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Information processing efficiency in Chronic Fatigue Syndrome (CFS) & multiple sclerosis

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OBJECTIVE–To compare the cognitive performance of subjects

with chronic fatigue syndrome (CFS), multiple sclerosis (MS),

and healthy controls. All subjects were matched for age,

education, and verbal intelligence, as previous

neuropsychological studies of CFS had not used appropriate

control groups.

DESIGN–Case-control design. All subjects were

given a neuropsychological battery and the test scores were

compared among the groups.

SETTING–Subjects with CFS and

subjects with MS were recruited from private and institutional

practice and from the community. Healthy subjects were

recruited from the community.

PATIENTS/OTHER

PARTICIPANTS–Twelve subjects (all female) with CFS

participated in the study. Chronic fatigue syndrome was

diagnosed in these patients in accordance with the

requirements outlined by the Centers for Disease Control as

modified subsequently to not exclude patients with concurrent

depression and/or anxiety. All subjects with CFS were referred

for a neuropsychological examination to assess persistent

cognitive complaints. Eleven subjects (10 female, one male)

with the diagnosis of clinically stable MS were chosen from

clinics and the community because of complaints of mild to

moderate cognitive impairment. The subjects with MS and 11

healthy volunteers (10 female, one male) were matched to the

group with CFS by age, education, and estimated verbal

intelligence (based on the Vocabulary subtest of the Wechsler

Adult Intelligence Scale-Revised). The subjects with MS had a

mean Kurtzke Expanded Disability Status Scale score of 4.95

(SD, 1.95; range, 2.0 to 7.5). As a result of the matching

procedure, there were no differences among the three groups in

age (F[2,31] = 0.32), education (F[2,31] = 0.80), and verbal

intelligence (F[2,31] = 0.31).

INTERVENTIONS–None.

MAIN OUTCOME MEASURES–These measures included the Beck Depression

Inventory (BDI), the Paced Auditory Serial Addition Test

(PASAT), Digit Span Test, and the Similarities Test of Verbal

Abstract Reasoning.

RESULTS–The mean number of correctly

identified responses collapsed across the four PASAT trials

was significantly different across groups (F[2,31] = 4.03; P <

.05). While the CFS and MS groups did not differ from each

other, subjects with CFS (SEM, 124.2 +/- 6.4) and subjects

with MS (SEM, 112.9 +/- 10.9) scored significantly below

controls (SEM, 146.4 +/- 6.4) (Fisher’s Protected Least

Significant Difference test; P < .05). There were significant

differences among the three groups on mean Digit Span Test

performance (F[2,31] = 5.5; P < .01). While the CFS and MS

group did not differ significantly from each other, only the

CFS group was significantly lower than control (Fisher’s

Protected Least Significant Difference test; P < .05). Mean

performance on the Similarities test did not differ among the

three groups (F = 0.58). In addition, there were significant

differences among the three groups in mean BDI scores (F[2,31]

= 7.6; P < .01). The CFS and MS groups did not differ

significantly from each other, and both groups showed a

statistically significantly elevated mean BDI score relative

to the control group (Fisher’s Protected Least Significant

Difference test; P < .05). No significant correlations were

found between BDI scores and PASAT total scores (CFS, r =

-.21; MS, r = .13; control, r = .27), or between BDI and Digit

Span Test (CFS, r = -.32; MS, r = -.40; control, r = -.19).

Results of the PASAT and Digit Span Test were significantly

correlated in the CFS group (r = .71; P < .01), but not in the

MS (r = .06) or control groups (r = .49).

CONCLUSIONS–These results indicate that subjects with CFS and subjects with MS show significant impairment on a test of complex concentration when compared with appropriate controls. The data suggest that subjects with CFS and subjects with MS have difficulty on

tasks that require the simultaneous processing of complex

cognitive information.

DeLuca J, Johnson SK, Natelson BH

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