Cognitive impairments in patients with persistent symptoms attributed to Lyme disease

Abstract 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.

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Cognitive impairments in patients with persistent symptoms attributed to Lyme disease

BMC Infectious Diseases ◽

10.1186/s12879-019-4452-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Anneleen Berende ◽

Joost Agelink van Rentergem ◽

Andrea W. M. Evers ◽

Hadewych J. M. ter Hofstede ◽

Fidel J. Vos ◽

...

Keyword(s):

Cognitive Impairment ◽

Lyme Borreliosis ◽

Cognitive Testing ◽

Self Report ◽

Study Cohort ◽

Performance Validity ◽

Information Processing Speed ◽

Persistent Symptoms ◽

Lower Education Level ◽

Normative Comparison

Abstract 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.

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Cognitive impairments in patients with persistent symptoms attributed to Lyme disease

10.21203/rs.2.9745/v1 ◽

2019 ◽

Author(s):

Anneleen Berende ◽

Joost Agelink van Rentergem ◽

Andrea W. M. Evers ◽

Hadewych J. M. ter Hofstede ◽

Fidel J. Vos ◽

...

Keyword(s):

Cognitive Impairment ◽

Lyme Borreliosis ◽

Cognitive Testing ◽

Self Report ◽

Study Cohort ◽

Performance Validity ◽

Information Processing Speed ◽

Persistent Symptoms ◽

Lower Education Level ◽

Normative Comparison

Abstract 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, 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 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.

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How to detect cognitive dysfunction at early stages of multiple sclerosis?

Multiple Sclerosis Journal ◽

10.1191/1352458506ms1289oa ◽

2006 ◽

Vol 12 (4) ◽

pp. 445-452 ◽

Cited By ~ 103

Author(s):

M SA Deloire ◽

M C Bonnet ◽

E Salort ◽

Y Arimone ◽

M Boudineau ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Dysfunction ◽

Neuropsychological Tests ◽

Cognitive Testing ◽

Self Report ◽

Cognitive Complaints ◽

Predictive Values ◽

Early Stages ◽

Cognitive Complaint

Detecting cognitive dysfunction may be clinically important during the early stages of multiple sclerosis (MS). We assessed a self-report questionnaire on cognitive complaints and individual neuropsychological tests to select patients with early relapsing-remitting MS (RRMS) who needed comprehensive cognitive testing. Fifty-seven patients underwent neurological and neuropsychological assessment, including Rao’s Brief Repeatable Battery (BRB) and the complete SEP-59 Questionnaire, a French adaptation of the MSQOL-54, which contains four specific questions about self-perception of cognitive functions. Predictive values, specificity, sensitivity and accuracy of five individual neuropsychological tests-Selective Reminding Test, Symbol Digit Modalities Test (SDMT), Similarities Subtest, PASAT and Stroop Test-were calculated to predict cognitive impairment. Only 10.5% of patients did not report any cognitive complaint, while most reported complaints. On the basis of cognitive performances, 59.7% of patients were classified as cognitively impaired, although only one cognitive score was correlated with cognitive complaints. Depressive symptoms and fatigue were associated with more cognitive complaints. Sensitivity of the SDMT to predict cognitive impairment was 74.2%, specificity was 76.9% and accuracy was 75.4%. Since, at this stage, patients’ cognitive complaints are already influenced by depression and fatigue and do not accurately reflect cognitive performances, the SDMT may help to select patients for testing with a more complete cognitive battery.

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The impact of subjective cognitive fatigue and depression on cognitive function in patients with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458517695470 ◽

2017 ◽

Vol 24 (2) ◽

pp. 196-204 ◽

Cited By ~ 19

Author(s):

