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Last updated January 1, 2014

Relationships of Cognitive Difficulties to Immune Measures, Depression and Illness Burden in CFS

Susan Lutgendorf PhD, Nancy G. Klimas MD, Michael Antoni PhD, Andrew Brickman PhD, Mary Fletcher PhD, Journal of Chronic Fatigue Syndrome, 1(2):23-41 1995

Objective. We related the subjective assessment of cognitive difficulties with lymphocyte phenotypes, cell-mediated immunity (CMI), cytokine and neopterin levels in patient with chronic fatigue syndrome (CFS), in order to determine if CFS patients complaining of greater cognitive difficulties would show greater impairments in cell-mediated immunity and a greater degree of immune system dysregulation, and to determine if these cognitive difficulties would correlate with the other non-affective measures of CFS-associated illness burden. We also assessed if these relationships would hold independent of depression in two ways, by statistically covarying depression severity scores and by comparing subsets of CFS patients with and without concurrent diagnoses of major depressive disorder.

Design. A case series of CFS patients. Setting. Outpatient tertiary referral clinic at the University of Miami School of Medicine, Miami, FL. Patients. Consecutive sample of 65 patients who were as CFS to the University of Miami Diagnostic Immunology Clinic , who met the Centers for Disease Control and Prevention (CDC) criteria for diagnosis of CFS and consented to participate.

Main Measures. Self-assessment of cognitive difficulties, depression and illness burden, clinician-assessed depression and CFS symptoms, lymphocyte phenotype, proliferative response to mitogens, serum levels of cytokines and neopterin. Results. Among CFS patients, high Cognitive Difficulty Scale (CDS) scores were significantly related to low lymphocyte proliferative responses to mitogens, higher neopterin levels, and higher CD4 and lower CD8 lymphocyte counts. These relationships, with the exception of T cell subset percentages, were maintained when depression severity was used as a co-variate. High CDS scores were also significantly related to lower Karnofsky scores, and greater illness burden as measured by the Sickness Impact Profile.

Conclusions. Evidence is presented that CFS patients with higher cognitive difficulty scores have more immune and clinical Dysfunction than those patients with less cognitive difficulty, and that these relationships are independent of depression. These observations provide support for the concept that although both cognitive difficulties and immunologic abnormalities, such as immune activation and impaired cell-mediated immunity, may represent secondary sequelae to the same event(s), they are not likely to be secondary sequelae to depression.




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