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Original Investigation
September 27, 2019

Association of Seropositivity to Borrelia burgdorferi With the Risk of Neuropsychiatric Disorders and Functional Decline in Older Adults: The Aging Multidisciplinary Investigation Study

Author Affiliations
  • 1University Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
  • 2Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
  • 3University Bordeaux, Inserm, BaRITOn, URM 1053, Pôle de Gérontologie Clinique, CHU Bordeaux, Bordeaux, France
  • 4French National Reference Center for Borrelia and Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, CHRU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
JAMA Neurol. Published online September 27, 2019. doi:10.1001/jamaneurol.2019.3292
Key Points

Question  Is there an association between seropositivity to Borrelia burgdorferi and incidental neuropsychiatric disorders and functional decline in older adults?

Findings  In this cohort study that included 689 participants, no significant association between seropositivity for Borrelia burgdorferi and any of the studied outcomes (ie, cognitive decline, incident dementia, depressive symptoms, and functional decline) was found.

Meaning  This study suggests that exposure to Borrelia burgdorferi is not a risk factor for certain incidental neuropsychiatric disorders or functional decline.

Abstract

Importance  Exposure to Borrelia burgdorferi (Bb) has been reported to be associated with certain neuropsychiatric disorders.

Objective  To establish the association between seropositivity to Bb and incidental neuropsychiatric disorders (eg, cognitive decline, incident dementia, and depressive symptoms) as well as functional decline.

Design, Setting, and Participants  This prospective, 6-year follow-up cohort study was conducted in a rural southwestern region of France and included 689 retired farmers 65 years or older randomly recruited from the Farmer Health Insurance System who agreed to submit a blood sample and were participants in the Aging Multidisciplinary Investigation study, an ongoing epidemiological prospective study of aging initiated in 2007. The data were analyzed from April to May 2019.

Exposures  Borrelia burgdorferi serology testing was performed in a 2-tiered approach. During the follow-up period, cognitive decline, incident dementia, depressive symptoms, and functional decline were repeatedly assessed.

Main Outcomes and Measures  Diagnosis of dementia relied on a 3-step procedure; cognitive decline was determined using the Mini-Mental State Examination and depressive symptomatology was assessed using the Center for Epidemiologic Studies Depression scale. For disability, scores on instrumental and basic activities of daily living were investigated.

Results  Of 689 participants, 432 (62.2%) were men and the mean (SD) age was 75.8 (6.4) years. The seroprevalence rate of Bb was 6.5%. At baseline, compared with Bb− participants, those who were Bb+ were older, predominantly men, and had lower depressive symptoms. No association between seropositivity and any of the studied outcomes (ie, cognitive decline, depressive symptoms, or functional decline) was found in the crude analysis and after adjusting for confounding variables. Regarding incident dementia, no increased risk was found among Bb+ participants (hazard ratio, 0.42; 95% CI, 0.1-1.17; adjusted for diverse confounders).

Conclusions and Relevance  To our knowledge, this is one of the few longitudinal studies exploring the risk of neuropsychiatric disorders and functional decline associated with exposure to Bb. Despite its limitations (eg, a lack of information if clinical manifestations of Lyme borreliosis existed, date of exposure, or treatment received), this study suggests that seropositivity to Bb is not a risk factor for incidental neuropsychiatric disorders and functional decline.

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