Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-27T21:26:42.208Z Has data issue: false hasContentIssue false

WAIS-III and WMS-III performance in chronic Lyme disease

Published online by Cambridge University Press:  23 January 2006

JOHN G. KEILP
Affiliation:
Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, New York New York State Psychiatric Institute, Department of Neuroscience, New York, New York
KATHY CORBERA
Affiliation:
Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, New York New York State Psychiatric Institute, Department of Therapeutics, New York, New York
IORDAN SLAVOV
Affiliation:
Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, New York New York State Psychiatric Institute, Department of Therapeutics, New York, New York
MICHAEL J. TAYLOR
Affiliation:
Department of Psychiatry, University of California at San Diego, California
HAROLD A. SACKEIM
Affiliation:
Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, New York New York State Psychiatric Institute, Department of Biological Psychiatry, New York, New York
BRIAN A. FALLON
Affiliation:
Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, New York New York State Psychiatric Institute, Department of Therapeutics, New York, New York

Abstract

There is controversy regarding the nature and degree of intellectual and memory deficits in chronic Lyme disease. In this study, 81 participants with rigorously diagnosed chronic Lyme disease were administered the newest revisions of the Wechsler Adult Intelligence Scale (WAIS-III) and Wechsler Memory Scale (WMS-III), and compared to 39 nonpatients. On the WAIS-III, Lyme disease participants had poorer Full Scale and Performance IQ's. At the subtest level, differences were restricted to Information and the Processing Speed subtests. On the WMS-III, Lyme disease participants performed more poorly on Auditory Immediate, Immediate, Auditory Delayed, Auditory Recognition Delayed, and General Memory indices. Among WMS-III subtests, however, differences were restricted to Logical Memory (immediate and delayed) and Family Pictures (delayed only), a Visual Memory subtest. Discriminant analyses suggest deficits in chronic Lyme are best characterized as a combination of memory difficulty and diminished processing speed. Deficits were modest, between one-third and two-thirds of a standard deviation, consistent with earlier studies. Depression severity had a weak relationship to processing speed, but little other association to test performance. Deficits in chronic Lyme disease are consistent with a subtle neuropathological process affecting multiple performance tasks, although further work is needed to definitively rule out nonspecific illness effects. (JINS, 2006, 12, 119–129.)

