Cognitive function in post-treatment Lyme disease Do additional antibiotics help?
Abstract
Background : It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD).
Objective : To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD.
Methods : A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied. Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative. Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos. Assessments were made at 90 and 180 days after treatment. Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS). Memory, attention, and executive functioning were assessed using objective tests. Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory.
Results : There were no significant baseline differences between seropositive and seronegative groups. Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores. The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days. However, there were no significant differences between those receiving antibiotics and placebo.
Conclusion : Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med . 1990; 323: 1438–1444.
2.
Halperin JJ, Luft BJ, Anand AK, et al. Lyme neuroborreliosis: central nervous system manifestation. Neurology . 1989; 39: 753–759.
3.
Kaplan RF, Jones-Woodward L. Lyme encephalopathy: a neuropsychological perspective. Semin Neurol . 1997; 17: 31–37.
4.
Kaplan RF, Jones-Woodward L, Workman K, et al. Neuropsychological deficits in Lyme disease patients with and without other evidence of central nervous system pathology. Appl Neuropsychol . 1999; 6: 3–11.
5.
Krupp LB, Masur D, Schwartz J, et al. Cognitive functioning in late Lyme borreliosis. Arch Neurol . 1991; 48: 1125–1129.
6.
Ravdin LD, Hilton E, Primeau M, Clements C, Barr WB. Memory functioning in Lyme borreliosis. J Clin Psychiatry . 1996; 57: 282–286.
7.
Halperin JJ, Pass HL, Anand AK, et al. Nervous system abnormalities in Lyme disease. Ann NY Acad Sci . 1988; 539: 24–34.
8.
Logigian EL, Kaplan RF, Steere AC. Successful treatment of Lyme encephalopathy with intravenous ceftriaxone. J Infect Dis . 1999; 180: 377–383.
9.
Bujak DI, Weinstein A, Dornbush RL. Clinical and neurocognitive features of the post Lyme syndrome. J Rheumatol . 1996; 23: 1293–1397.
10.
Elkins LE, Pollina DA, Scheffer SR, Krupp LB. Psychological states and neuropsychological performances in chronic Lyme disease. Appl Neuropsychol . 1999; 6: 19–26.
11.
Adams WV, Rose CD, Eppes SC, Klein JD. Cognitive effects of Lyme disease in children. Pediatrics . 1994; 94: 185–189.
12.
Adams WV, Rose CD, Eppes SC, Klein JD. Long-term cognitive effects of Lyme disease in children. Appl Neuropsychol . 1999; 6: 39–45.
13.
Fallon BA, Nields JA, Burrascano JJ, et al. The neuropsychiatric manifestations of Lyme borreliosis. Psychiatr Q . 1992; 63: 95–117.
14.
Barr WB, Rastogi R, Ravdin L, Hilton E. Relations among indexes of memory disturbance and depression in patients with Lyme borreliosis. Appl Neuropsychol . 1999; 6: 12–18.
15.
Kaplan RF, Meadows ME, Vincent LC, Logigian EL, Steere AC. Memory impairment and depression in patients with Lyme encephalopathy: comparison with fibromyalgia and nonpsychotically depressed patients. Neurology . 1992; 42: 1263–1267.
16.
Gaudino EA, Coyle PK, Krupp LB. Post-Lyme syndrome and chronic fatigue syndrome. Arch Neurol . 1997; 54: 1372–1376.
17.
Klempner MA, Hu LT, Evans JE, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med . 2001; 345: 85–92.
18.
Stewart AL, Ware JE, eds. Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Durham and London: Duke University Press, 1992.
19.
Smith A. Symbol Digit Modalities Test Manual. Los Angeles: Western Psychological Services, 1982.
20.
Miller EN. CalCAP, California Computerized Assessment Package Manual. Los Angeles: Eric N. Miller, PhD, 1993.
21.
Spreen O, Strauss E. A Compendium of Neuropsychological Tests, 2nd ed. New York: Oxford University Press, 1998.
22.
Ivan AB. Benton Visual Retention Test Manual, 5th ed. San Antonio: The Psychological Corporation, 1992.
23.
Lezak MD. Neuropsychological Assessment, 3rd ed. New York: Oxford University Press, 1995.
24.
