Cognitive and Psychiatric Impact of Tick-borne Disease

Tick-borne diseases, particularly Lyme disease, have recently become a growing public health concern. While many people associate these diseases with physical symptoms like fever, fatigue, and joint pain, they can also significantly impact cognitive and psychiatric functions. 

Studies show that illnesses transmitted through ticks can lead to various mental health difficulties, such as difficulty concentrating, memory problems, depression, anxiety, and other psychiatric disorders (Fallon et al., 1992). However, these cognitive and psychiatric impacts are often overlooked, leading to misdiagnosis and inadequate treatment.

It is important to note that tick-borne illness can impact a child or an adult immediately or many weeks or months later. Ticks can carry infections and parasites that lead to PANS, which is linked to psychiatric and neurocognitive symptoms. 

What is Lyme Disease?

The spiral-shaped Borrelia burgdorferi (Bb) bacterium is responsible for causing Lyme disease, an infection transmitted by ticks. Ticks are the primary carriers of Bb. However, some professionals believe other biting insects and spiders can transmit the bacteria. 

Furthermore, transmitting the bacteria from a pregnant woman to her unborn child through the placenta is possible. This condition is known as congenital Lyme. Studies by Schlesinger et al. in 1985 have reported poor treatment outcomes for individuals with congenital Lyme.

Neurological Lyme disease is a severe condition that results from the bacteria's invasion of the central nervous system. Individuals in the late stage of Lyme disease have a 15-40% possibility of developing neurological disorders. 

Such disorders can manifest in several months or even years if the initial infection remains untreated. In addition, diagnosing its physical and psychological symptoms can be challenging as it may impact any nervous system region, particularly the brain.

Symptoms of Lyme Disease

Lyme disease symptoms can vary widely depending on the stage of infection. In the early stages, typically within 3 to 30 days of a tick bite, symptoms may include:

• A red, bull's-eye-shaped rash (known as erythema migrans) that spreads from the site of the tick bite
• Flu-like symptoms, including fever, chills, headache, fatigue, muscle aches, and joint pain
• Swollen lymph nodes

As the disease progresses and if left untreated, chronic symptoms may worsen and can include:

• Severe headaches and neck stiffness
• Additional rashes on other areas of the body
• Facial palsy (drooping of one or both sides of the face)
• Arthritis with severe swelling and joint pain, particularly in the knees and other large joints
• Heart palpitations and dizziness
• Nerve pain
• Cognitive problems, like memory loss and difficulty concentrating
• Psychiatric symptoms, such as major depression, anxiety disorders, and irritability

What is PANS/PANDAS?

Pediatric Acute-onset Neuropsychiatric Syndrome, or PANS, is a condition that occurs when an infectious trigger causes an immune response that goes awry. Familiar infectious sources that may lead to PANS include Lyme disease, pneumonia, sinus infections, allergies, and environmental triggers such as mold. As the infectious trigger causes inflammation, severe neurological symptoms may form, significantly impacting the person’s well-being.

On the other hand, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections, or PANDAS, is a clinical condition triggered by Group A strep infections. The abrupt manifestation of neuropsychiatric symptoms, such as tics or obsessive-compulsive disorder, is a defining feature of the disease.

Typically, children diagnosed with PANDAS have a history of strep throat or a positive blood strep test. Streptococcal infections may not be apparent in a throat culture, but they can be present in the blood and organs of affected individuals.

Symptoms of PANS/PANDAS 

The following symptoms of PANS/PANDAS can vary widely, but both conditions are characterized by a sudden onset and persistent neuropsychiatric symptoms. Here are some common symptoms of each:

PANS:

• Obsessive-compulsive behaviors (OCD)
• Anxiety, including separation anxiety
• Extreme irritability, mood swings, and emotional instability
• Behavioral regression, including acting younger than their age
• Loss of academic abilities or sudden-onset learning disabilities
• Sensory or motor abnormalities, such as tics 
• Sleep disturbances and frequent nighttime awakenings
• Urinary frequency and bedwetting

PANDAS:

• Obsessive-compulsive (OCD) behaviors and symptoms, including intrusive thoughts and compulsive behaviors
• Tics, such as eye blinking or facial twitches
• Mood swings, irritability, and anxiety
• Behavioral regression, including acting younger than their age
• Sudden-onset learning disabilities or declines in academic abilities
• Sensory or motor abnormalities, such as handwriting changes or loss of coordination
• Sleep disturbances and frequent nighttime awakenings
• Urinary frequency and bedwetting

What are the Cognitive Impacts of Tick-Borne Diseases?

