹

The authors reviewed a paper by Gadila et al.² which concluded that a Lyme disease infection might cause Lewy body dementia. The case described a 69-year-old woman who died 15 years after her initial infection with Lyme disease with a clinical diagnosis of Lewy body dementia.

The woman had initially presented with an erythema migrans rash, headache, joint pain, and fever. Her symptoms resolved with 10 days of doxycycline.

Click below to watch a video discussing a case report on Lyme disease and dementia.

Over time, she developed a sleep behavior disorder, cognitive problems (processing speed, mental tracking, and word-finding), photophobia, paresthesias, fasciculations, and myoclonic jerks. She initially improved with IV followed by oral antibiotics. But her condition later worsened.

“The extensive workup at that time led to the diagnoses of both a REM behavioral disorder with verbalizations and movements and a neurodegenerative dementia characterized by expressive aphasia, visual agnosia, anomia, deficits in executive function and calculation, and mild memory problems.”

She passed away 15 years after the onset of her illness.²

An autopsy revealed the presence of Borrelia burgdorferi in the brain and spinal cord tissue of the patient.

The authors point out, “These results, however do not clarify whether the Borrelia infection had anything to do with her progressive neurodegenerative disorder.”

“Lewy body dementia is characterized by fluctuations in cognitive function, sometimes also with fluctuations in alertness and attention,” wrote Wormser et al.

The authors also added, “Patients with Lewy body dementia are easily distracted and can appear to be ‘zoning out’ at times. Impaired job performance is a common early sign, and patients with Lewy body dementia have problems with multitasking. Sleep disorders are common.”¹

No precise test can accurately diagnose Lewy Body Dementia (LBD). “Due to the incomplete specificity in the clinical diagnosis and the pathological definition of the disease, a postmortem biopsy or autopsy is the only method to secure a definite diagnosis,” explains Haider et al.³

Can Lyme disease cause dementia?

In their article, Wormser et. al conclude, “no convincing evidence exists that Lyme disease is a cause of either Alzheimer disease or Lewy body dementia.”

The authors expressed concern over the validity of laboratory testing, as it did not meet the CDC criteria and the temporary effectiveness of the antibiotic treatment prescribed. They also had reservations regarding the use of a nested PCR technique and the immunofluorescence antibody test.

“Cognitive complaints, such as concentration or memory disturbances, are common in patients with Lyme disease and in patients with residual subjective symptoms after treatment for Lyme disease,” Wormser et al. suggest.

“Dementia-like syndromes from Lyme disease occur as a consequence of the very rare late neurologic manifestation of Lyme disease referred to as chronic progressing meningoencephalomyelitis (also referred to as chronic encephalomyelitis).”

“Anecdotal evidence, however, does suggest that Lyme disease may rarely cause dementia.”¹

These dementia-like Lyme cases are primarily in Europe. “Thus, the few reported cases of dementia-like syndromes from Lyme disease are clinically very different from the Lewy body dementia case attributed to Lyme disease by Gadila and colleagues.”

The following questions are addressed in this Podcast episode:

1. What is Lewy body dementia?
2. How is Lewy body dementia diagnosed?
3. What findings in this patient suggested Lewy body dementia?
4. What cognitive problems have been described in Lyme disease?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.