We describe the case of a 61-year-old woman diagnosed with Borreliosis at the age of 57. Subsequently, the patient developed depression, anxiety, and behavioral disturbances. A lumbar puncture excluded the condition of Neuroborreliosis. The diagnostic workup included: an MRI scan, a 18F-FDG PET, a 123I-ioflupane-SPECT, an amyloid-β PET, a specific genetic analysis, and a neuropsychological evaluation. Based on our investigation, the patient was diagnosed with probable behavioral-frontotemporal dementia (bvFTD), whereas in the previous years, the patient had been considered firstly as a case of Post-Treatment-Lyme Disease and, secondly, a psychiatric patient. We believe that, in the present case, such initial symptoms of Borrelia infection may have superimposed on those of bvFTD rather than playing as a contributory cause.
McKhannGM, AlbertMS, GrossmanM, MillerB, DicksonD, TrojanowskiJQ; Work Group on Frontotemporal Dementia and Pick’s Disease (2001) Clinical and pathological diagnosis of frontotemporal dementia: Report of the Work Group on Frontotemporal Dementia and Pick’s Disease. Arch Neurol58, 1803–1809.
FederHMJr, JohnsonBJ, O’ConnellS, ShapiroED, SteereAC, WormserGP, Ad Hoc International Lyme Disease Group (2007) A critical appraisal of “chronic Lyme disease”. N Engl J Med357, 1422–1430.
MeassoG, CavarzeranF, ZappaláG, LebowitzBD, CrookTH, PirozzoloFJ, AmaducciLA, MassariD, GrigolettoF (1993) The mini mental state examination: Normative study of an Italian random sample. Dev Neuropsychol9, 77–95.
9.
DooneiefG, MarderK, TangMX, SternY (1996) The Clinical Dementia Rating scale: Community-based validation of profound and terminal stage. Neurology46, 1746–1749.
10.
SpinnlerH, TognoniG (1987) Standardizzazione e Taratura italiana di Test Neuropsicologici. Ital J Neurol Sci6, 1–120.
11.
CarlesimoGA, CaltagironeC, GainottiG, NocentiniU (1995) Batteria per la valutazione del deterioramento mentale (Parte II): Standardizzazione e affidabilitá diagnostica nell’identificazione dei pazienti affetti da sindrome demenziale. Arch Psicol Neurol Psichiatr56, 471–488.
12.
MondiniS, MapelliD, VestriA, ArcaraG, BisiacchiPS (2011) Esame neuropsicologico breve 2. Una batteria di test per lo screening neuropsicologico. Raffaello Cortina Editore.
13.
CummingsJL, MegaM, GrayK, Rosenberg-ThompsonS, CarusiDA, GornbeinJ (1994) The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology44, 2308–2308.
14.
FumagalliGG, BasilicoP, ArighiA, BocchettaM, DickKM, CashDM, HardingS, MercurioM, FenoglioC, PietroboniAM, GhezziL, van SwietenJ, BorroniB, De MendocaA, MasellisM, TartagliaMC, RoweJB, GraffC, TagliaviniF, FrisoniGB, LaforceR Jr, FingerE, SorbiS, ScarpiniE, RohrerJD, GalimbertiD (2018) Distinct patterns of brain atrophy in Genetic Frontotemporal Dementia Initiative (GENFI) cohort revealed by visual rating scales. Alzheimers Res Ther10, 46.
15.
CeramiC, MarconeA, GalimbertiD, VillaC, ScarpiniE, CappaSF (2011) From genotype to phenotype: Two cases of genetic frontotemporal lobar degeneration with premorbid bipolar disorder. J Alzheimers Dis27, 791–797.
16.
GalimbertiD, ReifA, Dell’OssoB, PalazzoC, VillaC, FenoglioC, Kittel-SchneiderS, LeonhardC, OlmesDG, SerpenteM, PaoliRA, AltamuraAC, ScarpiniE (2014) C9ORF72 hexanucleotide repeat expansion as a rare cause of bipolar disorder. Bipolar Disord16, 448–449.
17.
PickA (1892) Beiträge zur Lehre von den Störungen der Sprache. Arch Psychiatr Nervenkr23, 896–918.
FallonBA, NieldsJA (1994) Lyme disease: A neuropsychiatric illness. Am J Psychiatry151, 1571–1583.
23.
CairnsV, GodwinJ (2005) Post-Lyme borreliosis syndrome: A meta-analysis of reported symptoms. Int J Epidemiol34, 1340–1345.
24.
AkgozA, MukundanS, LeeTC (2012) Imaging of rickettsial, spirochetal, and parasitic infections. Neuroimaging Clin22, 633–657.
25.
ElkinsLE, PollinaDA, SchefferSR, KruppLB (1999) Psychological states and neuropsychological performances in chronic Lyme disease. Appl Neuropsychol6, 19–26.
26.
MiklossyJ, KhaliliK, GernL, EricsonRL, DarekarP, BolleL, HurlimannJ, PasterBJ (2004) Borrelia burgdorferi persists in the brain in chronic lyme neuroborreliosis and may be associated with Alzheimer disease. J Alzheimers Dis6, 639–649.
27.
MiklossyJ, KasasS, ZurnAD, McCallS, YuS, McGeerPL (2008) Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis. J Neuroinflammation5, 40.
28.
AaslyJ, NilsenG (1990) Cerebral atrophy in Lyme disease. Neuroradiology32, 252–252.
29.
BlancF, PhilippiN, CretinB, KleitzC, BerlyL, JungB, KremerS, NamerIJ, SellalF, JaulhacB, de SezeJ (2014) Lyme neuroborreliosis and dementia. Alzheimers Dis41, 1087–1093.
30.
WeitznerE, McKennaD, NowakowskiJ, ScavardaC, DornbushR, BittkerS, CooperD, NadelmanRB, VisintainerP, SchwartzI, WormserGP (2015) Long-term assessment of post-treatment symptoms in patients with culture-confirmed early Lyme disease. Clin Infect Dis61, 1800–1806.
31.
NewbergA, HassanA, AlaviA (2002) Cerebral metabolic changes associated with Lyme disease. Nucl Med Commun23, 773–777.
32.
CeramiC, DodichA, LettieriG, IannacconeS, MagnaniG, MarconeA, GianolliL, CappaSF, PeraniD (2016) Different FDG-PET metabolic patterns at single-subject level in the behavioral variant of fronto-temporal dementia. Cortex83, 101–112.
33.
KrudopWA, DolsA, KerssensCJ, EikelenboomP, PrinsND, MöllerC, SchouwsS, RhebergenD, van ExelE, van der FlierWM, SikkesS, ScheltensP, StekML, PijnenburgYAL (2017) The pitfall of behavioral variant frontotemporal dementia mimics despite multidisciplinary application of the FTDC criteria. J Alzheimers Dis60, 959–975.
34.
MorganS, KempP, BooijJ, CostaDC, PadayacheeS, LeeL, WalkerZ (2012) Differentiation of frontotemporal dementia from dementia with Lewy bodies using FP-CIT SPECT. J Neurol Neurosurg Psychiatry83, 1063–1070.