Daniel Golan ◽

Glen M Doniger ◽

Karl Wissemann ◽

Myassar Zarif ◽

Barbara Bumstead ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Function ◽

Motor Function ◽

Cognitive Testing ◽

Cognitive Domain ◽

Information Processing Speed ◽

Cognitive Fatigue ◽

The Impact ◽

Domain Scores

Background: The association between subjective cognitive fatigue and objective cognitive dysfunction in patients with multiple sclerosis (PwMS) has been studied, with conflicting results. Objective: To explore the impact of fatigue on cognitive function, while controlling for the influence of depression, disability, comorbidities, and psychotropic medications. Methods: PwMS completed a computerized cognitive testing battery with age- and education-adjusted cognitive domain scores. Disability (Expanded Disability Status Scale (EDSS)), cognitive fatigue, and depression were concurrently evaluated. Results: In all, 699 PwMS were included. Both cognitive fatigue and depression were significantly and negatively correlated with the same cognitive domains: information processing speed, executive function, attention, motor function, and memory (−0.15 ⩽ r ⩽ −0.14 for cognitive fatigue; −0.24 ⩽ r ⩽ −0.19 for depression). Multivariate analysis revealed significant but small independent correlations only between depression and neuropsychological test results, while cognitive fatigue had no independent correlation with objective cognitive function except for a trend toward impaired motor function in highly fatigued PwMS. Depression and cognitive fatigue accounted for no more than 6% of the variance in objective cognitive domain scores. Conclusion: Cognitive fatigue is not independently related to objective cognitive impairment. Depression may influence cognitive function of PwMS primarily when it is severe. Cognitive impairment in PwMS should not be ascribed to fatigue or mild depression.

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Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis

Neurology ◽

10.1212/wnl.0000000000007186 ◽

2019 ◽

Vol 92 (13) ◽

pp. e1447-e1455 ◽

Cited By ~ 7

Author(s):

Anneleen Berende ◽

Hadewych J.M. ter Hofstede ◽

Fidel J. Vos ◽

Michiel L. Vogelaar ◽

Henriët van Middendorp ◽

...

Keyword(s):

Cognitive Performance ◽

Antibiotic Treatment ◽

Lyme Borreliosis ◽

Additional Treatment ◽

Controlled Study ◽

Performance Validity ◽

Open Label ◽

Cognitive Domains ◽

Persistent Symptoms ◽

Speed Of Information Processing

ObjectiveTo investigate whether longer-term antibiotic treatment improves cognitive performance in patients with persistent symptoms attributed to Lyme borreliosis.MethodsData were collected during the Persistent Lyme Empiric Antibiotic Study Europe (PLEASE) trial, a randomized, placebo-controlled study. Study participants passed performance-validity testing (measure for detecting suboptimal effort) and had persistent symptoms attributed to Lyme borreliosis. All patients received a 2-week open-label regimen of intravenous ceftriaxone before the 12-week blinded oral regimen (doxycycline, clarithromycin/hydroxychloroquine, or placebo). Cognitive performance was assessed at baseline and after 14, 26, and 40 weeks with neuropsychological tests covering the cognitive domains of episodic memory, attention/working memory, verbal fluency, speed of information processing, and executive function.ResultsBaseline characteristics of patients enrolled (n = 239) were comparable in all treatment groups. After 14 weeks, performance on none of the cognitive domains differed significantly between the treatment arms (p = 0.49–0.82). At follow-up, no additional treatment effect (p = 0.35–0.98) or difference between groups (p = 0.37–0.93) was found at any time point. Patients performed significantly better in several cognitive domains at weeks 14, 26, and 40 compared to baseline, but this was not specific to a treatment group.ConclusionsA 2-week treatment with ceftriaxone followed by a 12-week regimen of doxycycline or clarithromycin/hydroxychloroquine did not lead to better cognitive performance compared to a 2-week regimen of ceftriaxone in patients with Lyme disease–attributed persistent symptoms.ClinicalTrials.gov identifierNCT01207739.Classification of evidenceThis study provides Class II evidence that longer-term antibiotics in patients with borreliosis-attributed persistent symptoms does not increase cognitive performance compared to shorter-term antibiotics.

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Cognitive impairment associated with chemotherapy for breast cancer: An exploratory case-control study

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.8501 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 8501-8501 ◽

Cited By ~ 6

Author(s):

C. M. Booth ◽

J. Vardy ◽

A. Crawley ◽

S. Rourke ◽

G. Pond ◽

...

Keyword(s):