Tick-borne diseases can have a significant impact on cognitive function. Some of the cognitive symptoms reported in patients with tick-borne diseases include:

1. Memory Loss

Lyme disease has been shown to cause short-term memory loss, making it difficult to recall recent events or conversations (Bujak et al., 1996). In some cases, patients may also experience long-term memory loss, which can affect the ability to recall events from the past.

2. Difficulty with Concentration and Attention

People with tick-borne diseases may be unable to focus on tasks and be easily distracted or forgetful. They may encounter challenges when completing tasks requiring sustained attention. They'll also need help with following conversations or lectures.

3. Confusion or Disorientation

Confusion and disorientation can be particularly concerning for patients, as they may feel they are losing touch with reality or cannot navigate their environment safely. In addition, it can be distressing for family members or caregivers who may be unsure how to provide support. As patients with tick-borne diseases experience disorientation, they may feel “out of it” or have difficulty understanding their surroundings.

4. Brain Fog or Mental Fatigue

Brain fog or mental fatigue can be particularly problematic for patients trying to work, attend school, or perform other complex tasks requiring high cognitive function. Due to cognitive difficulties, Lyme patients may feel frustrated or discouraged by their inability to perform as well as they usually would because they frequently experience mental exhaustion and sluggishness. 

5. Slowed Information Processing Speed

Slowed information processing speed can be particularly challenging for children and teens when they do academic work. Unfortunately, this symptom can lead to frustration and reduced quality of life. As they experience difficulty processing information at an average speed, they'll also exhibit delayed reactions, slowed thinking, and reduced mental efficiency. They are unable to make quick decisions.

6. Executive Dysfunction 

People with tick-borne diseases will have poor planning and decision-making skills. They'll also have issues with working memory, mental flexibility, and self-monitoring. Executive dysfunction can result in difficulty with organization, initiating, and completing tasks. It also results in problems with time management and emotional regulation.

7. Emotional Instability  

Emotional instability and mood changes may result from the infection's direct effects on the brain and nervous system. However, these may also be a secondary effect of other cognitive symptoms, such as executive dysfunction.

People with tick-borne diseases suffering from emotional instability may exhibit low mood, social withdrawal, and emotional outbursts that can impact their daily functioning. It also affects their relationships with family and friends.

Psychiatric Impact of Tick-Borne Diseases

Tick-borne diseases can have a significant psychiatric impact on affected individuals. These diseases are caused by bacterial, viral, or parasitic infections transmitted by ticks. In the United States, Lyme disease is the most prevalent tick-borne illness. Here are some of its psychiatric impacts:

1. Anxiety and Depression

Recent studies have shown that individuals with Lyme disease and other tick-borne illnesses are more likely to experience anxiety and depression (Mustafiz et al., 2022). It may be due to the physical symptoms of the condition, as well as the stress and uncertainty of living with chronic Lyme Disease.

2. Psychosis

In rare and severe cases, tick-borne diseases can cause psychosis, including delusions and hallucinations. It is more likely to occur in individuals with preexisting psychiatric disorders. Suicidal thoughts leading to actual suicide attempts are a risk factor here. 

3. Post-Treatment Lyme Disease Syndrome (PTLDS)

PTLDS (Post-Treatment Lyme Disease Syndrome) is a medical condition that can impact individuals even after undergoing treatment for Lyme disease. It can cause persistent symptoms such as joint pain, cognitive deficits, and chronic fatigue syndrome, leading to significant psychological distress for those affected.

Why is Lyme Disease Missed and Misdiagnosed?

Despite being a growing public health concern, Lyme disease is frequently missed and misdiagnosed, leading to inadequate treatment and potentially life-long complications. 

There are several reasons why Lyme disease is difficult to diagnose, which can contribute to a delayed or missed diagnosis:

Lack of Awareness and Education

Many healthcare providers are not adequately trained or educated about Lyme disease, leading to a lack of recognition of symptoms and a delay in diagnosis. Misconceptions about Lyme disease, such as the belief that it is only found in certain geographic regions, how long a tick must be attached, that you have to have a bullseye rash, etc., can also lead to missed diagnoses.

Over-Reliance on Testing

While laboratory testing can help diagnose Lyme disease, it is not always reliable. The standard testing for Lyme disease only detects antibodies, which may not be present in the early stages. False negatives are common with this test, leading to missed diagnoses.

Vague Symptoms

Symptoms of Lyme disease can be vague and nonspecific, making it difficult for healthcare providers to distinguish it from other illnesses. Symptoms like fatigue, joint pain, and headaches can be attributed to many other conditions, leading to misdiagnosis.

Delayed Onset of Symptoms

Symptoms of Lyme disease may not appear until weeks or months after infection, making it difficult to connect the symptoms to a tick bite. This delay can lead to missed diagnoses, as the patient may not associate their symptoms with Lyme disease.

