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The impact of chronic fatigue syndrome on cognitive functioning in adolescents

Tom Kindlon

Senior Member
Messages
1,734
http://link.springer.com/article/10.1007/s00431-015-2626-1
Free full text: http://link.springer.com/content/pdf/10.1007/s00431-015-2626-1.pdf

Original Article
European Journal of Pediatrics
First online:03 September 2015
Open Access
The impact of chronic fatigue syndrome on cognitive functioning in adolescents
  • Linde N. Nijhof
  • ,Sanne L. Nijhof
  • ,Gijs Bleijenberg
  • ,Rebecca K. Stellato
  • ,Jan L. L. Kimpen
  • ,Hilleke E. Hulshoff Pol
  • ,Elise M. van de Putte
Contributed equally
Download PDF(385 KB)
View Article

Abstract

Chronic fatigue syndrome (CFS) is characterized by persistent fatigue and severe disability.

Most adolescent patients report attention and concentration problems, with subsequent poor performance at school.

This study investigated the impact of CFS on intellectual capacity by (1) assessing discrepancies between current intelligence quotient (IQ) and school level and (2) exploring differences in current IQ and pre-CFS school performance, compared with healthy individuals.

Current data was cross-sectionally gathered and compared with retrospective pre-CFS school performance data.

Fifty-nine CFS adolescents and 40 controls were evaluated on performance on age-appropriate intelligence tests and school level.

Current IQ scores of CFS adolescents were lower than expected on the basis of their school level.

Furthermore, there was a difference in intelligence performance across time when current IQ scores were compared with pre-CFS cognitive achievement.

Healthy controls did not show any discrepancies.

Conclusion:

According to their pre-CFS intelligence assessments, CFS patients started with appropriate secondary school levels at the age of 12.

Our data suggest that CFS may be accompanied by a decline in general cognitive functioning.

Given the critical age for intellectual development, we recommend a timely diagnosis followed by appropriate treatment of CFS in adolescents.

What is Known:

• Adolescent chronic fatigue syndrome (CFS) is a debilitating condition with major impact on social and intellectual development.
• Most patients report concentration problems, with subsequent poor performance at school. Little is known about the influence of CFS on intellectual performances.

What is New:
• IQ scores of CFS adolescents are lower than the IQ scores of healthy peers with an equivalent school level.
• There is a decrease in intelligence performance across time when current IQ scores are compared with pre-CFS cognitive achievement. Healthy controls do not show any discrepancies between their current IQ, school level and previous cognitive functioning. This suggest that adolescent CFS may be accompanied by a decline in general cognitive functioning.

Keywords
Adolescent School performance Chronic fatigue syndrome Cognitive impairment IQ
 

Tom Kindlon

Senior Member
Messages
1,734
I found this paper to be generally fair.

I have two quibbles.
One is their talk about patients needing prompt treatment (i.e. CBT) when we have no data that this would reverse the problem.

Also this paragraph:
Thirdly, CFS may affect brain development and thereby cognitive development in adolescence and thus have a possible relationship with a reduced IQ since adolescence is a critical phase of brain development [28]. There are functional magnetic studies (fMRI) that show that activation of the lateral prefrontal cortex is common for a range of intelligence tests and that the magnitude of frontal cortical activation correlates highly with intelligence [2, 31]. Remarkably, MRI studies in CFS patients of de Lange et al. detected lower cortical grey matter volume in adult CFS compared with healthy controls, with a significant increase in grey matter volume in CFS patients, localized in the lateral prefrontal cortex after effective treatment with CBT [8, 9]. This change in cerebral volume was also related to improvements in cognitive speed in the CFS patients. De Lange et al. (2008) conclude that cortical plasticity in the adult human brain is responsible for the change in cerebral volume, demonstrating a surprisingly dynamic relation between behavioural state and cerebral anatomy. Given this possibility, CFS may affect brain development in adolescence and thus have a possible causal relationship with a reduced IQ.
The grey matter study of CBT had no CFS control group as I discussed in my published letter:
Change in grey matter volume cannot be assumed to be due to cognitive behavioural therapy
http://brain.oxfordjournals.org/content/132/7/e119.long
The changes seen could be due to the passage of time (patients are more likely to improve than disimprove over time particularly after they have been diagnosed).
 

