Neuropsychological Outcomes of Post-treatment Lyme Disease

Objective(s): Post-treatment Lyme Disease (PTLD) is characterized by persistent symptoms of fatigue, pain, and/or cognitive disturbance despite timely and appropriate antibiotic treatment. This systematic review will examine neuropsychological outcomes associated with PTLD.

Data Sources: Online databases include PubMed and PsychInfo.

Study Selection: Peer-reviewed, case-controlled journal articles with populations including physician diagnosed Lyme Disease. Keywords include ‘chronic Lyme,’ ‘Lyme encephalopathy,’ and ‘post-treatment Lyme Disease;’ additional keywords include ‘cognition’ and ‘neuropsychology.’ Studies selected via consensus method resulting in 17 studies selected.

Data Extraction: Independent data extraction was conducted by two authors. Inclusion criteria was physician diagnosed Lyme disease/classification of PTLD, antibiotic treatment, chronic Lyme disease, or Lyme encephalopathy per patient report of persistent post-Lyme symptoms with cognitive complaints. Included studies used standardized neuropsychological assessment. Extracted data included comparison of neuropsychological test performance among PTLD patients, healthy controls, and/or other patient populations, and neuropsychological test correlates of depression, fatigue, and associated neuroradiological findings.

Data Synthesis: Approximately 10-20% of patients treated for Lyme Disease develop PTLD. Review of neuropsychological literature suggests mild cognitive decrements primarily with verbal fluency, verbal memory, and processing speed. Case-control studies show slightly higher depressive symptoms among PTLD patients compared to healthy controls, with depressive symptoms not linked conclusively to neuropsychological outcomes. Clear biomarkers of PTLD and cognitive decline are unknown but neuroradiological findings are suggestive of circulating inflammatory markers.

Conclusions: Though a large majority of PTLD patients present with cognitive complaints, review of neuropsychological studies finds mild deficits in select areas of cognitive functioning that are not associated with mood and only variably with fatigue. There is no clear etiology to PTLD symptom reporting or neuropsychological findings, though more recent functional neuroradiological studies suggest underlying inflammation. While there is no evidence-based medical treatment beyond initial antibiotic treatment for PTLD, persistent symptoms may be better managed through a comprehensive rehabilitation approach.

Author(s) Disclosures: None.