Investigating subjective experiences of cognitive difficulties and objective measures of cognitive functioning in adolescents who had EBV, 2020, Rødø

[Tom Kindlon]

via Dr. Marc-Alexander Fluks

Source: Oslo University
Date: May 2020
URL: https://www.duo.uio.no/handle/10852/78603

https://www.duo.uio.no/bitstream/handle/10852/78603/PSYC6100-Hovedoppgave_B-lgen_Buer.pdf


A dive into the deep, mysterious waters of chronic fatigue and cognition in adolescents: Investigating subjective experiences of cognitive difficulties and objective measures of cognitive functioning
--------------------------------------------------------------
Maria Sletten Bolgen & Astrid Sofie Buer Rodo
- Department of Psychology, University of Oslo, Norway


Abstract

Objective
The focus of the current study was to examine cognitive functioning by
objective and subjective measures in adolescents with chronic fatigue
(CF) and chronic fatigue syndrome (CFS). The results were compared
between adolescents who developed CF/CFS and those who did not develop
CF/CFS following acute EBV infection and healthy controls. To the extent
of our knowledge, no studies to date on adolescents with CF/CFS have
examined both subjective and objective cognitive functioning six months
post EBV infection.

Methods
Cognitive functioning of 195 adolescents was assessed six months after
identification of acute EBV infection against 70 healthy controls. The
EBV patients were divided into two main groups at six months; EBV (CF+),
those who developed CF/CFS, and EBV (CF-), those who did not develop
CF/CFS. Those who met the symptom requirements for CFS were further
distinguished from the total group of adolescents with CF/CFS. Objective
measures were assessed with neuropsychological tests. For subjective and
clinical measures, various self-report questionnaires were applied. The
data used in this thesis is cross-sectional and based on data already
collected as part of the CEBA project. The groups were compared applying
one-way ANOVA and Student's t-test.

Results
The total EBV (CF+) was not adversely affected on objective cognitive
measures compared to EBV (CF-) and healthy controls. When measuring
cognitive flexibility, verbal learning and verbal memory, the CFS
subgroups performed worse compared to the total EBV (CF+) group. EBV
(CF+) reported significantly more cognitive problems compared to EBV
(CF-) and healthy controls. The CFS subgroups reported more subjective
cognitive difficulties compared to the total EBV (CF+) group.

Conclusion
The total group of adolescents with CF/CFS was not adversely affected on
objective measures compared to the non-fatigued and healthy controls.
Our findings suggest that adolescents who were diagnosed with CFS were
more severely affected on both subjective and objective measures of
cognitive functioning, which may indicate that symptom severity in
patients with CF/CFS contributes to reduced cognitive functioning and
should be addressed in future research.

 

[rvallee]

Doesn't seem like they chose relevant cognitive tests. Or relevant participants. They nearly all show almost identical performance with healthy controls. I can't even do the easiest tasks of a profession I was highly skilled at and did for well over a decade, things I would be able to do even very drunk and was professionally trained on. They're clearly not testing the right things, the differences should be very obvious.

All participants underwent cognitive testing in the following order: The Digit Span test from the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV) (Wechsler, 2008); the ColorWord Interference test from the Delis-Kaplan Executive Function System (D-KEFS) (Stroop, 1935); the Hopkins Verbal Learning Test - Revised (HVLT-R) (Benedict, 1998); and the Matrix Reasoning and Vocabulary tests from the Wechsler Abbreviated Scale of Intelligence, Fourth Edition (WASI) (Wechsler, 2007).

The tests seem relatively pertinent so I assume the issue was with the participants. Some of the tests take nearly 1h to take and there are several of them. I can barely fill in a disability form asking basic questions that I know intuitively, one that a healthy person would take about 15 minutes to fill (I'm fortunate that where I live those forms are fairly short, thankfully). I abandon at least half of the research questionnaires I begin because they are simply too demanding, even though they actually aren't.

 

[Kalliope]

 

[Hutan]

That abstract has to be read really carefully - distinguishing the subgroup with CFS from the broader group with chronic fatigue or CFS after EBV.

On objective measures, the CFS subgroup was worse than the broader group with chronic fatigue or CFS.

The total EBV (CF+) was not adversely affected on objective cognitive
measures compared to EBV (CF-) and healthy controls. When measuring
cognitive flexibility, verbal learning and verbal memory, the CFS
subgroups performed worse compared to the total EBV (CF+) group.

As @Michiel Tack says in that tweet, this is evidence that researchers need to carefully choose their sample. CF and CFS are not the same.

Out of 200 adolescents with an EBV infection followed for 6 months. 5 participants dropped out. so, out of the 195 people, 91 had chronic fatigue at 6 months. That seems incredibly high (47%).

In the current study, 26 participants – within the group of 91 participants who fulfilled
the requirements for chronic fatigue at 6 months after acute Epstein-Barr virus infection – also fulfilled the symptom requirements for chronic fatigue syndrome according to the Fukuda- criteria. Nineteen participants fulfilled the symptom requirements for chronic fatigue syndrome according to the Canadian criteria.

The chapter on the causes of ME/CFS is enough to make you weep. They quote Pedersen:

Adolescent CFS has been found associated with several pathophysiological features such as hormonal-, autonomic- and immunological alterations, impairment in executive function, sleeping problems, specific personality traits, emotional instabilities and negative life events (Pedersen et al., 2019).

and settle on the 'sustained arousal model'

In 2009, Wyller and colleagues introduced the sustained arousal model to explain the pathophysiological features in CFS. The model suggests that predisposing factors such as genetics and personality traits accompanied by triggering factors such as long-lasting infections and negative life events, consequently lead to an extended bodily stress response, called“sustained arousal” (Wyller, Eriksen, & Malterud, 2009). The sustained arousal explains cognitive impairment as well as hormonal-, autonomic- and immunological alterations, and in return these alterations function as active agents to the continuation of sustained arousal and fatigue (Wyller et al., 2009). The conceptualization of fatigue from an understanding of sustained arousal has provided the framework applied in the overall CEBA project.

 

[Sean]

The conceptualization of fatigue from an understanding of sustained arousal has provided the framework applied in the overall CEBA project.

Now there's a name I wish to never hear again. They have done terrible harm.

 

[Midnattsol]

Since it's part of CEBA I'm not surprised they went with the sustained arousal model. :/

I do wonder when they (CEBA project, not this particular thesis) decided to look at both CF and CFS. In the music study they include patients with CF who "if having additional symptoms" could also be diagnosed with CFS, even if the protocol states they were interested in those who already had developed CFS.

 

[James Morris-Lent]

If 'sustained arousal' - taken to mean something in the range of what one might reasonably intuit it to be implied to mean in the given context - is the cause, one wonders why there is a definitive lack of treatment success with any of the wide variety of sedative and anxiolytic drugs available.