Co-Infections

Ticks can transmit multiple infections, making it difficult to diagnose and treat Lyme disease. Co-infections can complicate the diagnosis and treatment process, leading to missed diagnoses and inadequate treatment.

It's important to advocate for yourself and your loved ones if you suspect Lyme disease. If a tick has bitten you or you have symptoms consistent with Lyme disease, seek expert care from a provider knowledgeable about tick-borne diseases. Early diagnosis and treatment are critical to prevent long-term complications.

Natural Treatment for Lyme Disease and PANS/PANDAS

Antibiotic treatment is primarily recommended for most tick-borne diseases, and it can be helpful in the early stages of the disease. Long-term antibiotic use can also be achieved through herbal antimicrobial therapy.

However, some natural treatment options may help alleviate symptoms and support the body's immune system. Many natural remedies for Lyme Disease and PANS/PANDAS support the brain and body. 

Here are science-backed, natural solutions for parents to help kids with Lyme diagnosis: 

1. Neurofeedback 

Neurofeedback is a safe and effective technique that helps calm the nervous system and improve cognitive function and attention. Working with an experienced neurofeedback practitioner is crucial in tick-borne diseases. They can help regulate the brain and manage related infections or toxins with significant expertise.

Neurofeedback is a potent method to mitigate rigidity and rage, including emotional and behavioral reactivity related to PANS/PANDAS. Ensuring safe and effective management of negative behaviors associated with these conditions is vital for recovery. It also improves the mental well-being of the entire family.

2. PEMF

PEMF (Pulsed Electromagnetic Field) is a non-invasive therapy beneficial for Lyme patients with tick-borne diseases and their associated conditions, such as anxiety, depression, and OCD. PEMF therapy involves the application of low-frequency electromagnetic waves to the body to enhance cellular functioning and stimulation.

The CALM PEMF™ mobile device has been shown to reduce inflammation, which is often a significant factor in these conditions. It has also demonstrated efficacy in regulating the immune system, which is frequently impaired in individuals with PANS/PANDAS.

3. Diet and Nutrition

Children and teens with tick-borne diseases are highly recommended to follow an anti-inflammatory diet to promote healing and reduce inflammation in the body and brain (Johnson et al., 2021). A nutrient-dense diet and magnesium supplements can help support blood sugar levels and promote cognitive, mood, and behavioral regulation.

Parents should approach nutrition cautiously and seek appropriate guidance, especially when their child has food restrictions, aversions, or an eating disorder. It is a long-term process requiring patience and the advice of mental health professionals.

Your Next Steps In Managing Neuropsychiatric Lyme Symptoms

If you're seeking expert care for your family dealing with the neuropsychiatric symptoms of Lyme Disease, PANS/PANDAS, we're here to help. We offer comprehensive support and solutions for children, teenagers, and their families. Check out our case studies to learn how we can help families in our one-to-one BrainBehaviorReset™ Program in our CT neurofeedback center or fully virtually with families worldwide. 

Dealing with Lyme Disease and PANS/PANDAS can be a nightmare when you don’t have the right path. Take our solution matcher quiz to understand how to navigate the challenges of Lyme Disease and PANS/PANDAS and want to find the right next step for your family.

Citations

Bujak, D. I., Weinstein, A., & Dornbush, R. L. (1996). Clinical and neurocognitive features of the post-Lyme syndrome. The Journal of Rheumatology, 23(8), 1392–1397. https://europepmc.org/article/med/8856619

Fallon, B. A., Nields, J. A., Burrascano, J. J., Liegner, K., DelBene, D., & Liebowitz, M. R. (1992). The neuropsychiatric manifestations of Lyme borreliosis. Psychiatric Quarterly, 63(1), 95–117. https://doi.org/10.1007/bf01064684

Johnson, M., Ehlers, S., Fernell, E., Hajjari, P., Wartenberg, C., & Wallerstedt, S. M. (2021). Anti-inflammatory, antibacterial and immunomodulatory treatment in children with symptoms corresponding to the research condition PANS (Pediatric Acute-onset Neuropsychiatric Syndrome): A systematic review. PLOS ONE, 16(7), e0253844. https://doi.org/10.1371/journal.pone.0253844

Mustafiz, F., Moeller, J., Kuvaldina, M., Bennett, C., & Fallon, B. (2022, May). The Journal of Nervous and Mental Disease. Journals.lww.com. https://journals.lww.com/jonmd/Abstract/2022/05000/Persistent_Symptoms

Schlesinger, P. A., Duray, P. H., Burke, B. A., Steere, A. C., & Stillman, M. T. (1985). Maternal-Fetal Transmission of the Lyme Disease Spirochete, Borrelia burgdorferi. Annals of Internal Medicine, 103(1), 67. https://doi.org/10.7326/0003-4819-103-1-67