Type
Research Article
Copyright
© 2006 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Barona, A., Reynolds, C., & Chastain, R. (1984). A demographically based index of premorbid intelligence for the WAIS-R. Journal of Consulting and Clinical Psychology, 52, 885887.Google Scholar
Barr, W.B., Rastogi, R., Ravdin, L., & Hilton, E. (1999). Relations among indexes of memory disturbance and depression in patients with Lyme borreliosis. Applied Neuropsychology, 6, 1218.Google Scholar
Benke, T., Gasse, T., Hittmair-Delazer, M., & Schmutzhard, E. (1995). Lyme encephalopathy: Long-term neuropsychological deficits years after acute neuroborreliosis. Acta Neurologica Scandinavica, 91, 353357.Google Scholar
Blair, J.R. & Spreen, O. (1989). Predicting premorbid IQ: A revision of the National Adult Reading Test. The Clinical Neuropsychologist, 3, 129136.Google Scholar
Bujak, D.I., Weinstein, A., & Dornbush, R.L. (1996). Clinical and neurocognitive features of the post Lyme syndrome. Journal of Rheumatology, 23, 13921397.Google Scholar
Center for Disease Control. (1997). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly, Rep. 46 (No. RR-10), 2021.Google Scholar
Fallon, B.A., Keilp, J., Prohovnik, I., Heertum, R.V., & Mann, J.J. (2003). Regional cerebral blood flow and cognitive deficits in chronic lyme disease. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 326332.Google Scholar
Fallon, B.A., Kochevar, J., & Nields, J.A. (1998). The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatric Clinics of North America, 21, 693703.Google Scholar
Fallon, B.A. & Nields, J.A. (1994). Lyme disease: A neuropsychiatric illness. American Journal of Psychiatry, 151, 15711583.Google Scholar
Gaudino, E.A., Coyle, P.K., & Krupp, L.B. (1997). Post-Lyme syndrome and chronic fatigue syndrome. Neuropsychiatric similarities and differences. Archives of Neurology, 54, 13721376.Google Scholar
Gustaw, K., Beltowska, K., & Studzinska, M.M. (2001). Neurological and psychological symptoms after the severe acute neuroborreliosis. Annals of Agricultural and Environmental Medicine, 8, 9194.Google Scholar
Halperin, J.J., Krupp, L.B., Golightly, M.G., & Volkman, D.J. (1990). Lyme borreliosis-associated encephalopathy. Neurology, 40, 13401343.Google Scholar
Kaplan, R.F., Jones-Woodward, L., Workman, K., Steere, A.C., Logigian, E.L., & Meadows, M.E. (1999). Neuropsychological deficits in Lyme disease patients with and without other evidence of central nervous system pathology. Applied Neuropsychology, 6, 311.Google Scholar
Kaplan, R.F., Meadows, M.E., Vincent, L.C., Logigian, E.L., & Steere, A.C. (1992). Memory impairment and depression in patients with Lyme encephalopathy: Comparison with fibromyalgia and nonpsychotically depressed patients. Neurology, 42, 12631267.Google Scholar
Kaplan, R.F., Trevino, R.P., Johnson, G.M., Levy, L., Dornbush, R., Hu, L.T., Evans, J., Weinstein, A., Schmid, C.H., & Klempner, M.S. (2003). Cognitive function in post-treatment Lyme disease: Do additional antibiotics help? Neurology, 60, 19161922.Google Scholar
Krupp, L.B., Masur, D., Schwartz, J., Coyle, P.K., Langenbach, L.J., Fernquist, S.K., Jandorf, L., & Halperin, J.J. (1991). Cognitive functioning in late Lyme borreliosis. Archives of Neurology, 48, 11251129.Google Scholar
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.
Logigian, E.L., Johnson, K.A., Kijewski, M.F., Kaplan, R.F., Becker, J.A., Jones, K.J., Garada, B.M., Holman, B.L., & Steere, A.C. (1997). Reversible cerebral hypoperfusion in Lyme encephalopathy. Neurology, 49, 16611670.Google Scholar
Logigian, E.L., Kaplan, R.F., & Steere, A.C. (1990). Chronic neurologic manifestations of Lyme disease. New England Journal of Medicine, 323, 14381444.Google Scholar
Newberg, A., Hassan, A., & Alavi, A. (2002). Cerebral metabolic changes associated with Lyme disease. Nuclear Medicine Communications, 23, 773777.Google Scholar
Orloski, K.A., Hayes, E.B., Campbell, G.L., & Dennis, D.T. (2000). Surveillance for Lyme disease: United States, 1992–1998. Morbidity and Mortality Weekly, Rep. 49 (SS-3), 111.Google Scholar
Pollina, D.A., Elkins, L.E., Squires, N.K., Scheffer, S.R., & Krupp, L.B. (1999a). Does process-specific slowing account for cognitive deficits in Lyme disease? Applied Neuropsychology, 6, 2732.Google Scholar
Pollina, D.A., Sliwinski, M., Squires, N.K., & Krupp, L.B. (1999b). Cognitive processing speed in Lyme disease. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 12, 7278.Google Scholar
Rao, S.M. (1996). White matter disease and dementia. Brain Cognition, 31, 250268.Google Scholar
Ravdin, L.D., Hilton, E., Primeau, M., Clements, C., & Barr, W.B. (1996). Memory functioning in Lyme borreliosis. Journal of Clinical Psychiatry, 57, 282286.Google Scholar
Reed, B.R., Eberling, J.L., Mungas, D., Weiner, M., Kramer, J.H., & Jagust, W.J. (2004). Effects of white matter lesions and lacunes on cortical function. Archives of Neurology, 61, 15451550.Google Scholar
Shadick, N.A., Phillips, C.B., Logigian, E.L., Steere, A.C., Kaplan, R.F., Berardi, V.P., Duray, P.H., Larson, M.G., Wright, E.A., Ginsburg, K.S., Katz, J.N., & Liang, M.H. (1994). The long-term clinical outcomes of Lyme disease: A population-based retrospective cohort study. Annals of Internal Medicine, 121, 560567.Google Scholar
Steere, A.C. (2001). Lyme disease. New England Journal of Medicine, 345, 115125.Google Scholar
Svetina, C., Barr, W.B., Rastogi, R., & Hilton, E. (1999). The neuropsychological examination of naming in Lyme borreliosis. Applied Neuropsychology, 6, 3338.Google Scholar
Veiel, H.O.F. (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology, 19, 587603.Google Scholar
Westervelt, H.J. & McCaffrey, R.J. (2002). Neuropsychological functioning in chronic Lyme disease. Neuropsychology Review, 12, 153177.Google Scholar
Willshire, D., Kinsella, G., & Prior, M. (1991). Estimating WAIS-R IQ from the National Adult Reading Test: A cross-validation. Journal of Clinical and Experimental Neuropsychology, 13, 204216.Google Scholar
Zakzanis, K.K., Leach, L., & Kaplan, E. (1998). On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 11, 111119.Google Scholar