慢性莱姆病患者的认知障碍。
Cognitive impairments in patients with persistent symptoms attributed to Lyme disease.
机构信息
Department of Internal Medicine 463 and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
BMC Infect Dis. 2019 Oct 7;19(1):833. doi: 10.1186/s12879-019-4452-y.
BACKGROUND
Persistent symptoms attributed to Lyme borreliosis often include self-reported cognitive impairment. However, it remains unclear whether these symptoms can be substantiated by objective cognitive testing.
METHODS
For this observational study, cognitive performance was assessed in 280 adults with persistent symptoms attributed to Lyme borreliosis (as part of baseline data collected for the Dutch PLEASE study). Cognitive testing covered the five major domains: episodic memory, working memory / attention, verbal fluency, information-processing speed and executive function. Patients' profiles of test scores were compared to a large age-, education- and sex-adjusted normative sample using multivariate normative comparison. Performance validity was assessed to detect suboptimal effort, and questionnaires were administered to measure self-reported cognitive complaints, fatigue, anxiety, depressive symptoms and several other psychological factors.
RESULTS
Of 280 patients, one was excluded as the test battery could not be completed. Of the remaining 279 patients, 239 (85.4%) displayed sufficient performance validity. Patients with insufficient performance validity felt significantly more helpless and physically fatigued, and less orientated. Furthermore, they had a lower education level and less often paid work. Of the total study cohort 5.7% (n = 16) performed in the impaired range. Among the 239 patients who displayed sufficient performance validity, 2.9% (n = 7) were classified as cognitively impaired. No association between subjective cognitive symptoms and objective impairment was found.
CONCLUSIONS
Only a small percentage of patients with borreliosis-attributed persistent symptoms have objective cognitive impairment. Performance validity should be taken into account in neuropsychological examinations of these patients. Self-report questionnaires are insufficiently valid to diagnose cognitive impairment.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01207739 . Registered 23 September 2010.
背景
莱姆病患者常自述存在持续性症状，包括认知障碍。然而，这些症状是否能通过客观的认知测试来证实仍不清楚。
方法
本观察性研究共纳入 280 例莱姆病患者（为荷兰 PLEASE 研究的基线数据的一部分），评估其认知功能。认知测试涵盖五个主要领域：情景记忆、工作记忆/注意力、词语流畅性、信息处理速度和执行功能。采用多元正态比较法，将患者的测试成绩与一个年龄、教育和性别相匹配的大型常模样本进行比较。评估患者的表现效度，以发现其是否未尽力作答，并采用问卷评估其自述的认知抱怨、疲劳、焦虑、抑郁症状和其他一些心理因素。
结果
280 例患者中，有 1 例因无法完成测试组合而被排除。在剩余的 279 例患者中，有 239 例（85.4%）表现出足够的表现效度。表现效度不足的患者感到更无助和身体疲劳，定向力也更差。此外，他们的教育程度较低，从事有薪工作的频率也较低。在总研究队列中，有 5.7%（n=16）的患者表现出认知障碍。在表现出足够表现效度的 239 例患者中，有 2.9%（n=7）被归类为认知障碍。未发现主观认知症状与客观损害之间存在关联。
结论
仅有一小部分莱姆病患者存在持续性症状，伴有客观认知障碍。在对这些患者进行神经心理学检查时，应考虑表现效度。自我报告的问卷不能充分诊断认知障碍。
试验注册
ClinicalTrials.gov NCT01207739。于 2010 年 9 月 23 日注册。
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