Study confirms memory and concentration problems after Lyme disease
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November 15, 2022 – People who have been treated for Lyme disease but continue to have symptoms have changes in their brains that confirm the memory and concentration problems many of them have reported, a new study has found.
Many people with what is known as post-treatment Lyme disease — or PTLD — complain of memory and concentration problems, sometimes accompanied by fatigue, muscle pain, insomnia, and depression.
To understand possible changes in brain function that might explain these cognitive difficulties, the researchers used specialized imaging techniques to compare the brains of 12 adults with PTLD and 18 adults without a history of Lyme disease.
The researchers found changes in the white matter of the brains of people with PTLD. White matter is found in the deeper brain tissues and contains nerve fibers, which are extensions of nerve cells.
“We found that … white matter function increased while participants with PTLD performed a cognitive task,” says lead researcher Cheri Marvel, PhD, associate professor of neurology, psychiatry and behavioral sciences at Johns Hopkins University School of Medicine in Baltimore.
“I think when patients hear that, they might feel reassured that there’s a biological basis for their ongoing symptoms, even though there’s not yet a good way to treat the cognitive difficulties,” she says. This could be similar to patients with a long history of COVID, Marvel says.
The study was published online Oct. 26 in the journal Plus one.
“We could start connecting the dots”
“Objective biological measurements” of PTLD symptoms “cannot usually be identified with regular MRIs, CT scans, or blood tests,” said senior author John Aucott, MD, director of the Johns Hopkins Lyme Disease Clinical Research Center, in a press release.
Because of the number of people affected by the condition — 10% to 20% of the nearly half a million Americans who contract the disease each year — researchers felt there was a need to “broaden” the assessment methods.
“We were motivated by the persistent complaints of cognitive difficulties in patients being treated for their Lyme disease, with a lack of data to explain the cause of these symptoms,” says Marvel.
It seemed logical “that if cognitive and neurological symptoms are involved, the brain might reveal something about it. Then we could start connecting the dots between the patient experience and the underlying mechanisms that drive it,” she says.
To study this, Marvel’s team used functional magnetic resonance imaging (fMRI), an imaging technique that measures blood flow to areas of the brain, often while performing specific tasks — in this case, short-term memory tasks involving memorization and recall of large – and lowercase went letters, as well as the alphabetical order of several letters.
Those with PTLD performed more slowly on some memory tasks, although their slower speed did not affect the accuracy of their performance.
The researchers found unusual activity in the white matter of the frontal lobe – an area of the brain involved in cognitive tasks such as memory and concentration – in the PTLD group.
Typically, this type of tissue receives less blood flow compared to the gray matter in the brain and is responsible for moving information around the brain and “delivering” it to the gray matter. The amount of activity they saw “is unusual to see with the MRI methods we used, and we didn’t see such activity in the healthy control group,” says Marvel.
signs of healing?
To confirm the finding, the researchers used a second imaging technique called diffusion tensor imaging in all 12 PTLD patients and 12 of the 18 people without PTLD. The imaging process detects whether water is moving in the brain tissue and in which direction it is flowing.
In the patients with PTLD, the researchers found that what’s known as axon diffusion — or leakage — out of the white matter was linked to better brain function. The diffusing water was found in the same areas of white matter identified by the first imaging test.
“This led us to speculate that the white matter changes are a healthy response to the effects of Lyme disease on the brain,” says Marvel. She suggests that the increased white matter leakage “could be a marker of healing during PTLD and represent a healthier outcome.”
In the meantime, the researchers want to work with other experts to answer their remaining questions, she says.
“It is important for clinicians to know that PTLD results in real, quantifiable brain changes and that patients’ cognitive complaints may be a direct result of these brain changes and not a side effect of other symptoms, such as fatigue,” Wunder said.
Commenting on the study for this report, John Keilp, PhD, associate professor of clinical psychology at Columbia University in New York City, said it is an “important, well-conducted study that complements previous brain imaging studies of patients with PTLD expanded”. “state-of-the-art brain imaging and analysis methods.”
The researchers “provided us with a way to study these patients and this disorder more closely while trying to uncover the uncertainties surrounding the physiological basis of these patients’ symptoms,” says Keilp, who runs the neuropsychology lab in the Department of Neurology Molecular directs imaging and neuropathology at the New York State Psychiatric Institute.
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