Relationships of Cognitive Difficulties to Immune Measures, Depression and Illness Burden in Chronic Fatigue Syndrome

Susan Lutgendorf, Nancy G. Klimas, Michael Antoni, Andrew Brickman, Mary Ann Fletcher

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objective. We related the subjective assessment of cognitive difficulties with lymphocyte phenotypes, cellmediated immunity (CMI), cytokine and neopterin levels in patients 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 whether 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 a concurrent diagnosis 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. Patienrs. Consecutive sample of 65 patients who were referred 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 lower 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 sequence to the same event(s), they are not likely to be secondary sequence to depression.

Original languageEnglish (US)
Pages (from-to)23-41
Number of pages19
JournalJournal Of Chronic Fatigue Syndrome
Issue number2
StatePublished - Jan 1 1995

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology


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