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Mac S, Bahia S, Simbulan F, Pullenayegum EM, Evans GA, Patel SN, Sander B. Long-Term Sequelae and Health-Related Quality of Life Associated With Lyme Disease: A Systematic Review. Clin Infect Dis 2021; 71:440-452. [PMID: 31773171 DOI: 10.1093/cid/ciz1158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022] Open
Abstract
Lyme disease (LD) is the most commonly reported vector-borne disease, but its clinical consequences remain uncertain. We conducted a systematic review of the long-term sequelae and health-related quality of life (HRQoL) associated with LD in North America and Europe. We performed searches in 6 electronic databases up to December 2018 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including observational studies reporting long-term sequelae, HRQoL, and prognostic factors. We included 46 studies, published between 1994 and 2019. Based on 21 studies reporting attributable outcomes, higher proportions of sequelae reported from exposed patients were: neck pain, myalgia, arthralgia, paresthesia, sleep disorder, poor appetite, and concentration difficulties. Patients with PTLDS reported impaired HRQoL compared to the general US population. Included studies were highly heterogeneous in terms of study design, settings, patient characteristics, and quality. Patients with LD are more likely to report nonspecific long-term sequelae, especially those experiencing persistent symptoms posttreatment. Opportunities exist for prospective longitudinal studies to better understand LD outcomes.
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Affiliation(s)
- Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,THETA Collaborative, University Health Network, Toronto, Canada
| | - Simran Bahia
- Department of Biochemistry, University of Ottawa, Ottawa, Canada
| | | | - Eleanor M Pullenayegum
- The Hospital for Sick Children (SickKids), Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gerald A Evans
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Queen's University, Kingston, Canada.,Institute of Clinical Evaluative Sciences, Toronto, Canada
| | - Samir N Patel
- Public Health Ontario, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,THETA Collaborative, University Health Network, Toronto, Canada.,Institute of Clinical Evaluative Sciences, Toronto, Canada.,Public Health Ontario, Toronto, Canada
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Schmidt H, Djukic M, Jung K, Holzgraefe M, Dechent P, von Steinbüchel N, Blocher J, Eiffert H, Schmidt-Samoa C. Neurocognitive functions and brain atrophy after proven neuroborreliosis: a case-control study. BMC Neurol 2015; 15:139. [PMID: 26286440 PMCID: PMC4545711 DOI: 10.1186/s12883-015-0386-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 07/17/2015] [Indexed: 12/05/2022] Open
Abstract
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. Conclusion 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.
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Affiliation(s)
- Holger Schmidt
- University Medical Centre Göttingen, Department of Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. .,Elbe Kliniken Stade-Buxtehude, Department of Neurology, Bremervörder Str. 111, Stade, 21682, Germany.
| | - Marija Djukic
- Ev. Hospital Göttingen-Weende, Department of Geriatrics, An der Lutter 24, Göttingen, 37075, Germany. .,University Medical Centre Göttingen, Department of Neuropathology, Robert-Koch-Str. 40, Göttingen, 37075, Germany.
| | - Klaus Jung
- University Medical Centre Göttingen, Department of Medical Statistics, Humboldtallee 32, Göttingen, 37073, Germany.
| | - Manfred Holzgraefe
- Asklepios Schildautal-Hospital Seesen, Department of Neurological Rehabilitation, Karl-Herold-Str. 1, Seesen/Harz, 38723, Germany.
| | - Peter Dechent
- University Medical Centre Göttingen, Department of Cognitive Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany.
| | - Nicole von Steinbüchel
- University Medical Centre Göttingen, Department of Medical Psychology and Medical Sociology, Waldweg 37, Göttingen, 37073, Germany.
| | - Joachim Blocher
- University Medical Centre Göttingen, Department of Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany.
| | - Helmut Eiffert
- University Medical Centre Göttingen, Department of Medical Microbiology, Kreuzbergring 57, Göttingen, 37075, Germany.
| | - Carsten Schmidt-Samoa
- University Medical Centre Göttingen, Department of Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany. .,University Medical Centre Göttingen, Department of Cognitive Neurology, Robert-Koch-Str. 40, Göttingen, 37075, Germany.
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Ekner-Grzyb A, Sajkowska Z, Dudek K, Gawałek M, Skórka P, Tryjanowski P. Locomotor performance of sand lizards ( Lacerta agilis): effects of predatory pressure and parasite load. Acta Ethol 2013; 16:173-179. [PMID: 24052686 PMCID: PMC3775096 DOI: 10.1007/s10211-013-0148-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/10/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
Abstract
Locomotor performance affects foraging efficiency, predator avoidance and consequently fitness. Agility and speed determine the animal's social status and reflect its condition. In this study, we test how predatory pressure and parasite load influences locomotor performance of wild specimens of the sand lizard Lacerta agilis. Animals were chased on a 2-metre racetrack. Lizards with autotomy ran significantly faster than lizards with an intact tail, but there was no significant difference in running speed between individuals with fresh caudal autotomy and regenerated tails. Parasite presence and load, age and sex had no significant effect on speed. Our results indicate that autotomy either alters locomotory behaviour or that individuals with autotomised tails were those that previously survived contact with predators, and therefore represented a subgroup of the fastest individuals. Therefore, in general, predatory pressure but not parasites affected locomotor performance in lizards.
