Brain Drain – Brain Gain: Dr. Lapp On The Cognitive Problems In Chronic Fatigue Syndrome And What To Do About Them

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Reprinted with kind permission of Health Rising, Sunday, October 20th, 2013

By Cort Johnson

Dr. Lapp has been treating chronic fatigue syndrome and fibromyalgia patients for decades at the Hunter-Hopkins Center, and regularly participates in clinical trials. In his latest newsletter he addresses the cognitive problems found in ME/CFS, briefly reviews the scientific literature, and offers up some treatment ideas.

It’s tough to lose your mental sharpness to a disease but all may not be lost. Dr. Lapp suggests some ways to combat the cognitive declines common in chronic fatigue syndrome. The research says the cognitive deficits in ME/CFS are relatively subtle compared to some other illnesses, but my guess is that a series of subtle deficits in information processing, short term memory, concentration, etc., can lead to pretty big cognitive and emotional hits.

Dr. Lapp notes cognitive problems are amongst the ‘most functionally disabling and disturbing symptoms found in ME/CFS.

The easy distractability, and flitting from half-completed task to half-completed task is something that I struggle with every day. It’s perhaps not surprising that several studies suggest high rates of ADHD are present in both fibromyalgia and chronic fatigue syndrome.

Short-term memory problems and intrusive body sensations can make it difficult to follow conversations and understand the printed word. Of course, there’s also the sheer mental fatigue; the inability to, at times, meaningfully incorporate, grasp or even understand outside events. It’s as if a wall came down, and all one’s mental energy is devoted to keeping one’s body going.

The loss of spontaneity and richness that disappears from interactions, and the kind of blasted or half-self that’s left over sometimes can be devastating emotionally. For me, when it gets that bad, all I can do is cultivate patience.

Documenting the Brain Drain 

Dr. Lapp notes that neuropsychological tests can find deficits, but other tests can provide insights into the causes of the cognitive issues in ME/CFS.  Brain MRI’s find Unidentified Bright Objects (UBO’s not UFO’s) – small brain lesions –  in up to 80% of  ME/CFS patients, and they appear to be correlated with physical impairment. The amygdala may be one area of the brain damaged in ME/CFS.

Researchers have not known what to do with these small lesions. Because they tend to occur in different places in different people, and because healthy people can have them, it’s not clear how important they are. However important or not important each specific lesion is, though, the fact that people with ME/CFS have significantly more small lesions than healthy people, in itself, suggests something significant has gone awry.)

SPECT scans often show reduced blood flow (i.e., reduced metabolism – reduced brain functioning) in the temporal lobes, amygdala, hippocampus and midbrain. PET scans show reduced metabolism in the brainstem, which controls many of the basic functions of the body (heart rate, breathing, sleeping.)  Some brain volume appears to have been lost in the most severely ill – perhaps because of reduced physical activity) – and can be prevented or reversed by physical activity –  if you can do it. Japanese studies indicate low levels of carnitine (acetyl-carnitine) are associated with reduced cognition.

Improving Cognition in Chronic Fatigue Syndrome and Fibromyalgia Supplements 

  • Carnitine – Dr. Lapp confirms that carnitine  (1000 mg/day) can help with thinking, concentration and memory. Acetyl-carnitine increases glutathione levels (reduced in brains of ME/CFS patients), increases brain blood flow (reduced in ME/CFS), ATP production, and acetylcholine activity.
  • Gingko Biloba – can increase brain blood flows – again, a documented problem in ME/CFS.
  • Phosphatidyl serine (PS) – brain PS levels are associated with normal nervous system signaling,  glucose consumption and other factors important in brain functioning.
  • B-12 – methylcobalamin 1000mcg to 5000mcg daily / methylfolate (400mcg daily)
  • Procera AVH (acetyl-carnitine + vinpocetine+ huperzine) – Derived from the periwinkle flower, vinpocetine  increases cerebral blood flows, and, according to Procera’s manufacturers, has been shown to increase memory and brain processing speed – both of which are impaired in ME/CFS.
  • Vinpocetine also is an anti-oxidant/neuro-protective agent, and can increase glucose metabolism (energy levels) in the brain. Derived from Chinese Club Moss, huperzine A (HUP) increases the levels of the neurotransmitter acetylcholine in the brain, and is an antioxidant.