Breast Cancer ◽

Cognitive Impairment ◽

Case Control Study ◽

General Health Questionnaire ◽

Case Control ◽

Cognitive Testing ◽

Self Report ◽

Computerized Testing ◽

Blood Tests ◽

Control Study

8501 Background: There is evidence that some women suffer cognitive impairment after adjuvant chemotherapy (CT) for breast cancer and it may be sustained. We report a case-control study to explore underlying mechanisms with blood tests and functional imaging. Methods: Women diagnosed with breast cancer within 5 years were recruited to 3 groups of 20. Cases (group A) had received CT and self-reported cognitive dysfunction on a prototype FACT-COG questionnaire. There were 2 groups of controls: group B had received CT but did not report cognitive problems; group C had breast cancer but did not receive CT. Comprehensive tests of cognitive function (2.5 hr) were performed. Blood tests evaluated sex hormones, coagulation factors, 10 cytokines, and apolipoprotein genotype. Functional MRI (fMRI) scans were performed while subjects performed a mental task. Results: Currently, 60 women have completed FACT-COG, 39 have undergone neuropsychological assessment and 31 have completed fMRI; testing and analysis will be complete by May 2006. Median time from diagnosis was 2 years. There was increased self-report of cognitive impairment in CT vs non-CT patients (p<0.0001). Formal cognitive testing disclosed more impairment in group C (no CT) as compared to groups A and B: 29% vs 0% by classical tests (p=0.046), and 61% vs 47% and 25% (p=0.38) by computerized testing. This may be due to slight imbalance of demographic factors. Decreased activation in fMRI was seen in frontal areas and right parahippocampus of women who self-reported greater cognitive impairment (p<0.0005), while separate frontal areas show increased activity in women with greater objective cognitive impairment (p<0.0005). Patients who received CT reported more fatigue than non-CT patients (p=0.027). There was an association between fatigue and self-reported cognitive impairment (p=0.004) and anxiety and depression (General Health Questionnaire) (p=0.009), but not with objective cognitive testing. As yet there is no significant correlation between symptoms and cytokine levels. Conclusions: Self-reported cognitive impairment is associated with prior chemotherapy and changes in fMRI but not with formal cognitive testing. The larger sample size is required to confirm these changes and explore possible mechanisms. No significant financial relationships to disclose.

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Cognitive impairment in Chinese neuromyelitis optica

Multiple Sclerosis Journal ◽

10.1177/1352458515576982 ◽

2015 ◽

Vol 21 (14) ◽

pp. 1839-1846 ◽

Cited By ~ 24

Author(s):

N Zhang ◽

YJ Li ◽

Y Fu ◽

JH Shao ◽

LL Luo ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Dysfunction ◽

Neuromyelitis Optica ◽

Verbal Learning ◽

Education Level ◽

California Verbal Learning Test ◽

Semantic Fluency ◽

Information Processing Speed ◽

Lower Education Level ◽

Lower Education

Background: Cognitive dysfunction is frequently seen in neuromyelitis optica (NMO). However, the features and influencing factors of cognitive impairment of Chinese NMO patients are unclear. Objective: To investigate the patterns of cognitive impairment in Chinese NMO patients, and correlate the neuropsychiatric scores with clinical and MRI parameters. Methods: Thirty-six Chinese NMO patients, and 30 sex and age-matched healthy controls were recruited with extensive neuropsychological assessments, using the modified Minimal Assessment of Cognitive Function in MS (MACFIMS). The demographic and clinical characteristics as well as MRI parameters were compared between cognitively impaired (CI) and cognitively preserved (CP) patients. Results: NMO patients were significantly impaired in the Paced Auditory Serial Addition Task ( P<0.05), the Symbol Digit Modalities Test ( P<0.001), the California Verbal Learning Test-Second Edition ( P<0.05), the Brief Visuospatial Memory Test-Revised ( P<0.05) and semantic fluency ( P<0.001). Only lower education level was associated with cognitive dysfunction in NMO (odds ratio: 0.57, P<0.05). There were no significant differences of MRI parameters regarding white matter (WM) lesions, grey matter and WM brain volume between CI and CP patients. Conclusions: Chinese NMO patients particularly demonstrated cognitive impairment in information processing speed, executive function and memory. Lower education level was the main factor contributing to cognitive impairment in NMO.

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The CoGenT3 Study: Cognition and Gender Trends in Three American Generations

Innovation in Aging ◽

10.1093/geroni/igaa057.2975 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 817-817

Author(s):

Shana Stites

Keyword(s):

Cognitive Impairment ◽

Quantitative Methods ◽

Cognitive Testing ◽

Library Science ◽

Sexual And Gender Minorities ◽

Functional Impairments ◽

Gender Minorities ◽

Wide Range ◽

And Gender ◽

New Research

Abstract Many studies find gender differences in how older adults’ report on their memory, perform on cognitive testing, and manage functional impairments that can accompany cognitive impairment. Thus, understanding gender’s effects in aging and Alzheimer’s research is key for advancing methods to prevent, slow, manage, and diagnosis cognitive impairment. Our study, CoGenT3 – The study of Cognition and Gender in Three Generations – seeks to disambiguate the effects of gender on cognition in order to inform a conceptual model, guide innovations in measurement, and support future study. To accomplish this ambitious goal, we have gathered an interdisciplinary team with expertise in psychology, cognition, sexual and gender minorities, library science, measurement, quantitative methods, qualitative methods, and gender and women’s studies. The team benefits from the intersections of expertise in being able to build new research ideas, gain novel insights, and evaluate a wide-range of actions and re-actions but this novelty can also raise challenges.

