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Cognitive testing causes mental exhaustion lasting days

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Simon McGrath takes a brief look at a recent paper that reveals some of the most powerful evidence of cognitive problems in people with ME/CFS to date...

It might not come as a huge surprise to patients, but a new study has found that mental fatigue can persist long after mental exertion is over.

Specifically, after a 3-hour session of cognitive testing of memory and attention, healthy controls took an average of 7 hours to recover, compared with 57 hours - more than two days - for CFS patients.

While one previous study found mental fatigue continues days after physical exertion, this appears to be the first research paper to demonstrate that mental exertion itself leads to prolonged mental fatigue.

To me, the large difference found between patients and controls makes this some of the most powerful evidence of the cognitive problems in ME/CFS.

Interestingly, this finding only came about thanks to the alertness of Susan Cockshell, the lead researcher who told me:

“I hadn’t originally planned to collect this data, but I had to follow up one of my first participants a few days after testing and she told me she was still fatigued.”

So, post-test mental fatigue was added to the measures.

Mental fatigue for both healthy controls and patients peaked several hours after testing (albeit at lower levels for controls), but 24 hours later, controls were back to pre-test levels while patients were not.

It’s hard to believe we've waited till now to even see testing of post-exertional mental fatigue. Cockshell commented that surprisingly little data existed in this area, but her study shows it is an issue that needs further investigation.

Subjective measures don't match objective measures

The main aim of the study was actually to see if patients’ reports of problems with mental tasks were backed up by objective test of cognitive function - specifically of memory and concentration, two distinctive problems with ME/CFS.

The result? There was no significant correlation between patient reports of fatigue and measured cognitive performance. But this doesn’t mean that patients don’t really have problems with mental tasks because, as Cockshell pointed out, there was also no correlation in healthy controls either (healthy controls reported some problems with memory and concentration too).

The paper concludes:

“There is little evidence for a relationship between subjective and objective measures of cognitive functioning for both people with CFS and healthy controls, which suggests that they may be capturing different constructs.”

In fact, a lot of evidence now shows that people’s self-reported cognitive problems aren't matched by the kind of objective tests used in these studies, which does beg the question: Do we need better tests of cognitive problems in the real world?

stroop1.jpg
To understand this issue better, let’s take the example of concentration, which in the real world means problems such as focusing on reading or blocking out background noise. One measure of concentration (or ‘attention’ in the jargon) is the "Stroop" - a quirky test with a quirky name.

The simplest way to see how it works is just to look at the two lists above. Don’t read them, instead say the colour each word is displayed in, as quickly as you can. Not so easy, but try it online!

Of course, we never have to do tasks like this in real life (and most other cognitive tests are similarly contrived), so is this a meaningful way to measure patients’ problems?

One researcher and clinician, Gudron Lange, has highlighted how everyday tasks, such as going shopping, involve multi-tasking, something that most cognitive tests miss.

Lange has suggested using cognitive tests that include multi-tasking – and virtual reality now provides a way to test real-life scenarios using multi-tasking in the lab.

Cockshell agrees that more work is needed in this area:

“I think a better understanding of the cognitive problems occurring in the real world is required ... but that's a whole other area of research.”

Patients don’t overestimate their problems

Some researchers have argued that the problem in CFS isn't that patients can't do much or perform well, but that they simply underestimate how much they actually do, almost seeing CFS as a delusion syndrome. But this new study, like several others, found that the theory doesn’t hold up:

“Self-reported problems were not due to people with CFS overestimating their problems, as they were able to accurately evaluate their performance on most cognitive tests.”

In fact, patients were at least as good as controls at judging their own performance.

The future...

These clear findings of extended fatigue after the testing fit with an earlier fMRI study (also by Lange), indicating that CFS patients had to use more brain areas to achieve the same results as healthy controls. As Cockshell says:

“People with CFS may perform comparably to their peers by expending additional cognitive effort, and this may subsequently impact on their levels of fatigue.”

This paper provides powerful new evidence of the problems faced by patients with our condition. Yet the mismatch between reported issues and objective performance suggests there we still haven’t found the best way to measure the very real problems experienced by ME/CFS.

Hopefully, this will soon change.

Susan Cockshell will be speaking about her work at the IACFS Conference on Sunday 23.3.14. Read more: Brain Fog: The research.

Simon McGrath tweets on ME/CFS research:




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I have one leg "functionally" shorter than the other.:cautious:

They haven't suggested it's somatoform, or sent me to a shrink for it yet. :rolleyes:

But I haven't been sent to a shrink for my ME either.
Apparently there was one in Dundee, but he was desperately oversubscribed, so refusing to take any more on, and not having any success anyway. (That's what my gp told me. But he is known to tell lies.)

