Cognitive deficits in children with chronic Lyme disease

Abstract

Objective. In adults, neurologic Lyme disease (LD) is known to cause cognitive dysfunction, but in children the one controlled study found no abnormalities. We examined this question further. Methods . Twenty children (age 8--16) with chronic LD and persistent cognitive complaints and 20 age- and sex-matched controls were assessed with a neuropsychological battery. Tests included the WISC III, the WRAML, the WCST, the CELF-R, and Conners CPT. The Child Behavior Checklist, Conner's Parent Rating Scale, and a symptom checklist were completed by parents and the Children's Depression Inventory, Youth Self-Report, and a physical symptom analog scale were completed by the children. Results. Patients and controls were comparable on demographic variables and premorbid ability. With Bonferroni correction, the patients scored significantly lower on Performance IQ (p = .005), General Memory (p = .004), Verbal Memory (p = .007), and WRAML Finger Windows (p = .003). Significantly lower scores were also noted on Freedom from Distractibility (p = .010), Coding (p = .009), Visual Memory (p = .013), Number/Letter (p = .017), and others. After correction, the Lyme children also had significantly more psychopathology. After controlling separately for anxiety, depression, and fatigue, patients continued to have significant cognitive deficits across various tests. Discussion. Children with chronic neurologic LD with persistent cognitive complaints have significant deficits, primarily affecting visual and auditory attention and short term memory on neuropsychological evaluation. Teachers, psychologists, and psychiatrists need to be aware that cognitive problems may be a manifestation of ongoing LD.