Can Lyme Disease Present as Dementia?
Lyme neuroborreliosis can rarely present as dementia
Rapid cognitive decline may be reversible
Early recognition and antibiotic treatment matter
Can Lyme disease cause dementia? Although Lyme disease is not considered a cause of neurodegenerative disorders such as Alzheimer’s disease, Lyme neuroborreliosis can rarely present as a reversible dementia-like syndrome. Recognizing this uncommon presentation is important because appropriate antibiotic treatment may lead to substantial improvement in cognitive function.
In a retrospective study entitled Secondary dementia due to Lyme neuroborreliosis, Kristoferitsch and colleagues describe several patients with dementia-like syndromes associated with Lyme neuroborreliosis that improved following antibiotic treatment.2
Rapid improvement with antibiotic treatment
A 76-year-old woman developed progressive cognitive decline, weight loss, nausea, gait disturbance, and tremor over a 12-month period before being referred for neurologic evaluation.
Three months earlier, she had been diagnosed with tension headaches and depression, but treatment did not improve her symptoms.
MRI revealed bilateral white matter lesions and an old lacunar infarct in the left striatum. Neurocognitive testing demonstrated “a severe decline of attention, memory and executive functions corresponding to subcortical dementia,” the authors reported.
Further cerebrospinal fluid (CSF) testing established the diagnosis of Lyme neuroborreliosis by demonstrating intrathecal Borrelia burgdorferi-specific antibody production.
After a 3-week course of intravenous ceftriaxone, the patient “recovered rapidly,” the authors wrote.
At telephone follow-up six years later, at age 82, she reported no cognitive impairment or gait problems and had recently returned from a trip to Cuba.
Woman admitted with rapidly progressive dementia
A 71-year-old woman was admitted to a psychiatric hospital because of rapidly progressive dementia accompanied by brief episodes of altered consciousness. Six months earlier, she had experienced only mild forgetfulness.
MRI findings showing slight mesiotemporal atrophy and neurocognitive testing initially supported a diagnosis of primary dementia.
[bctt tweet=”Dementia-like syndromes can occur as the result of Lyme neuroborreliosis.” username=”DrDanielCameron”]
Later, the patient’s daughter recalled a previous tick bite followed by a widespread rash.
Lyme neuroborreliosis was subsequently confirmed through CSF testing.
Following a 2-week course of ceftriaxone, her cognition improved substantially.
At her 5-year follow-up, memory testing was above average for women of her age, strongly arguing against an underlying neurodegenerative dementia.
READ MORE: 80-year-old man with Lyme encephalopathy instead of dementia
Newer reports of reversible dementia-like symptoms
More recent reports continue to describe dementia-like presentations in patients with suspected or confirmed Lyme neuroborreliosis. In one 2023 case report, Sanchini and colleagues described a 75-year-old man admitted to an Alzheimer’s disease care unit because of hallucinations, confusion, aggressive behavior, and cognitive impairment that had not responded to antipsychotic therapy.3
The patient had positive Lyme serology confirmed by Western blot, along with arthritis and a history of possible tick exposure. Although CSF testing was not performed, the authors reported marked clinical improvement after antimicrobial treatment, including improvement in orientation, behavior, insomnia, urinary incontinence, and neuropsychological scores.
A 2024 review also emphasized that dementia-like syndromes are an infrequent manifestation of Lyme neuroborreliosis and that careful differentiation from primary neurodegenerative disease may require clinical history, laboratory studies, CSF evaluation, MRI, and, in selected cases, PET imaging.4
Lyme neuroborreliosis versus Alzheimer’s disease
Lyme neuroborreliosis differs from Alzheimer’s disease in several important ways. Patients with Lyme neuroborreliosis often experience a more rapid onset of cognitive decline and may also develop gait disturbance, headache, nausea, weight loss, tremor, or other systemic symptoms. Unlike Alzheimer’s disease, cognitive symptoms may improve substantially after appropriate antibiotic treatment when Lyme neuroborreliosis is identified promptly.
This distinction is important because a dementia-like syndrome associated with Lyme neuroborreliosis may be treatable, while Alzheimer’s disease and other primary neurodegenerative dementias typically follow a progressive course.
How Lyme neuroborreliosis differs from primary dementia
After reviewing published cases, Kristoferitsch and colleagues identified several clinical features that may distinguish Lyme neuroborreliosis from primary neurodegenerative dementias.
Although no single finding is diagnostic, several clinical features may raise suspicion for Lyme neuroborreliosis rather than a primary neurodegenerative dementia.
- Many patients or family members did not recall a tick bite, erythema migrans rash, or earlier Lyme disease symptoms. However, untreated erythema migrans or other manifestations occurring 1 to 2 years before cognitive decline may provide an important clue.
- Unlike Alzheimer’s disease and most other neurodegenerative dementias, Lyme neuroborreliosis often progresses rapidly.
- Marked weight loss may occur. The authors note that weight loss can reach 20 kg per year in chronic Lyme neuroborreliosis, substantially greater than is typically observed in Alzheimer’s disease.
