The thesis focuses on a current issue in neurology, namely determining the
frequency, structure and prognostically significant factors in the development of
cognitive disorders in patients with Lyme borreliosis. It explores their interaction
with the clinical characteristics of the disease, psycho-emotional disorders and
quality of life.
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The study involved 69 patients (47 women and 22 men) with a verified
diagnosis of Lyme borreliosis, aged 23-77 years (mean age (M±σ) – 49.9±16.26
years).
They underwent examination and treatment at the Center of Infectious Lesions
of the Nervous System of the State Institution “Gromashevsky Institute of
Epidemiology and Infectious Diseases of the National Academy of Medical
Sciences of Ukraine” and Communal non-commercial enterprise of the Kyiv
Regional Council «Kyiv Regional Clinical Hospital» in 2014-2022. The duration of
the disease ranged from 1.5 months to 20 years (3.06±3.95 years on average). To
address the objectives of the thesis, namely to implement the research using the casecontrol method, 69 matched controls were selected, comparable in terms of gender,
age, place of residence, etc. The survey results from healthy individuals, including
students, and clinic employees, were used.
For laboratory verification of the diagnosis of Lyme borreliosis, a two-stage
serological study was performed. This included determining the titers of
immunoglobulins IgM and IgG using the enzyme-linked immunosorbent assay
(ELISA) method and identifying IgM and IgG to specific Borrelia antigens using
immunoblotting. In addition to determining IgM and IgG antibody classes to
Borrelia, cerebrospinal fluid was also tested for specific antibodies to Borrelia.
All patients with Lyme borreliosis underwent specific antibiotic therapy in
accordance with the recommendations of modern clinical guidelines.
The research methodology was based on the assessment of the overall
condition of patients, analysis of anamnestic data, laboratory results, and magnetic
resonance imaging. The survey plan for respondents included a questionnaire to
determine the presence and severity of cognitive disorders, anxiety-depressive
disorders, fatigue, as well as an assessment of the quality of life. To assess the
presence and severity of cognitive disorders, the Mini-Mental State Examination
(MMSE) and the Montreal Cognitive Assessment (MoCA) were used. For psychoemotional disorders, the Hospital Anxiety and Depression Scale (HADS) was used,
and the severity of fatigue was assessed using the Fatigue Severity Scale (FSS). The
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study participants filled out the Short Form Health Survey – 36 (SF-36) to assess
their quality of life.
The primary outcome of the study was the presence and severity of cognitive
and psychoe-motional disorders in patients with Lyme borreliosis, as well as their
correlation with clinical characteristics of the disease. As secondary outcomes, the
quality of life of patients in this category was assessed, and predictors of its negative
dynamics were studied.
Lyme borreliosis is an infectious disease caused by the bite of Ixodes ticks
infected with the bacterium Borrelia burgdorferi (В. burgdorferi). Despite significant
efforts to address this problem, understanding the severity of the disease, its
pathophysiology, long-term consequences of infection, and optimal management of
Lyme borreliosis remain controversial. This disease is multisystemic, characterized
by involvement of the skin, joints, heart, and, in rare cases, the eyes, and regularly,
the nervous system. The latter contributes to the likely development of cognitive and
psycho-emotional disorders. Data on the prevalence, severity of these disorders, as
well as their correlation with clinical characteristics of the disease are limited.
The results of our study confirmed significant polymorphism of the disease
with involvement of various organs and systems. It was found that in the structure
of neuroborreliosis, chronic radiculopathy syndrome predominated (29%), followed
by encephalopathy (24.6%), mono- and polyneuropathy (15.9%), and chronic
borreliosis encephalomyelitis (4.23%). Combined central and peripheral nervous
system involvement was identified in 15.9% of patients. Neurovisualization findings
on MRI revealed changes in 28.9% of patients: focal changes in cranial nerves were
observed in 10.1% of patients, focal changes in the white matter of the brain in
21.7%, and atrophic changes of various localization in 29%.
