Can Lyme Disease Cause Cognitive Dysfunction or Dementia?

Lyme disease cognitive dysfunction is a common concern among patients with neurologic symptoms. But can Lyme disease actually cause dementia? Wormser and colleagues addressed this question in their article “Lack of Convincing Evidence That Borrelia burgdorferi Infection Causes Either Alzheimer Disease or Lewy Body Dementia,” published in Clinical Infectious Diseases.¹

The authors reviewed a report by Gadila and colleagues² describing a 69-year-old woman who died 15 years after her initial Lyme disease infection with a clinical diagnosis of Lewy body dementia.

At the time of her original Lyme disease illness, the woman had presented with an erythema migrans rash, headache, joint pain, and fever. Her symptoms resolved after 10 days of doxycycline.

Click below to watch a video discussing a case report on Lyme disease and dementia.

Watch the video on Lyme disease and dementia

Over time, she developed sleep behavior disorder, cognitive problems involving processing speed, mental tracking, and word-finding, along with photophobia, paresthesias, fasciculations, and myoclonic jerks. She initially improved with intravenous followed by oral antibiotics, but her condition later worsened.

“The extensive workup at that time led to the diagnoses of both a REM behavioral disorder with verbalizations and movements and a neurodegenerative dementia characterized by expressive aphasia, visual agnosia, anomia, deficits in executive function and calculation, and mild memory problems.”

She died 15 years after the onset of her illness.²

Autopsy Findings and Their Limits

An autopsy revealed the presence of Borrelia burgdorferi in the brain and spinal cord tissue of the patient.

However, Wormser and colleagues emphasized that these findings do not clarify whether the Borrelia infection caused the patient’s progressive neurodegenerative disorder.

They noted that Lewy body dementia is characterized by fluctuations in cognitive function, along with changes in alertness and attention. Patients may appear distracted or “zone out,” and early symptoms often include impaired job performance, difficulty multitasking, and sleep disorders.¹

No precise test can definitively diagnose Lewy body dementia during life. As Haider and colleagues explain, a postmortem examination remains the only way to establish a definite diagnosis.³

Can Lyme Disease Cause Dementia?

Wormser and colleagues concluded that there is no convincing evidence that Lyme disease causes either Alzheimer disease or Lewy body dementia.

The authors also raised concerns about the testing used in the published case, including methods that did not meet CDC criteria and the interpretation of temporary improvement with antibiotic therapy. They questioned the validity of the nested PCR and immunofluorescence antibody testing used in the report.

Still, they acknowledged that cognitive complaints are common in patients with Lyme disease and in some individuals with persistent symptoms after treatment.

“Cognitive complaints, such as concentration or memory disturbances, are common in patients with Lyme disease and in patients with residual subjective symptoms after treatment for Lyme disease,” Wormser and colleagues wrote.

Rare Dementia-Like Syndromes in Lyme Disease

The authors noted that dementia-like syndromes related to Lyme disease can rarely occur as part of the very uncommon late neurologic manifestation known as chronic progressive meningoencephalomyelitis.

“Anecdotal evidence, however, does suggest that Lyme disease may rarely cause dementia.”¹

These rare Lyme disease dementia-like cases have been reported primarily in Europe. Importantly, they are clinically very different from the Lewy body dementia case described by Gadila and colleagues.

Questions Addressed in This Podcast Episode

1. What is Lewy body dementia?
2. How is Lewy body dementia diagnosed?
3. What findings in this patient suggested Lewy body dementia?
4. What cognitive problems have been described in Lyme disease?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

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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