- Headache, nausea, malaise, and vomiting are unusual in degenerative dementias but may accompany secondary dementia caused by Lyme neuroborreliosis.
- Early gait disturbance, which occurred in every patient in this series, is atypical for Alzheimer’s disease and should prompt consideration of alternative diagnoses.
Importantly, the authors observed that most patients began improving within days after starting antibiotic therapy.
Can Lyme disease cause dementia?
Lyme disease does not cause Alzheimer’s disease or other primary neurodegenerative dementias. However, Lyme neuroborreliosis can rarely present as a reversible dementia-like syndrome. Although uncommon, recognizing this presentation is clinically important because timely antibiotic treatment may prevent permanent neurologic complications and, in some patients, lead to substantial recovery.
Frequently Asked Questions
Can Lyme disease present as dementia?
Yes. Although uncommon, Lyme neuroborreliosis can present with rapidly progressive cognitive decline that resembles dementia. Published case reports describe patients whose cognitive function improved after antibiotic treatment.
Can Lyme disease cause a reversible dementia-like syndrome?
Rather than causing Alzheimer’s disease, Lyme neuroborreliosis may produce a reversible dementia-like syndrome in rare cases. Early diagnosis and treatment offer the greatest chance for recovery.
How can Lyme-related dementia differ from Alzheimer’s disease?
Lyme neuroborreliosis may progress more rapidly and can be accompanied by gait disturbance, headache, nausea, malaise, vomiting, tremor, and marked weight loss—features that are less typical of Alzheimer’s disease.
Should Lyme disease be considered in someone with rapidly progressive dementia?
In patients with possible tick exposure, compatible neurologic symptoms, or an atypical clinical presentation, Lyme neuroborreliosis may be included in the differential diagnosis because it represents a potentially treatable cause of cognitive decline.
Clinical Takeaway
Lyme neuroborreliosis is an uncommon but potentially reversible cause of a dementia-like syndrome. Rapid cognitive decline accompanied by gait disturbance, headache, nausea, weight loss, tremor, or other atypical neurologic features should prompt consideration of Lyme neuroborreliosis among the differential diagnoses, particularly in patients with possible tick exposure.
Recognizing this rare presentation early may allow antibiotic treatment before permanent neurologic injury develops.
Related Articles
Learn more about neurologic manifestations of Lyme disease and other potentially reversible causes of cognitive impairment.
80-year-old man with Lyme encephalopathy instead of dementia
Reversible causes of dementia and normal pressure hydrocephalus
POTS patients with brain fog have neurocognitive deficits
Tick-borne encephalitis can lead to chronic illness
References
- Blanc F, Philippi N, Cretin B, et al. Lyme neuroborreliosis and dementia. J Alzheimers Dis. 2014;41(4):1087-1093.
- Kristoferitsch W, Aboulenein-Djamshidian F, Jecel J, et al. Secondary dementia due to Lyme neuroborreliosis. Wien Klin Wochenschr. 2018;130(15-16):468-478.
- Sanchini C, Papia C, Cutaia C, Poloni TE, Cesari M. A case of reversible dementia? Dementia vs delirium in Lyme disease. Ann Geriatr Med Res. 2023;27(1):80-82.
- Bashchobanov DH, Stamatova E, Andonova R, Dragusheva E, Gadzhovska V, Popov G. Lyme neuroborreliosis in the context of dementia syndromes. Cureus. 2024;16(8):e67057.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I am 68 and have recently been diagnosed with Black Mold, CAEBV and now Lyme. Triple hitter! I have struggled for the last 30+ years, off and on, with extreme fatigue and body/joint – aches/pain, low grade fever AND brain fog for many years. Always feeling like I am going to get very sick with the flu and then it passes. Looking back I can almost relate the flares to extra stressful times in my life. The brain issues have been getting worse and so now this last diagnosis of Lyme shines a new light. I remember having a blood filled tick on my leg back in my very early teens. Could I have had this in my system all these years and not have known until now? I am praying that treatment will give me back my life and short term memory. The word-loss is the most frustrating part of all of this. I am a walker, I eat organic as much as possible and I am not on any meds accept Armor Thyroid. This article has given me new hope! We will be starting treatment on the Lyme, once we go through the series of anti-fungal for the mold toxins. I am so thankful for the insight!
I had Neurological Lyme in 2013, PICC line, antibiotics, felt great back to my normal self. Fast forward 2024 I’m diagnosed with PPAOS/FTLD. There is definitely a connection. My speech is back to how it was when I got diagnosed and a new list of cognitive issues. No I don’t have Lyme anymore, I was just left with the damage it had done and I’m only 51.
PPAOS/FTLD combines a speech-specific language disorder, Primary Progressive Apraxia of Speech (PPAOS), with the neurodegenerative condition Frontotemporal Lobar Degeneration (FTLD). It causes difficulty planning and sequencing speech movements, resulting in slow or unclear speech. It might have been better if it were Lyme as that is treatable.