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Affiliation(s)
- Anna Ekner-Grzyb
- Department of Behavioural Ecology, Adam Mickiewicz University, Umultowska 89, 61-614 Poznan, Poland
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McAuliffe P, Brassard MR, Fallon B. Memory and executive functions in adolescents with posttreatment Lyme disease. ACTA ACUST UNITED AC 2008; 15:208-19. [PMID: 18726742 DOI: 10.1080/09084280802324473] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although adults with late stage posttreatment Lyme disease often experience difficulties in memory, little is known about the relationship between cognition and Lyme disease in children and adolescents. Twenty-five adolescents with late stage posttreatment Lyme disease (symptoms > 6 months) and 25 participants without Lyme disease (matched on gender, IQ, age, socioeconomic status) were assessed for neuropsychological functioning, depression, school functioning, and predisease academic achievement. The Lyme group had significant deficits in cognition (short-term visual memory, short-term and delayed verbal memory, all forms of recognition memory), as well as worse attendance, grades, and subjective reports of memory problems, without differing in predisease achievement or depression. Deficits in visual memory exceeded deficits in verbal memory-a striking difference from what is reported in adults. These results reveal that adolescents with a history of treated Lyme disease are at risk for long-term problems in cognition and school functioning.
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Affiliation(s)
- Patrick McAuliffe
- Teacher's College, Columbia University New York, New York 10027, USA.
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Barry D, Bates ME, Labouvie E. FAS and CFL forms of verbal fluency differ in difficulty: a meta-analytic study. ACTA ACUST UNITED AC 2008; 15:97-106. [PMID: 18568601 DOI: 10.1080/09084280802083863] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Controlled Oral Word Association (COWA) Test is a brief and sensitive measure of executive cognitive dysfunction. There are two commonly used forms of the test, one using the letters F, A, and S, and the other using C, F, and L. This study examines the relative difficulty of the two forms using a meta-analytic approach that includes multiple samples of normal individuals. The effects of age, education, gender composition, exclusion criteria, and age of study are also examined. Results indicate that the CFL form of the test is more difficult and that age, education, and the use of strict exclusion criteria influence performance. Performance is more variable for the FAS form, and age and age of study influence performance variability.
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Affiliation(s)
- Danielle Barry
- University of Connecticut Health Center, Farmington, Connecticut 06030, USA.
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Nau R, Schmidt H. Long-term neuropsychological deficits after central nervous system infections despite adequate therapy. J Neurol 2007; 254 Suppl 2:II80-3. [PMID: 17503137 DOI: 10.1007/s00415-007-2019-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuropsychological deficits are common consequences of central nervous system infections despite adequate treatment. The frequency and severity depends on the causative pathogen and the site(s) of injured brain parenchyma. The severity ranges from mild cognitive abnormalities not interfering with everyday life performance to fully developed Wernicke-Korsakow syndrome with complete inability to incorporate new information into long-term memory and to persistent vegetative state. In several conditions, rapid initiation of adequate therapy is crucial to minimise neuropsychological impairment.
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Affiliation(s)
- Roland Nau
- Dept. of Neurology, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Keilp JG, Corbera K, Slavov I, Taylor MJ, Sackeim HA, Fallon BA. WAIS-III and WMS-III performance in chronic Lyme disease. J Int Neuropsychol Soc 2006; 12:119-29. [PMID: 16433951 DOI: 10.1017/s1355617706060231] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 08/25/2005] [Accepted: 08/28/2005] [Indexed: 11/06/2022]
Abstract
There is controversy regarding the nature and degree of intellectual and memory deficits in chronic Lyme disease. In this study, 81 participants with rigorously diagnosed chronic Lyme disease were administered the newest revisions of the Wechsler Adult Intelligence Scale (WAIS-III) and Wechsler Memory Scale (WMS-III), and compared to 39 nonpatients. On the WAIS-III, Lyme disease participants had poorer Full Scale and Performance IQ's. At the subtest level, differences were restricted to Information and the Processing Speed subtests. On the WMS-III, Lyme disease participants performed more poorly on Auditory Immediate, Immediate, Auditory Delayed, Auditory Recognition Delayed, and General Memory indices. Among WMS-III subtests, however, differences were restricted to Logical Memory (immediate and delayed) and Family Pictures (delayed only), a Visual Memory subtest. Discriminant analyses suggest deficits in chronic Lyme are best characterized as a combination of memory difficulty and diminished processing speed. Deficits were modest, between one-third and two-thirds of a standard deviation, consistent with earlier studies. Depression severity had a weak relationship to processing speed, but little other association to test performance. Deficits in chronic Lyme disease are consistent with a subtle neuropathological process affecting multiple performance tasks, although further work is needed to definitively rule out nonspecific illness effects.
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Affiliation(s)
- John G Keilp
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, New York 10032, USA.
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Abstract
Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with chronic Lyme disease are generally consistent with the deficits that can be seen in processes with primarily frontal systems involvement. These observations are generally consistent with neuroradiologic findings. The clinical presentation in chronic Lyme disease and the nature of the neuropsychological deficits are discussed, as are several central issues in understanding neuropsychological functioning in chronic Lyme disease, such as the impact of chronic illness, response to treatment, and the relationship between neuropsychological performance and depression, fatigue, and neurological indicators of disease.
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Affiliation(s)
- Holly James Westervelt
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
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