LYME ENCEPHALOPATHY - A NEUROPSYCHOLOGICAL PERSPECTIVE

A mild chronic encephalopathy may be the most common neurologic sympto m in patients with late stage Lyme disease. The symptoms tend to be di ffuse and nonspecific, and patients typically report memory loss, slee p disturbance, fatigue, and depression. Among patients with these symp toms, it is generally felt that those with abnormal cerebral spinal fl uid (CSF) have a neurological basis to their illness. A comparison of Lyme patients, with and without abnormal CSF, revealed that only the a bnormal CSF group had lower memory test scores than normal controls. H owever, most patients in both Lyme groups complained of memory loss an d also reported significantly more symptoms of depression and fatigue than controls. Thus, while depressive symptoms may not be a factor in objective memory performance, they may indeed play a role in perceived memory loss. A survey of the neuropsychological literature suggests t hat active neurologic involvement, the psychological consequences of c hronic illness, and possibly residual neurologic deficits from past in fection with Lyme disease all may affect the patient's perception of c ognitive dysfunction.