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What’s going on following acute covid-19? Clinical characteristics of patients in an out-patient rehabilitation program

Neurorehabilitation ◽

10.3233/nre-210025 ◽

2021 ◽

pp. 1-12

Author(s):

Sergiu Albu ◽

Nicolas Rivas Zozaya ◽

Narda Murillo ◽

Alberto Garcia-Molina ◽

Cristian Andres Figueroa Chacón ◽

...

Keyword(s):

Quality Of Life ◽

Cognitive Impairment ◽

Acute Infection ◽

Rehabilitation Program ◽

Neuropsychological Impairment ◽

Outpatient Rehabilitation ◽

Screening Process ◽

Icu Patients ◽

Persistent Symptoms

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients present long-lasting physical and neuropsychological impairment, which may require rehabilitation. OBJECTIVES: The current cross-sectional study characterizes post COVID-19 sequelae and persistent symptoms in patients in an outpatient rehabilitation program. METHODS: Thirty patients [16 post-ICU and 14 non-ICU; median age = 54(43.8–62) years; 19 men] presenting sequelae and/or persistent symptoms (>3 months after acute COVID-19) were selected of 41 patients referred for neurorehabilitation. Patients underwent physical, neuropsychological and respiratory evaluation and assessment of impact of fatigue and quality of life. RESULTS: The main reasons for referral to rehabilitation were: fatigue (86.6%), dyspnea (66.7%), subjective cognitive impairment (46.7%) and neurological sequelae (33.3%). Post-ICU patient presented sequelae of critical illness myopathy and polyneuropathy, stroke and encephalopathy and lower forced vital capacity compared to non-ICU patients. Cognitive impairment was found in 63.3% of patients, with a similar profile in both sub-groups. Increased physical fatigue, anxiety and depression and low quality of life were prevalent irrespective of acute COVID-19 severity. CONCLUSIONS: The variability of post COVID-19 physical and neuropsychological impairment requires a complex screening process both in ICU and non-ICU patients. The high impact of persistent symptoms on daily life activities and quality of life, regardless of acute infection severity, indicate need for rehabilitation.

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Elevated Inflammatory Markers and Arterial Stiffening Exacerbate Tau but Not Amyloid Pathology in Older Adults with Mild Cognitive Impairment

Journal of Alzheimer s Disease ◽

10.3233/jad-201382 ◽

2021 ◽

pp. 1-13

Author(s):

Alexandra L. Clark ◽

Alexandra J. Weigand ◽

Kelsey R. Thomas ◽

Seraphina K. Solders ◽

Lisa Delano-Wood ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Inflammatory Markers ◽

Memory Performance ◽

Cognitive Testing ◽

Interactive Effects ◽

Protein Biomarkers ◽

Age Related ◽

T Tau

Background: Age-related cerebrovascular and neuroinflammatory processes have been independently identified as key mechanisms of Alzheimer’s disease (AD), although their interactive effects have yet to be fully examined. Objective: The current study examined 1) the influence of pulse pressure (PP) and inflammatory markers on AD protein levels and 2) links between protein biomarkers and cognitive function in older adults with and without mild cognitive impairment (MCI). Methods: This study included 218 ADNI (81 cognitively normal [CN], 137 MCI) participants who underwent lumbar punctures, apolipoprotein E (APOE) genotyping, and cognitive testing. Cerebrospinal (CSF) levels of eight pro-inflammatory markers were used to create an inflammation composite, and amyloid-beta 1–42 (Aβ 42), phosphorylated tau (p-tau), and total tau (t-tau) were quantified. Results: Multiple regression analyses controlling for age, education, and APOE ɛ4 genotype revealed significant PP x inflammation interactions for t-tau (B = 0.88, p = 0.01) and p-tau (B = 0.84, p = 0.02); higher inflammation was associated with higher levels of tau within the MCI group. However, within the CN group, analyses revealed a significant PP x inflammation interaction for Aβ 42 (B = –1.01, p = 0.02); greater inflammation was associated with higher levels of Aβ 42 (indicative of lower cerebral amyloid burden) in those with lower PP. Finally, higher levels of tau were associated with poorer memory performance within the MCI group only (p s < 0.05). Conclusion: PP and inflammation exert differential effects on AD CSF proteins and provide evidence that vascular risk is associated with greater AD pathology across our sample of CN and MCI older adults.

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