Lyme neuroborreliosis and dementia.
BACKGROUND
Descriptions of Lyme disease and dementia are rare.


OBJECTIVE
To describe patients with dementia and a positive "intrathecal anti-Borrelia antibody index" (AI), specific for neuroborreliosis.


METHODS
Among 1,594 patients seen for dementia, we prospectively identified and studied 20 patients (1.25%) with dementia and a positive AI. Patients underwent a battery of neuropsychological tests brain, MRI, FDG-PET, and cerebrospinal fluid (CSF) analysis. An etiological diagnosis of the dementia was made at the end of the follow-up of 5.0 ± 2.9 years.


RESULTS
We found two groups of patients with dementia, the first (n = 7, 0.44%) with certain neuroborreliosis and stability or mild improvement of dementia after treatment by antibiotics and the second (n = 13, 0.81%) with progressive worsening of dementia, despite the antibiotics. In the second group, the final diagnoses were Alzheimer's disease (AD) (n = 4), AD and Lewy body disease (LBD) (n = 3), LBD (n = 1), FTLD (n = 3), hippocampal sclerosis (n = 1), and vascular dementia (n = 1). We did not observe any differences in cognitive test between the two patient groups at baseline. Brain MRI showed more focal atrophy and FDG-PET showed more frontal hypometabolism in the second group. Tau, p-tau, and Aβ42 concentrations in the CSF were normal in the neuroborreliosis group, and coherent with diagnosis in the second.


CONCLUSIONS
Pure Lyme dementia exists and has a good outcome after antibiotics. It is advisable to do Lyme serology in demented patients, and if serology is positive, to do CSF analysis with AI. Neurodegenerative dementia associated with positive AI also exists, which may have been revealed by the involvement of Borrelia in the CNS.
University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France University of Strasbourg and CNRS, ICube Laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg) Strasbourg, France University Hospital of Strasbourg, CMRR (Memory Resource and Research Center), Strasbourg, France.
Frederic
F
Blanc
University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France University of Strasbourg and CNRS, ICube Laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg) Strasbourg, France University Hospital of Strasbourg, CMRR (Memory Resource and Research Center), Strasbourg, France.
Nathalie
N
Philippi
University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France University of Strasbourg and CNRS, ICube Laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg) Strasbourg, France University Hospital of Strasbourg, CMRR (Memory Resource and Research Center), Strasbourg, France.
Benjamin
B
Cretin
University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France University Hospital of Strasbourg, CMRR (Memory Resource and Research Center), Strasbourg, France.
Catherine
C
Kleitz
University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France University Hospital of Strasbourg, CMRR (Memory Resource and Research Center), Strasbourg, France.
Laetitia
L
Berly
University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France University of Strasbourg and CNRS, ICube Laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg) Strasbourg, France University Hospital of Strasbourg, CMRR (Memory Resource and Research Center), Strasbourg, France.
Barbara
B
Jung
University of Strasbourg and CNRS, ICube Laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg) Strasbourg, France University Hospital of Strasbourg, Neuroradiology Service, Strasbourg, France.
Stephane
S
Kremer
University of Strasbourg and CNRS, ICube Laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg) Strasbourg, France University Hospital of Strasbourg, Nuclear Medicine Service, Strasbourg, France.
Izzie Jacques
IJ
Namer
University Hospital of Strasbourg, CMRR (Memory Resource and Research Center), Strasbourg, France General Hospital of Colmar, Neurology Service, Colmar, France.
François
F
Sellal
University Hospital of Strasbourg, Laboratory of Bacteriology and National Center for Borrelia, Strasbourg, France.
Benoit
B
Jaulhac
University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France INSERM U119, Strasbourg, France.
Jerome
J
de Seze
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology*; D003704:Dementia / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography
D000900:Anti-Bacterial Agents; D019788:Fluorodeoxyglucose F18
Alzheimer's disease; Lewy body dementia; Lewy body disease; Lyme disease; Lyme neuroborreliosis; dementia; frontotemporal lobe dementia; hippocampal sclerosis; intrathecal anti-Borrelia antibody index; vascular dementia