Lyme Encephalopathy Mistaken for Dementia in 80-Year-Old Man
Confusion and memory loss suggested dementia
Testing revealed Lyme neuroborreliosis instead
Symptoms improved after ceftriaxone treatment
An 80-year-old man was initially believed to have dementia and possible early Alzheimer’s disease. However, further testing revealed Lyme neuroborreliosis, and his confusion improved following treatment with ceftriaxone.
Acute confusion initially attributed to dementia
“While mostly vigilant and awake, he intermittently lacked full orientation, had reduced attention, concentration, short-term memory function, increased motor activity, mild formal thought disorder (including some tangential thinking), but no frank psychotic symptoms,” the authors explain.1
The man was diagnosed with delirium, potentially related to dementia. An abnormal F18-FDG-PET scan was interpreted as being consistent with early Alzheimer’s disease, and memantine was prescribed.
However, the patient remained confused despite receiving the antipsychotic medications risperidone and pipamperone for sleep disturbances.
“The patient lacked orientation, had recurrent pervasive disturbances of sleep-wake-cycles, was intermittently restless, and also incontinent,” states Karrasch.
This case illustrates how neurologic Lyme disease may resemble dementia, delirium, or other neurologic disorders in older adults.
Evidence supporting neuroborreliosis
The patient’s spinal tap revealed elevated protein levels, lymphocytic pleocytosis of 260 leukocytes/μl, intrathecal IgM synthesis, and elevated lactate.
“The lymphocytic pleocytosis with signs of activation together with the dominance of intrathecal IgM-synthesis raised the differential diagnosis of neuroborreliosis,” writes Karrasch.
The CSF abnormalities—including marked lymphocytic pleocytosis and intrathecal antibody production—supported a diagnosis of Lyme neuroborreliosis rather than an isolated progressive dementia.
CXCL13 may aid diagnosis
The patient also had elevated levels of the chemokine CXCL13.
Although CXCL13 has not been validated as a stand-alone routine diagnostic test, Karrasch explains that cerebrospinal fluid (CSF) CXCL13 may improve diagnostic sensitivity when interpreted alongside lymphocytic pleocytosis and other findings supporting neuroborreliosis.
The biomarker continues to be investigated as a potential tool in the evaluation of central nervous system manifestations of Lyme borreliosis.
Symptoms improved after treatment
The patient was treated with a 21-day course of ceftriaxone.
Following treatment, his confusion and delirious symptoms resolved.
The man was “dismissed from the hospital in a clearly improved clinical status,” writes Karrasch, “despite an additional complication of aspiration pneumonia.”
The patient’s improvement after treatment provided further support that his neurologic symptoms were related to Lyme neuroborreliosis rather than solely to a progressive neurodegenerative condition.
The authors point out that their case report demonstrates that acute confusion or encephalopathy can be a presenting feature of neuroborreliosis. They also suggest that CXCL13 may be a useful supportive biomarker in central nervous system manifestations of Lyme borreliosis.
This case illustrates why potentially treatable infectious and inflammatory causes should be considered when an older adult develops acute or fluctuating confusion, particularly when the clinical course is atypical for progressive dementia.
Frequently Asked Questions
What is Lyme encephalopathy?
Lyme encephalopathy refers to cognitive and neurologic symptoms associated with Lyme disease, including confusion, memory impairment, difficulty concentrating, and altered mental status.
Can Lyme disease cause confusion?
Yes. Lyme disease can affect the nervous system and may lead to confusion, delirium, cognitive impairment, and other neurologic symptoms in some patients.
Can Lyme disease cause dementia?
Lyme neuroborreliosis can rarely produce cognitive and behavioral symptoms that resemble dementia. This does not mean that Lyme disease commonly causes Alzheimer’s disease or other degenerative dementias.
Are dementia-like symptoms from Lyme disease reversible?
Some patients with cognitive symptoms caused by Lyme neuroborreliosis improve substantially after antibiotic treatment. Recovery varies according to the manifestation, severity and duration of illness, and other medical conditions.
Clinical Takeaway
This case highlights how Lyme encephalopathy can resemble dementia or Alzheimer’s disease in older adults.
Recognition of neuroborreliosis allowed treatment with ceftriaxone and substantial clinical improvement, underscoring the importance of considering potentially reversible causes of acute or fluctuating cognitive decline.
Related Articles
Lyme disease complications include Lyme encephalopathy
Can Lyme disease cause dementia?
Neurologic Lyme disease symptoms and complications
References
- Karrasch M, Fingerle V, Boden K, Darr A, Baier M, Straube E, Nenadic I. Neuroborreliosis and acute encephalopathy: The use of CXCL13 as a biomarker in CNS manifestations of Lyme borreliosis. Ticks Tick Borne Dis. 2018;9(2):415-417.
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 age 61 and I have battled neuroborreliosis. My mother is age 87 and has been diagnosed with severe anxiety and dementia. It angers me that nobody even thinks to search for… nor test and treat neuroborreliosis.
I have suspected this for years. .also M.S….bites from ticks, mites, spiders and scratches from infected animals.
Can anyone help or point me in the right direction?
I’ve been suffering with additional neurological issues in the last few years (on top of the delightful array of Lyme symptoms I’ve had for 23 years in total). I’m tyring to work out whether this particular set of new symptoms tie in with my starting the anti biotics 2.5 years ago but can’t recall.
In essence my short term memory is dire. I can never remember anything earlier in the day or in previous days. It all just feels like a blank brick wall of nothing. I sometimes spend an hour just thinking did I bath before bed last night and there’s no info there at all. I have additional confusion around word finding and get confused very easily. My long term memory by contrast is still great. I’m seeing a Neurologist on Thursday on the NHS to look into the memory loss and inc to cognitive symptoms and weird dementia like symptoms (even though I’m sure they are more likely Lyme related).
Do I mention I have Lyme and is there any specific scan I should ask for? Or anything 8 can take in terms of info as I’m assuming that as the NHS don’t recognise Lyme this won’t be a consideration. I’ve seen numerous links between dementia like symptoms and misdiagnosis and don’t want to get the wrong diagnosis treatment.