I am 5' 0" when I stand one one of them, and 5' 2" if I stand on the other.
The sciatica is caused by the imbalance in my hips, something is pressing on some major nerve right inside my right buttock, (it sends pains up and down the whole leg, jerks, twitches, etc.)
and the fact that I now tend to walk on a camber.:D

Well if you could 'Somatoform' the length of your legs, then I would wish myself two inches taller both sides :). I have lost two inches in height since ME.

Don't know about a GP. We need Doctor Who to transport you back to the 1970s so that you can wear great big 8" platforms on one foot, and sawn off 6" platforms on the other. :D
 
Which Dr.Who? (I'm fussy ;))

Before it got "seen" to I did spend about 3 months wearing one high-heeled (2") bright red clog and one lower-heeled (I") bright lime green one.
Fortunately, it didn't look out of place on me.:rofl:

I had my teens in the early '70s. :cautious:
Don't knock it. We had heavy metal, glam rock, punk and ska then. :thumbsup:
It wasn't all Grease-y disco!
And while the clothes and shoes were ridiculous, at least we all knew it - that was the point.:p
 
Well if you could 'Somatoform' the length of your legs, then I would wish myself two inches taller both sides :). I have lost two inches in height since ME.

I appear to have gained 2 inches in the past 2 years! I probably haven't, but I am having to use walking sticks that are two inches longer now. The ones I was using before are much too short now.

The most likely explanation is that I was stooping before (although my posture has tended to be good all my life).

Or my arms have become shorter, which may mean that I have evolved...

Or I am holding my shoulders higher, maybe thanks to my muscle redevelopment.

It's intriguing, and I must get my height measured when I have the opportunity.
 
I appear to have gained 2 inches in the past 2 years! I probably haven't, but I am having to use walking sticks that are two inches longer now. The ones I was using before are much too short now.

The most likely explanation is that I was stooping before (although my posture has tended to be good all my life).

Or my arms have become shorter, which may mean that I have evolved...

Or I am holding my shoulders higher, maybe thanks to my muscle redevelopment.

It's intriguing, and I must get my height measured when I have the opportunity.
I have read something to do with Testosterone deficiency causing loss of height... think it had something to do with spinal disks.. but cannot swear to it...
 
I have had my height officially measured (by various nurses) recently at;
5' 0.5"
5'
5' 1.5"
5' 2"

I was 5' 1.5" all my life before...

Your longer sticks, I would think, MeSci, are needed because you are probably holding yourself better?

- or your arms are disappearing into your shoulders - the way my leg has gone up into my hip:p
 
I have read something to do with Testosterone deficiency causing loss of height... think it had something to do with spinal disks.. but cannot swear to it...
There was also a recent case on one of the British newspaper sites about a women with a collagen disorder (often associated with Ehler-Danlos Syndrome) who was shrinking due to her neck basically having less support.
 
There was also a recent case on one of the British newspaper sites about a women with a collagen disorder (often associated with Ehler-Danlos Syndrome) who was shrinking due to her neck basically having less support.

A friend of mine with Diabetes, had had a long time off work feeling really run-down and they thought eventually it was because he was being too strict with his diet. So he upped the intake of sugar, began feeling better: but then a test result came back showing his was rather low in testosterone.

They measured it over time and still it was showing a marked below average - in a man. So they've now boosted his testosterone levels artificially with shots (or something), and he's back and work and better than before.

I am not sure if testosterone has anything to do with diabetes or if this was simply a case of him having diabetes as well as being low in testosterone. Incidentally, it took a private series of tests - based on his hunch and I think word of mouth - before the NHS would treat him for these low levels.

I have never really looked into testosterone before - and haven't now - but it's possible I guess he noticed other things that might have concerned him and indicated to him a low testosterone reading. Men don't always confide much in other men.
 
A friend of mine with Diabetes, had had a long time off work feeling really run-down and they thought eventually it was because he was being too strict with his diet. So he upped the intake of sugar, began feeling better: but then a test result came back showing his was rather low in testosterone.

They measured it over time and still it was showing a marked below average - in a man. So they've now boosted his testosterone levels artificially with shots (or something), and he's back and work and better than before.

I am not sure if testosterone has anything to do with diabetes or if this was simply a case of him having diabetes as well as being low in testosterone. Incidentally, it took a private series of tests - based on his hunch and I think word of mouth - before the NHS would treat him for these low levels.

I have never really looked into testosterone before - and haven't now - but it's possible I guess he noticed other things that might have concerned him and indicated to him a low testosterone reading. Men don't always confide much in other men.
The answer to your implied question @Firestormm is a resounding yes. Testosterone has a relationship to some forms of diabetes (more strongly in type II) and more recent research implies it plays a role in Insulin action (that is by no means universally agreed as yet).

Lowered testosterone is very common in people with PWME but by no means universal.

About normal isn't it? The ME patients must prove their own problem before receiving any help at all.