After 37 years treating Lyme disease, I’ve seen older adults whose symptoms were dismissed as aging when infection was the cause. A woman in her late 60s was getting weaker. Her joints ached. Her memory was slipping. Her balance felt off. She woke up exhausted, sometimes with her heart racing. She was told it was aging. Then anxiety. Then nothing more could be done. But when we looked closer, the story pointed to Lyme disease.

Lyme Is Still Being Missed

I’ve seen this story play out too often: an older adult with multisystem symptoms is misdiagnosed or dismissed. Instead of infection, they’re told it’s aging, depression, menopause, or stress. But when Lyme disease is missed—especially in older adults—the results can be devastating.

Fortunately, published case reports show that recognition and treatment can dramatically change outcomes.

Neurologic Lyme That Looked Like Dementia or Stroke

Case 1: Reversible Dementia in a 75-Year-Old Man

A man was admitted to an Alzheimer’s unit with hallucinations, confusion, aggression, incontinence, and insomnia. Imaging was unremarkable, but Lyme serology was positive. After a 21-day IV ceftriaxone course, many symptoms reversed.

Takeaway: Lyme neuroborreliosis can mimic dementia but may be treatable if caught in time.

Case 2: Stroke in an 83-Year-Old Man

An 83-year-old presented with sudden weakness and speech loss. No vascular risk factors were found, but blood and CSF were positive for Borrelia. Treated with IV antibiotics, he stabilized.

Takeaway: Lyme should be considered in elderly stroke patients with no clear cause.

Case 3: Recurrent Strokes From Cerebral Vasculitis

A 58-year-old man had repeated strokes in the same brain region over a year. Serology confirmed Lyme. After doxycycline, strokes stopped.

Takeaway: Lyme-induced vasculitis is rare but serious—and treatable with antibiotics.

Case 4: Neuroborreliosis Without Rash in an 84-Year-Old

An elderly man developed confusion and headaches—without a rash. Lyme testing was positive. With early antibiotics, he fully recovered.

Takeaway: In older adults, neuroborreliosis may be the first or only symptom of Lyme.

Clinical Takeaway

After 37 years treating Lyme disease, I’ve learned that some of my sickest Lyme patients didn’t fit the mold—they were older adults whose symptoms were dismissed as “just aging.” These published cases demonstrate critical patterns: presentations were atypical without erythema migrans or recalled tick bite, symptoms were attributed to aging or dementia rather than infection, yet antibiotic treatment produced dramatic improvement—even reversing presumed irreversible conditions like dementia and complete heart block. Age should not be a barrier to considering Lyme disease.

Frequently Asked Questions

Can older adults get Lyme disease?
Yes. Lyme disease affects all age groups, but older adults face particular risk because symptoms are often dismissed as aging.

Why is Lyme disease in older adults often missed?
Symptoms like fatigue, joint pain, and memory problems are attributed to aging rather than infection, and classic features like rash may be absent.

Can Lyme disease cause dementia-like symptoms?
Yes. A 75-year-old admitted to Alzheimer’s unit with hallucinations and confusion improved dramatically after IV ceftriaxone treatment.

Can Lyme disease cause stroke in elderly patients?
Yes. Lyme-induced cerebral vasculitis can cause stroke, particularly in patients without typical vascular risk factors.

Is it too late to treat Lyme disease in older adults?
Not necessarily. Case reports show even late-stage complications—dementia-like symptoms, heart block, seizures—can improve or resolve with antibiotics.

Related Reading

Lyme Disease Misdiagnosis: Why It Happens and What Patients Need to Know
Lyme Disease and Dementia: When Brain Fog Isn’t Alzheimer’s
Can You Have Neurologic Lyme Disease Even If Your Spinal Tap Is Normal?
Lyme Carditis: When Infection Affects the Heart
Brain Fog Lyme Disease: When Thinking Becomes Exhausting

References

1. Ann Geriatr Med Res. 2023 Feb 6;27(1):80–82. Sanchini C, Papia C, Cutaia C, Poloni TE, Cesari M. A case of reversible dementia? Dementia vs delirium in Lyme disease. doi:10.4235/agmr.22.0128. PMID: 36740841; PMCID: PMC10073979.
2. Case Rep Neurol Med. 2018 Apr 1;2018:1720725. Moreno Legast G, Schnider A, Nicastro N. Ischemic stroke: do not forget Lyme neuroborreliosis. doi:10.1155/2018/1720725. PMID: 29805824; PMCID: PMC5899873
3. Riescher, S., Dos Santos, A., Lecomte, R. et al. A case report of unilateral cerebral vasculitis in adults: keep in mind Lyme neuroborreliosis. BMC Infect Dis 23, 283 (2023). https://doi.org/10.1186/s12879-023-08259-z
4. Eur J Case Rep Intern Med. 2025 Jan 17;12(2):005034. Mata E, Lage Garcia B, Pereira A, Rego J, Santos F, Fernandes C, Cotter J. Lyme neuroborreliosis as initial expression of Lyme disease in an elderly patient. doi:10.12890/2025_005034. PMID: 39926582; PMCID: PMC11801497.