Prescription Drugs 

Pharmaceutical companies are more and more interested, as our population ages, in finding drugs to enhance cognition


Defects in folate and B12 metabolism are sometimes found in chronic fatigue syndrome, and some patients find B-12 protocols work very well.  Both defects are thought to contribute to cognitive issues.

  • B-12 –  Deplin ( 15 mg of methylfolate), Metanx ( 3 mg methylfolate / 2 mg B12 / 35mg pyridoxil-5-phosphate), and Cerefolin NAC (methylfolate 5.6mg, B12 2mg, N-acetyl cysteine 600mg).

Brain Enhancers 

Pharmaceutical companies have been plumbing the ‘brain enhancement’ market more and more as our population ages, and studies reveal nutritional deficits in the brain. The ‘medical foods’ below target nutritional deficiencies associated with disease.

  • Vayacog (omega-3 fatty acids 26mg + phosphatidyl serine 100mg) – this ‘medical food’ was created to repair lipid (fatty acid) imbalances that have been associated with memory problems.
  • Axona (an alternative energy source that the brain can use instead of glucose, 40 gm twice daily) – FDA approved to treat Alzheimer’s, Axona attempts to alleviate the effects of the reduced brain glucose levels associated with that disease. Axona metabolizes to ketone bodies which the brain can use when it’s not using glucose. Axona comes in small packets and is mixed with liquids. Half the ME/CFS patients in one study demonstrated reduced cerebral glucose uptake in one part of their brain for another in one study, and 90% did in another earlier one.
  • Prevagen (a jellyfish extract that affects calcium channels).

Drugs Used in Alzheimer’s

Dr. Lapp reported that galantamine (Razadyne), donezepil (Aricept), and memantine (Namenda) have all undergone brief trials in ME/CFS, but while some patients respond to them, most do not, and in general, unless dementia is present, he doesn’t recommend them. Dr. Lapp has run the Hunter-Hopkins Center for the treatment of Chronic Fatigue Syndrome and Fibromyalgia for almost 20 years

Mind-Stimulation the Old Fashioned (and New-Fashioned Way) 

Dr. Lapp recommends challenging your mind with crossword puzzles, word games, card or board games and computer games.  (Like anything else – if you don’t use it – you can lose it.)  He also recommends mind-stimulating websites such as Lumosity whose authors, Dr. Lapp reports, have ‘a special interest’ in ME/CFS).

Not Mentioned 

Interestingly, Dr. Lapp did not recommend some of the more well-known cognitive enhancing drugs such as Ritalin (methylphenidate), Provigil (Modafinil) and Adderall. [Note: All of these are stimulants, which are known to cause rebound fatigue in ME/CFS patients]

  • Carnosine – Carnosine supplementation in Gulf War Syndrome (GWS) increased one cognitive outcome substantially (and lead to a decrease in diarrhea as well )
  • Yoga, Meditation/Mind/Body Techniques – have been shown to increase concentration and improve cognition as well.

About the Author:  Cort Johnson has had ME/CFS for over 30 years. The founder of Phoenix Rising and Health Rising, Cort has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort’s and other bloggers’ work at Health Rising

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2 thoughts on “Brain Drain – Brain Gain: Dr. Lapp On The Cognitive Problems In Chronic Fatigue Syndrome And What To Do About Them”

