Lyme neuroborreliosis and dementia
Commentary: Lyme disease and Alzheimer’s disease can both cause cognitive difficulties with dementia. In this article published in the Journal of Alzheimer’s disease, two groups of patients were identified with dementia. Among a group of 20 patients studied, 7/20 patients had Lyme in their central nervous system, and stabilized or improved their cognitive status with antibiotics. Looking for treatable causes of cognitive difficulties is essential as we deal with an expanding Lyme and Alzheimer’s disease epidemic. Unfortunately the present 2 tiered system of Lyme testing is not sensitive enough to pick up all cases of Lyme disease (or associated borrelia infections) in the central nervous system, nor are spinal taps just using antibody and PCR assays (PCR tests are not sensitive enough to pick up all infections, and antibody-antigen complexes in the CNS may also be present, decreasing our ability to detect Lyme). Using brain MRI’s with FDG-PET scans, combined with Tau, p-tau, and Aβ42 concentrations in the CSF may be helpful in differentiating the two diseases. We can also use the score on the MSIDS questionnaire with bands on the Western Blot as an initial screening tool to help determine the probability of suffering from Lyme. Both diseases however may also be present. Dr Judith Miklossy published an excellent article in the Journal of Neuroinflammation in 2011 entitled “Alzheimer’s disease: a neurospirochetosis”, where she applied Koch’s postulate to prove that there is a probable causal relationship between neurospirochetosis and Alzheimer’s disease(http://www.jneuroinflammation.com/content/8/1/90).
When we apply the MSIDS map, other causes of cognitive problems can include viral encephalitis, metabolic abnormalities (ammonia..), hypothyroidism, vitamin deficiencies, heavy metal burdens and other environmental toxins, inflammation, POTS, and other tick-borne diseases. Creating a differential diagnosis is essential if we are to discover possible multi factorial causes of dementia and cognitive problems in our patients. Pages 77-78 of “Why Can’t I Get Better” discuss some of the common differential diagnoses seen in cognitive disorders, and pages 266-267 also discusses the role of mitochondrial dysfunction in neurological disease.
Lyme neuroborreliosis and dementia, PubMed.gov