Benton AL, Sivan AB, Hamsher KS, Varney NR, Spreen O. Contributions to Neuropsychological Assessment, 2nd ed. New York: Oxford University Press, 1994.
25.
Beck AT, Steer RA. Beck Depression Inventory Manual. San Antonio: The Psychological Corporation, 1987.
26.
Hathaway SR, McKinley JC. MMPI-2 Minnesota Multiphasic Personality Inventory-2. Minneapolis: University of Minnesota Press, 1991.
27.
Larrabee GL, Levin HS. Memory self-ratings and objective memory test performance in a normal elderly sample. J Clin Exp Neuropsychol . 1986; 8: 275–284.
28.
Bolla KI, Lingren KN, Bonaccorsy C, Bleecker ML. Memory complaints in older adults fact or fiction? Arch Neurol . 1991; 48: 61–64.
29.
Shadick NA, Phillips CB, Logigian EL, et al. The long-term clinical outcome of Lyme disease: a population-based retrospective study. Ann Intern Med . 1994; 121: 560–567.
30.
Shadick NA, Philllips CB, Sangha O, et al. Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease. Ann Intern Med . 1999; 131: 919–926.
31.
Kalish RA, Kaplan RF, Taylor E, et al. Evaluation of study patients with Lyme disease, 10–20 year follow up. J Infect Dis . 2001; 183: 453–460.
32.
Halperin JJ, Krupp LB, Golightly MG, Volkman DJ. Lyme borreliosis-associated encephalopathy. Neurology . 1990; 40: 1340–1343.
33.
Logigian EL, Johnson KA, Kijewski MF, et al. Reversible cerebral hypoperfusion in Lyme encephalopathy. Neurology . 1997; 49: 1661–1670.
Information & Authors
Information
Published In
Copyright
© 2003.
Publication History
Received: October 2, 2002
Accepted: February 21, 2003
Published online: June 24, 2003
Published in print: June 24, 2003
Authors
Metrics & Citations
Metrics
Citation information is sourced from Crossref Cited-by service.
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Current and emerging approaches for eliminating Borrelia burgdorferi and alleviating persistent Lyme disease symptoms, Frontiers in Microbiology, 15, (2024).https://doi.org/10.3389/fmicb.2024.1459202
- Chapter 12. Infectious Diseases, Clinical Manual of Psychopharmacology in the Medically Ill, Third Edition, (525-572), (2024).https://doi.org/10.1176/appi.books.9781615375264.lg12
- Treatment of post‐treatment Lyme disease symptoms—a systematic review, European Journal of Neurology, 31, 7, (2024).https://doi.org/10.1111/ene.16293
- Besondere Aspekte der Lyme-Borreliose in den USA, Lyme-Borreliose, (113-138), (2024).https://doi.org/10.1007/978-3-031-49764-3_5
- Investigation of Possible Link Between Interferon-α and Lyme Disease, Emerging Infectious Diseases, 29, 11, (2023).https://doi.org/10.3201/eid2911.230839
- Efficacy and safety of antibiotic therapy for post-Lyme disease? A systematic review and network meta-analysis, BMC Infectious Diseases, 23, 1, (2023).https://doi.org/10.1186/s12879-023-07989-4
- Treating cognitive impairments in primary central nervous system infections: A systematic review of pharmacological interventions, Medicine, 102, 28, (e34151), (2023).https://doi.org/10.1097/MD.0000000000034151
- Lyme disease: modern approaches to treatment and prevention (based on international recommendations of 2020), Antibiotics and Chemotherapy, 66, 9-10, (57-63), (2022).https://doi.org/10.37489/0235-2990-2021-66-9-10-57-63
- The Diagnostic Challenges and Clinical and Serological Outcome in Patients Hospitalized for Suspected Lyme Neuroborreliosis, Microorganisms, 10, 7, (1392), (2022).https://doi.org/10.3390/microorganisms10071392
- Multidisciplinary Management of Suspected Lyme Borreliosis: Clinical Features of 569 Patients, and Factors Associated with Recovery at 3 and 12 Months, a Prospective Cohort Study, Microorganisms, 10, 3, (607), (2022).https://doi.org/10.3390/microorganisms10030607
- See more
Loading...
View Options
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.