  1. Cleobonny says:

    In comparisons of Malawi and South African Public administrations, South Africa will never be like Zimbabwe, Nigeria or Malawi therefore president’s speech should be analysed before it can be communicated and recommend its findings on the roads, shady administrations in Malawi, Zimbabwe, Nigeria and the rest of Africa before it can be announced deliberately to the stakeholders around the world. Below are four pieces of problems why the president Zuma could be right
    The president was so right South Africans are not Africans comparing with the time years has been wasted with no signs of development at all. Africa was only divided in 1884 if I am right but some African countries got independence in 1964 and others extremely earlier. To this day the number of years African leaders have ruled equal to number of years that colonisers have ruled is quite disturbing that to this day the rightful owners of these African countries look like refugees in their own countries. South Africa has achieved a lot in 19 years, world cup, it has hosted many international events, BRT systems, Gautrain, infrastructures, welfare state and et cetera.
    It’s true that no scholar knows where EXACTLY to start to analyse other countries, perhaps the problem could lie in the small brain of Africans which has shrunk over many centuries due to African kings and emperors and chiefs who handed over African Natural resources, land and wealthy to the Western world and whom THE later became African Gods. This pattern behaviour has continued to this day as demonstrated by the speech. We have Gods we look up to, the Gods we serve politically, culturally, economically, as well as socially.
    Shrunk brain of an African people is principally caused by the maintained template of western world, and Eastern World where the inferiority is been manufactured at different multitasking levels such in the speech, in education especially in government primary schools where in many countries the little children so called “future leaders” are forced to clean the unflushed toilets with their bare hands. Little children are punished through favouritism in class, teachers’ calls the students’ names such as monkeys, baboons, stupid, and some of the children even in Lesotho are being raped. In Emlazi and Mafikeng there are traces of teenage pregnancies, in fact teenagers such as students are victims to the perverts around Africa and South Africa.
    The shrunk of the brain of Africans is caused by mentors in institutions where superiority among Africans was supposed to be manufactured instead inferiority. In the work place African colleagues from morning shows signs of sex and pervert symbols. In the administration of governments and private sectors are not effective because of wasting time with trivial and inferiority among each other. Political parties carry on using the past inferiority to the present world. Some literatures, libraries and publishing companies run by certain curtail and monopoly substitutes anything else that is written by Africans. Even Some media would not promote or write an article on any African who is special but if it’s done by some different race the media seems to receive it whole heartedly.
    The brain is shrunk with years of colonization, parents who to this day can degrade their own children, shouting, angry towards them, beating their own children, not making friends with own children where they could a lot about their children. Therefore the inferiority is manufactured in the homes of many Africans. This is passed down from generation to the next generation.
    South Africans do not think like Africans to say the least, South Africans are like Albinos’. They are black only inside side not outside perhaps coconut. Real Africans inside and outside Africans get angrily quickly, short temper, warmongers, they fight a lot, they like arguing, they lack information, they are behind with everything, their leaders have denied them many rights such freedom of speech, economic freedom, policy making freedom, social freedom, cultural freedom, education freedom, development freedom, gender and wealthy equality, infrastructure freedom, and Journalists are arrested. How many How Many South Africans are in America, Asians, and Europe. How many South Africans are Nigeria, Malawi, Zimbabwe, Botswana and all other countries equal to an unimaginable number of those from Europe, America, Asian and all other Africans that are in South Africa. One day South Africa is going to be ruled by a foreigner just wait live long enough and see.
    South African crimes and Aids epidemic and other social ills are not as high as it is always researched and published in the media. This is because any statistics in South Africa are published, audited, reported and national and international research societies and institutions are free not killed or paid by the government to lie about their stats.
    South Africans are more civilised than other countries, whether you scream and jump but it’s like. The problem is the future of South Africa is not guaranteed especially government grant systems. South Africans rely too much on these systems to the point that they differ to other African dictatorial administration of security of only the person in power.
    Many Africans are refugees in their own countries; you can see their clothes, energy system, roads systems, communication systems, administrations, foreign direct investment, issues they fight for. It just becomes insane and petty how these Africans can be refugees in their own countries. One is far from civilization once one arrives at the borders. As a result South Africa must for years welcome all the nations in the world into South Africa as if their countries have no leaders whose brain has not shrunk by the historical and present evasion by outsiders.
