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Cognitive dysfunction
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==Possible causes== ===Neurological changes in ME/CFS === [[File:MECFS-neuroeffects-brain.jpg|alt=Sketch of a brain with words inside saying intracranial hypertension, impaired cerebral blood flow, hyperventilation/hypocapnia, and adrenergic hyperactivity.|thumb|Key neurological pathomechanisms in ME/CFS.<br>'''Source:''' Wirth, K.J., Scheibenbogen, C. & Paul, F. [https://doi.org/10.1186/s12967-021-03143-3 An attempt to explain the neurological symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.] J Transl Med 19, 471 (2021). https://doi.org/10.1186/s12967-021-03143-3]] Causes of neurological symptoms in ME/CFS include: *hyperventilation/hypnocapnia (reduced carbon dioxide levels in the blood) *[[intracranial hypertension]] (increased pressure within the skull and around brain) * reduced blood flow to the brain * [[Neuroinflammation|brain inflammation]] may also be a factor<ref name="Wirth2021b" /> Wirth, Scheibenbogen and Paul (2021) state these "can explain cognitive impairment, [[brain fog]], [[headache]], psychomotor slowing, [[ataxia]] and loss of coordination of movements, [[Sensory overload|hypersensitivity]], [[sleep dysfunction|sleep disturbances]] and [[dysautonomia]]."<ref name="Wirth2021b" /> ===Cerebrospinal fluid changes === [[Mady Hornig]] and colleagues have found evidence in the [[cerebrospinal fluid]] (CSF) of ME/CFS patients that may explain their cognitive dysfunction.<ref name="Hornig, 2016">{{Cite journal | last1 = Hornig | first1 = M | author-link1 = Mady Hornig | last2 = Gottschalk | first2 = G | author-link2 = Gunnar Gottschalk | last3 = Peterson | first3 = D | author-link3 = Daniel Peterson | last4 = Knox | first4 = KK | author-link4 = | last5 =Schultz | first5 = AF | author-link5 = | last6 = Eddy | first6 = ML | author-link6 = | last7 = Che | first7 = X | author-link7 = | last8 =Lipkin | first8 = WI | author-link8 = Ian Lipkin | title = Cytokine network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome. | journal = Molecular Psychiatry | volume = 21 | issue = 2 | page = 261-9 | date = 2016 | doi = 10.1038/mp.2015.29}}</ref> ===Brain changes === [[File:CLROA-2-110-F1.gif|850px|thumb|center| Figure 1: Results of LORETA current source density in a case with CFS showing widespread decreased current density for delta at 2 Hz and beta (12- 15 Hz) demonstrating a global reduction in brain functioning (blue). The higher frequencies (beta) have been shown to be a function of delta frequencies. In other words, local oscillations are under constant influence of global brain dynamics (Buzsaki, 2006).<ref name="Zinn2016" />]] Zinn et al. (2016) studied brain functioning in chronic fatigue syndrome and concluded: <blockquote>Our case study confirmed the pattern of dysregulation in the cortex reviewed in the introduction. Furthermore, since both periods of phase shift/lock durations were found to be significantly shorter, that might contribute to an increased rate of phase reset, also seen in our data. Phase reset deregulation--phase locking periods being too brief and phase reset happening too often—appear to be consistent with the associated lower rate of information processing and reaction times found in the ME and CFS literature. These deregulated states represent the brain during nonoptimal functioning, rendering it inefficient for most types of information processing functioning, whether it is executive functioning, [[Memory problems|memory]], perceptual reasoning or information processing speed. When phase lock is significantly less than normal, as in this data set, the ability of the brain to sustain commitment of resources to mediate different functions is severely compromised. Phase shift duration in this data is also hypoactive, meaning that significantly less neurons are being recruited to perform a function than normal. The results here indicate slowed verbal comprehension, executive functions, perceptual reasoning, processing speed and memory, the sum total of which is known as [[cognitive impairment]].<ref name="Zinn2016" /></blockquote> ===Drug and supplements === Drugs, supplements or treatment interventions that may cause cognitive problems in some ME/CFS patients: *[[Diphenhydramine]] (Benadryl) an [[antihistamine]] also used to aid sleep *Certain [[Analgesic|pain killers]], particularly [[opioid]]s, [[gabapentin]] (Neurontin), [[:Category:Tricyclic antidepressants|tricyclic antidepressants]] including [[amitriptyline]] (Elavil, Endep) and [[nortriptyline]] (Aventyl, Pamelor)<ref name="medicinecabinet">https://www.health.harvard.edu/mind-and-mood/stuck-in-a-brain-fog-look-in-your-medicine-cabinet</ref> * [[:Category:Sleep aids and hypnotics|sleep medications]]<ref name="medicinecabinet" /> ===Exercise and graded exercise therapy === A healthy person becomes more alert after [[exercise]], but people with ME/CFS find their cognitive difficulties increase, they become much slower at mental activities, and cognitive tasks seem to take extra effort.<ref name="ICC" /><ref name="canadianconsensus-CCC" /><ref name="Collatz2014" /> [[Graded exercise therapy]] (GET) / Graded Activity Therapy also has this effect in ME/CFS patients.<ref name="ICC" /><ref name="canadianconsensus-CCC" /><ref name="Collatz2014" /> {{See also|Exercise}} ===Other illnesses or health conditions === Cognitive dysfunction can be caused or made worse by other health conditions, most of which should be [[Differential diagnosis|ruled out or identified]] during diagnostic process for ME/CFS: * [[Cancer]] or cancer treatment ("chemo brain") * [[Depression]] * [[Fibromyalgia]] * [[Long COVID]] symptoms<ref name="WHO-longcovid-criteria">{{citation | title = A clinical case definition of post COVID-19 condition by a Delphi consensus | date =Oct 6, 2021 | publisher = [[World Health Organization]] | others = World Health Organization (WHO) clinical case definition working group on post COVID-19 condition | first1 = Joan B. | last1 = Soriano | first2 = Maya | last2 = Allan | first3 = Carine | last3 = Alsokhn | first4 = Nisreen A. | last4 = Alwan | author-link4 = Nisreen Alwan | first5 = Lisa | last5 = Askie | first6 = Hannah E. | last6 = Davis | author-link6 = Hannah Davis | first7 = Janet V. | last7 = Diaz | first8 = Tarun | last8 = Dua | first9 = Wouter | last9 = de Groote | first10 = Robert | last10 = Jakob | first11 = Marta | last11 = Lado | first12 = John | last12 = Marshall | first13 = Srin | last13 = Murthy | first14 = Jacobus | last14 = Preller | first15 = Pryanka | last15 = Relan | first16 = Nicoline | last16 = Schiess | first17 = Archana | last17 = Seahwag | ref = WHO reference number: WHO/2019-nCoV/Post_COVID-19_condition/Clinical_case_definition/2021.1 | url = https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1}}</ref> * [[Systemic lupus erythematosus|Lupus]] * [[Menopause]] * [[Multiple sclerosis]] * [[Pregnancy]] * [[Sleep dysfunction]] or [[:Category:Sleep disorders|sleep disorders]]<ref>{{Cite web | url = https://www.webmd.com/brain/ss/slideshow-brain-fog | title = Reasons You May Have Brain Fog | website = WebMD|language=en|access-date=2022-01-22}}</ref>
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