Cognitive functioning & depression in patients with Chronic Fatigue Syndrome (CFS) & multiple sclerosis

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OBJECTIVE: To assess cognitive function in patients with chronic

fatigue syndrome (CFS) and multiple sclerosis (MS) and to

evaluate the role of depressive symptoms in cognitive


DESIGN: Case-control. All subjects were given a

neuropsychological battery, self-report measures of depression

and fatigue, and a global cognitive impairment rating by a

neuropsychologist “blinded” to clinical diagnosis. Patients

with MS and CFS were additionally evaluated with a Structured

Clinical Interview for DSM-III-R (Diagnostic and Statistical

Manual of Mental Disorders, Revised Third Edition) disorders.

SETTING: Institutional and private neurological practices and

the community at large.

PATIENTS: Twenty patients with CFS

diagnosed in accord with the Centers for Disease Control and

Prevention-revised criteria who had cognitive complaints; 20

patients with clinically definite MS who were ambulatory and

were matched for fatigue severity, age, and education to CFS

subjects; and 20 age- and education-matched healthy controls.

RESULTS: Patients with CFS had significantly elevated

depression symptoms compared with patients with MS and healthy

controls (P < .001) and had a greater lifetime prevalence of

depression and dysthymia compared with MS subjects. Patients

with CFS, relative to controls, performed more poorly on the

Digit Symbol subtest (P = .023) and showed a trend for poorer

performance on logical memory (P = .087). Patients with MS

compared with controls had more widespread differences of

greater magnitude on the Digit Span (P < .004) and Digit

Symbol (P < .001), Trail Making parts A (P = .022) and B (P =

.037), and Controlled Oral Word Association (P = .043) tests.

Patients with MS also showed a trend of poorer performance on

the Booklet Category Test (P = .089). When patients with CFS

and MS were directly compared, MS subjects had lower scores on

all measures, but the differences reached significance only

for the Digit Span measure of attention (P = .035).

CONCLUSIONS: Patients with CFS compared with MS have more

depressive symptoms but less cognitive impairment. Relative to

controls, a subset of CFS subjects did poorly on tests of

visuomotor search and on the logical memory measure of the

Wechsler Memory Scale-revised. Poor performance of logical

memory in CFS appears to be related to depression, while

visuomotor deficits in CFS are unrelated. Cognitive deficits

in patients with MS are more widespread compared with those in

patients with CFS and are independent of depressive symptoms.

Krupp LB, Sliwinski M, Masur DM, Friedberg F, Coyle PK

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