    President polygamy is a good example that can be a solution to Africa’s economy. If every Africa has practice polygamy Africa was not going to be like this today. The fact that western world has convinced Africans the evil things of polygamy and encourage divorce and broken African nations, tribes, families.
    There is a paper at Lesotho University where it states the clear evidence how polygamy was undermined. The reasons were many African men who had more three wives were wealthy and powerful. They had vast lands, many houses for the wives, many live stocks, many children that could protect them evaders such as barbaric westerners who arrived in the disguised as religious diplomats. As we speak there are hills lands in Botswana, Zimbabwe, Malawi, Lesotho and many African countries that belong to such churches and people mainly not Africans. Some of these lands government is leasing from these lands in their own countries in which they governing.
    The disagreements and absence of polygamy in Africa and South Africa has forced both honourable gentlemen and privately insane and uncivilised men cheating on their wives gruesomely.
    Polygamy was seen and is still seen as a threat than terrorism in Africa thereby the project through policies in religious, political and traditional authority communities had to make sure that agents and actors of change both around African societies and Western world had to be started. To this day as women were used to protests against African men on issue of polygamy and to this day the project is reactive and proactive.
    Each time the outsiders came close to a polygamist man he seemed prominent and really powerful African had personal assistant, advisor, mistress, and wives by his side, thousands of workers and had children who were also productive and he controlled everything around him. Toady quite unlikely to find African men of that quality. This mounted to jealousy and envy and powerlessness by western world then it had to be identified as problem and develop it into a policy that any African men found to be having many wives had to condemned to death, his herds of cattle and lands had to be taken away from him by men of the church who demanded everything from the villages. Polygamy is good and thank you Mr President for showing good examples to African men.
    Europeans, Americans, Asians, Australians, Africans whether you jump or scream you need to forget about what you know, what you heard, what you have learnt, what you have touched, what you have read, what you believe. Leave everything and take everything look into yourself and ask yourself this question. Does the politics affect your life, does it determine the food you eat, the clothes you wear, the beer you drink, the religion you are in, the house you live in, the education you have, the job you have, the business you have, the income you earn, the wealthy you have, the poverty you are in, the area you residing, the lack of education you are in, the pictures and words on TV and radio, the books you read, the technology you have, the shopping centres and the shop owners you see, the friends you have, the death in your family, the disease they have, the life-span you have, the car you drive. Yes take time look at all these and think of a new idea and change your ways. Politics affects every part of your life whether you jump, you scream you rejcet the notion, it does affect everybody.
    To politicians
    Formulate policies that are effective, stop elite model policy where you govern the ill-informed public masses. Your people are not herds of cattle, in fact they are humans. Give the value preferences to your own people before your interests. The first phase is to start from scratch not to continue with any elite policy. Many African countries legitimise only the ruling party and the president policies and only individual policies apply to all members of societies. How is that possible in a country of the masses?
    Allow the general public to negotiate and participate and the government can only mediate and resolve the conflict among the public. Development and sustain your nations instead of manufacturing inferiority among Africans.
    Let the public set the agenda through your leadership and let the masses even lead from behind. Encourage and let the strong points that matters from the masses converted to national policies and identify the main problems that the masses face not the elite’s problems alone. Arrive at stability and inspiring nation from just focusing on power relations and crisis management against your own nation.
    Stop manufacturing the African continent of inferiority through the mendicant or beggar culture. Depend on yourself not your Gods, you are destroying Africa by begging too much. Do not be surprised when South African president utters such. The whole administration should not focus on administering begging systems. South African administration is not a begging administration but welfare administration that is manufacturing the superiority among South Africans. It will always be like at least for now.
    When you formulate your policies for your masses work it within the budget and the cost so that you do not beg much.
    Many of these African countries uses unprogrammed and impulsive and even programmed policies, gender setting and decisions against when it suit them. This should be neutralised and civilise yourself and your nations and implement issues that becomes solution to the masses not to individual.
    Many African countries lack a capacity and does not regards and commit themselves to the masses as their legitimate clients.

  2. gbrown2 says:

    due to the devastating effect chemicals have on people with mcs those that suffer mcs along with me/cfs fms would be well advised to carefully monitor drugs they take even those that eminent drs like Lapp recommend
    I recommend you introduce them one at a time to observe their effects

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