Tom Kindlon

Senior Member
Messages
1,734
Seems relevant to this poor Chalder study on CFS, IQ and parental expectations that sometimes still gets cited: http://forums.phoenixrising.me/inde...rental-expectations-of-their-childs-iq.22629/
Yes, they discuss it first in the introduction as part justification for the study and then in light of the findings:
The role of IQ in adults and adolescents with CFS has not been well studied. Godfrey et al. studied IQ in CFS adolescents in a cross-sectional study design [12]. Taking into account differences in methodology, our study agrees with Godfrey in that actual IQ in CFS adolescents does not match expectations, which in our study were based on their present school level and pre-CFS school performance. Godfrey et al. showed that parents’expectations regarding the IQ of adolescents with CFS were significantly higher than those of healthy controls. They concluded that the high expectations of parents could contribute to the development of CFS. However, pre-CFS IQ levels of CFS adolescents in our study were equal to that of healthy peers, suggesting that the actual lower IQ levels in CFS adolescents represent a consequence rather than a cause of CFS. This could imply that the parents in the study of Godfrey et al. had realistic expectations about their children’s intellectual potential but that IQ was affected during the course of the disease.
 
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15,786
"School levels" probably refers to the different types of Dutch high schools: pre-university, pre-college, and pre-tradeschool.

So the students made it into one of those levels based on their test scores and a teacher review at age 11-12. Then they apparently began underperforming later, compared to other students at the same type/level of high school, following CFS onset.
 
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7
Location
Kongsberg, Norway
Appropriate treatment, what is that supposed to mean? I really wish there were appropriate treatment to prevent kids from loosing their education. The cognitive impairment is obvious for us parents of kids with ME. Both my kids could read at the age of 4-5, now they seem to have dyslexia. Math is even worse.
 

Snow Leopard

Hibernating
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5,902
Location
South Australia
That seems fair... although it's still rather a shame research funding was spent on this.

I think this study was worthwhile because they showed objectively that cognitive performance declines as a result of this illness.

I just don't agree that CBT will necessarily prevent or reverse this decline as there is no evidence that CBT leads to better cognitive performance, despite being investigated in several studies.
 
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13,774
I think this study was worthwhile because they showed objectively that cognitive performance declines as a result of this illness.

Yeah... but it does really just show us that people who report being exhausted are less good at taking IQ tests than they were before they started reported feeling exhausted. It's a bit of a shame that we're at the point where it's worth spending finding on things like that, and I think that the ill-founded speculations of Chalder and her colleagues have played a role in that.
 
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user9876

Senior Member
Messages
4,556
Appropriate treatment, what is that supposed to mean? I really wish there were appropriate treatment to prevent kids from loosing their education. The cognitive impairment is obvious for us parents of kids with ME. Both my kids could read at the age of 4-5, now they seem to have dyslexia. Math is even worse.

I see particular issues with short term memory which make learning hard.

With my child I've also noticed that her ability to do maths and remember the techniques she was learning varies with how well she is feeling.
 

user9876

Senior Member
Messages
4,556
Yeah... but it does really just show us that people who report being exhausted are less good at taking IQ tests than they were before they started reported feeling exhausted. It's a bit of a shame that we're at the point where it's worth spending one on showing that, at least partly because of the ill-founded speculations of Chalder and her colleagues.

An interesting control would be to test healthy people with IQ tests under different conditions. For example, after a lot of activity or when they have a bug or when they are in severe pain (maybe not ethical!). It seems to me that there is a need to test the stability of IQ tests under different conditions before any conclusions can be made.
 

