Neurocognitive functions and brain atrophy after proven neuroborreliosis: a case-control study.
BACKGROUND
Patients often report neurocognitive difficulties after neuroborreliosis (NB). The frequency and extent of cognitive problems in European patients have been studied incompletely.


METHODS
Sixty patients received a neurological and neuropsychological work-up 6 months or longer after treatment for proven NB. Quality of life, psychiatric symptom load, and brain atrophy were measured. All results were compared with a group of 30 healthy control persons adapted for age, gender and education being serologically negative for Borrelia burgdorferi senso latu. A cognitive sum score and a global sum score including cognitive, psychological results and quality of life data was calculated for both groups.


RESULTS
Patients after NB showed a lower (i.e. more impaired) score on the Scripps Neurological rating scale (SNRS), but the observed neurological deficits were generally mild (mean ± SD: 97.1 ± 4.7 vs. 99.1 ± 2.4, p = 0.02). The mean neuropsychological domain results of the NB group were all within the normal range. However, a lower performance was found for the frontal executive function z-values (mean ± SD -0.29 ± 0.60 vs. 0.09 ± 0.60; p = 0.0059) of NB patients. Comparing the global sum score (mean ± SD 11.3 ± 4.2 NB vs. 14.3 ± 2.9 control , p = 0.001) and the cognitive sum score of the NB group with those of the control group (mean ± SD -0.15 ± 0.42 NB vs. 0.08 ± 0.31 control , p = 0.0079), both differences were statistically different. The frequencies of impaired global sum scores and those of the pathological cognitive sum scores (p = 0.07) did not differ statistically. No significant differences were found for health-related quality of life (hrQoL), sleep, psychiatric symptom load, or brain atrophy.


CONCLUSIONS
The mean cognitive functions of patients after proven NB were in the normal range. However, we were able to demonstrate a lower performance for the domain of frontal executive functions, for the mean cognitive sum score and the global sum score as a sign of subtle but measurable sequelae of neuroborreliosis. Brain atrophy is not a common consequence of neuroborreliosis.
University Medical Centre Göttingen, Department of Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. h.schmidt@med.uni-goettingen.de.|Elbe Kliniken Stade-Buxtehude, Department of Neurology, Bremervörder Str. 111, Stade, 21682, Germany. h.schmidt@med.uni-goettingen.de.
Holger
H
Schmidt
Ev. Hospital Göttingen-Weende, Department of Geriatrics, An der Lutter 24, Göttingen, 37075, Germany. mdjukic@gwdg.de.|University Medical Centre Göttingen, Department of Neuropathology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. mdjukic@gwdg.de.
Marija
M
Djukic
University Medical Centre Göttingen, Department of Medical Statistics, Humboldtallee 32, Göttingen, 37073, Germany. kjung1@uni-goettingen.de.
Klaus
K
Jung
Asklepios Schildautal-Hospital Seesen, Department of Neurological Rehabilitation, Karl-Herold-Str. 1, Seesen/Harz, 38723, Germany. rehasekretariat.seesen@asklepios.com.
Manfred
M
Holzgraefe
University Medical Centre Göttingen, Department of Cognitive Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. pdechen@gwdg.de.
Peter
P
Dechent
University Medical Centre Göttingen, Department of Medical Psychology and Medical Sociology, Waldweg 37, Göttingen, 37073, Germany. nvsteinbuechel@med.uni-goettingen.de.
Nicole
N
von Steinbüchel
University Medical Centre Göttingen, Department of Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. joachim.blocher@med.uni-goettingen.de.
Joachim
J
Blocher
University Medical Centre Göttingen, Department of Medical Microbiology, Kreuzbergring 57, Göttingen, 37075, Germany. heiffer@gwdg.de.
Helmut
H
Eiffert
University Medical Centre Göttingen, Department of Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. Carsten.Schmidt-Samoa@med.uni-goettingen.de.|University Medical Centre Göttingen, Department of Cognitive Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. Carsten.Schmidt-Samoa@med.uni-goettingen.de.
Carsten
C
Schmidt-Samoa
D000328:Adult; D001284:Atrophy / Q000473:pathology; D001899:Borrelia Infections / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology* / Q000523:psychology; D025065:Borrelia burgdorferi; D001921:Brain / Q000382:microbiology / Q000473:pathology; D016022:Case-Control Studies; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology / Q000523:psychology; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology* / Q000523:psychology; D009483:Neuropsychological Tests; D011788:Quality of Life