Touradji Pegah, Aucott John N, Yang Ting, Rebman Alison W, Bechtold Kathleen T
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Arch Clin Neuropsychol. 2019 Jun 1;34(4):455-465. doi: 10.1093/arclin/acy051.
Patient-reported cognitive complaints are common in those with post-treatment Lyme disease syndrome (PTLDS). Objective evidence of cognitive impairment in this population is variable in part due to methodological variability in existing studies. In this study, we sought to use a systematic approach to characterizing PTLDS based on the most current consensus diagnosis. We further examined PTLDS-related cognitive decline, operationalized as a significant decline in cognitive test performance relative to premorbid cognitive ability.
We enrolled a case series of 124 patients with confirmed PTLDS defined by Infectious Diseases Society of America-proposed case definition. Cognitive functioning was evaluated using standardized neuropsychological measures.
The majority (92%) of participants endorsed some level of cognitive difficulty, yet 50% of the sample showed no statistically or clinically significant cognitive decline, 26% of the sample evidenced significant cognitive decline on measures of memory and variably on measures of processing speed, and 24% of the sample were excluded from analyses due to suboptimal test engagement.
The current findings are consistent with the literature showing that the most robust neurocognitive deficit associated with PTLDS is in verbal memory and with variable decline in processing speed. Compared to population normative comparison standards, PTLDS-related cognitive decline remains mild. Thus, further research is needed to better understand factors related to the magnitude of subjective cognitive complaints as well as objective evidence of mild cognitive decline.
患者报告的认知主诉在治疗后莱姆病综合征（PTLDS）患者中很常见。该人群认知障碍的客观证据存在差异，部分原因是现有研究方法的变异性。在本研究中，我们试图采用系统方法，根据最新的共识诊断来描述PTLDS。我们进一步研究了与PTLDS相关的认知衰退，将其定义为相对于病前认知能力，认知测试表现显著下降。
我们纳入了一个病例系列，共124例确诊为PTLDS的患者，PTLDS由美国传染病学会提出的病例定义确定。使用标准化神经心理学测量方法评估认知功能。
大多数（92%）参与者认可一定程度的认知困难，但50%的样本未显示出统计学或临床上显著的认知衰退，26%的样本在记忆测量方面表现出显著的认知衰退，在处理速度测量方面表现不一，24%的样本因测试参与度欠佳而被排除在分析之外。
目前的研究结果与文献一致，表明与PTLDS相关的最明显神经认知缺陷在于言语记忆，处理速度也有不同程度的下降。与人群规范比较标准相比，与PTLDS相关的认知衰退仍然较轻。因此，需要进一步研究以更好地理解与主观认知主诉程度以及轻度认知衰退客观证据相关的因素。
