Correlates and Predictors of Subjective Cognitive Complaints in Post-Treatment Lyme Disease

John Keilp, Columbia Univ/NYSPI, New York, United States
Navya Singh, Columbia Univ/NYSPI, New York, United States
Marianne Gorlyn, Columbia Univ/NYSPI, New York, United States
Brian Fallon, Columbia Univ/NYSPI, New York, United States


Post-Treatment Lyme Disease (PTLD) is a post-infectious condition involving reemergence of symptoms following infection with, and presumably adequate treatment for Lyme disease.  Subjective complaints of neurocognitive impairment are elevated in individuals with PTLD, and deficits in performance are commonly found on processing speed, memory, working memory, and language tasks.  Subjective complaints, however, are often more severe than actual deficits identified by testing.  This study examined the relationship of PTLD patients’ subjective cognitive complaints to a variety of symptom measures, as well as to actual neuropsychological performance, in a clinic sample of PTLD patients.

Participants and Methods:

Participants included 74 patients with probable or definite PTLD and no other serious medical or neurological illnesses or other comorbid tick-borne illnesses.  Participants received the Cognitive Failures Questionnaire (CFQ) to assess cognitive complaints.  They also received a battery of behavioral and physical symptom rating scales (Beck Depression Inventory-II [BDI-II], Zung Anxiety Scale, Epworth Sleep Scale, Fatigue Severity Scale, McGill Pain Scale, SF36 Physical and Mental Scales) as well as a battery of neuropsychological tests (NAART-R, abbreviated WAIS-IV, WMS-IV Logical Memory and Visual Memory subtests, Finger Tapping, Grooved Pegboard, Trail Making, Buschke Selective Reminding Test, Letter and Category Fluency, Choice Reaction Time, CPT-IP, computerized Stroop task, and A, Not B Timed Reasoning Test).  Correlations and stepwise regressions were run to determine the best correlates and predictors of the CFQ scores.


PTLD patients averaged 41.0 ± 16.5 years of age (range 16-75), were 60.8% male with approximately 16 years of education and high average estimated ability.  Cognitive complaints were elevated (CFQ mean 52.0 ±19.8) and patients reported mild depression, mild to moderate anxiety, higher than normal daytime sleepiness, moderate fatigue, mildly elevated pain, and mild to moderate functional impairment.  The CFQ score did not correlate with age, sex or education, but did with estimated ability (NAART-R, r=.22, p=.05) depression (BDI-II, r=.48, p<.001), anxiety (Zung, r=.44, p<.001), sleepiness (Epworth, r=.45, p<.001), fatigue (FSS, r=.44, p<.001), physical dysfunction (SF36 Physical, r= -.24, p=.04), and mental dysfunction (SF36 Mental, r= -.41, p<.001).  However, CFQ corelated with only 1/27 test scores (Digit Span, r=.26, p=.03).  Stepwise regression generated an equation (Multiple R=.65, F[4,69]=12.36, p<.001) with four predictors that accounted for 41.7% of the variance in CFQ, including BDI-II (Beta=.45), Epworth Sleepiness (Beta=.27), sex (Beta=.20), and NAART-R (Beta=.19).  Exploratory regressions revealed an additional contribution from poor Trails A performance (Beta= -.18) with an additional 1.8% of variance in CFQ explained, but no other neuropsychological test scores.


Subjective cognitive complaints in PTLD were primarily affected by mood and sleep disturbance, female sex, and higher premorbid ability, with little association to actual test performance.  Characterization of neurocognitive deficits in PTLD requires formal testing, though further research examining the interactions between specific patient characteristics and specific areas of cognitive performance may improve prediction of PTLD patients’ subjective experience.

Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses)

Keyword 1: lyme disease
Keyword 2: cognitive functioning
Keyword 3: self-report