Tom Kindlon

Senior Member
Messages
1,734
"School levels" probably refers to the different types of Dutch high schools: pre-university, pre-college, and pre-tradeschool.

So the students made it into one of those levels based on their test scores and a teacher review at age 11-12. Then they apparently began underperforming later, compared to other students at the same type/level of high school, following CFS onset.
Yes, that's it.
 

leokitten

Senior Member
Messages
1,541
Location
U.S.
"School levels" probably refers to the different types of Dutch high schools: pre-university, pre-college, and pre-tradeschool.

So the students made it into one of those levels based on their test scores and a teacher review at age 11-12. Then they apparently began underperforming later, compared to other students at the same type/level of high school, following CFS onset.

It's not just the Dutch, I believe most if not all continental European countries have this system.

In all my years studying and working in Europe and teaching undergraduate and graduate students at university I found this to be one of the most barbaric and idiotic concepts. It's decided at the young age of 11 what a child's entire life potential is and if they are worthy enough to go to university (or technical college or trade school). From that point on children go to different schools, effectively segregating them forever based on some crude measurement of their intelligence and potential at that age. This further impacts childrens' potentials because lower achieving kids don't interact or form friendships anymore with higher achievers. And even though it's theoretically possible once you've been on a track to jump up to a higher one almost no one does it because it requires years of extra schooling and testing, putting them years behind everyone else. This system effectively puts people into classes for the rest of their lives and perpetuates a classist society.

How many people in my life do i know or have met who were terrible students when they were young only to be excellent scientists/doctors/lawyers/engineers/professionals with advanced university degrees? Tons...

For all the terrible flaws in the American system this is something they get right. Almost all kids go to the same school system from K-12 and interact and form friendships with each other. While being in the same school kids are put on different subject tracks based on testing and achievement in that subject, which is much more granular and modeled after how people are in the real world. Some people excel at certain subjects and not others. In America only the top 1-5% students achieve high enough that it's determined they are beyond the subject tracks and need to go to a special gifted school with a particular focus.
 
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15,786
It's decided at the young age of 11 what a child's entire life potential is and if they are worthy enough to go to university (or technical college or trade school).
Theoretically it might work educationally - by age 11 or 12 it might be clear which kids are better at handling the types of abstract thinking which is eventually needed for university degrees. As far as segregation ... yes bad on one level, but also good on the level that the smart kids aren't isolated in large schools and treated like socially inferior freaks.

My major problem with that system in the Netherlands is that there is a lot of racism and anti-immigrant sentiment here. Most of it isn't overt (though overt racism is generally tolerated), but there are huge problems with the CVs (resumes) of minorities not getting nearly as many responses as white CVs with identical qualifications, for example. That lower level of bias is almost certainly affecting at least some teachers who will view some children based on preconceived stereotypes instead of actual capabilities, and recommend a lower level of education than is warranted.
 

SOC

Senior Member
Messages
7,849
I think we need studies in adults too, with controls matched for age and other factors.

Including educational level. I'm constantly being told that my cognition is no worse than the average person's (it is in a number of ways, but I don't usually argue with these people), but what's really significant to me is that my cognition is nowhere near what it was. I might test okay compared to a population average, but I'd fail dismally compared to people at an educational level similar to mine. I've lost a lot, and that is what is important if we're trying to evaluate the impact of the illness.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
@SOC, quite so. In an interview, on a good day, I can come across as much smarter than the interviewer. So people might jump to the conclusion that there is nothing wrong with my cognition, and that it has not degraded. Someone who is super fit before getting ME might still be able to do tons. A loss of even 75% capacity might still put them with higher physical capacity than most people. I think cognitive function is similar.

However with cognitive function there are parts of my brain that seem to operate on zombie level, and indeed if zombies existed they might be smarter than me in those capacities. As I get sicker more and more of my brain goes into zombie mode, I lose more capacities, and as I improve the opposite happens. Its not a broad loss of capacities so much as specific losses. It more resembles repeated micro-strokes rather than dementia.