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Cognitive Functioning and Depression in Patients With Chronic Fatigue Syndrome and Multiple Sclerosis
Lauren B. Krupp, MD;
Martin Sliwinski, PhD;
David M. Masur, PhD;
Fred Friedberg, PhD;
P. K. Coyle, MD
Arch Neurol. 1994;51(7):705-710.
Abstract
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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 performance.
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 educationmatched 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.
Author Affiliations
From the Departments of Neurology (Drs Krupp and Coyle) and Psychiatry and Behavioral Medicine (Dr Friedberg), State University of New York—Stony Brook; and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, and Montefiore Hospital and Medical Center, New York, NY (Drs Sliwinski and Masur).
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