From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Gudrun Lange, PhD, is a clinical neuropsychologist who works with Dr. Benjamin Natelson at the Pain & Fatigue Study Center, New York, New York. There she heads studies on brain fog in chronic fatigue syndrome and fibromyalgia.
- 2017, Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM): Design and Implementation of a Prospective/Retrospective Rolling Cohort Study
"Abstract - In the Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM), we relied on expert clinician diagnoses to enroll patients from 7 specialty clinics in the United States in order to perform a systematic collection of data on measures of myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Healthy persons and those with other illnesses that share some features with ME/CFS were enrolled in comparison groups. The major objectives were to: 1) use standardized questionnaires to measure illness domains of ME/CFS and to evaluate patient heterogeneity overall and between clinics; 2) describe the course of illness, identify the measures that best correlate with meaningful clinical differences, and assess the performances of questionnaires as patient/person-reported outcome measures; 3) describe prescribed medications, orders for laboratory and other tests, and management tools used by expert clinicians to care for persons with ME/CFS; 4) collect biospecimens for future hypothesis testing and for evaluation of morning cortisol profiles; and 5) identify measures that best distinguish persons with ME/CFS from those in the comparison groups and detect subgroups of persons with ME/CFS who may have different underlying causes. Enrollment began in 2012 and is planned to continue in multiple stages through 2017. We present the MCAM methods in detail, along with an initial description of the 471 patients with ME/CFS who were enrolled in stage 1."
- 2017, Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity
"Abstract - The purpose of this study was to investigate whether CFS patients without comorbid psychiatric diagnoses differ from CFS patients with comorbid psychiatric diagnoses and healthy control subjects in neuropsychological performance, the proportion with elevated spinal fluid protein or white cell counts, cerebral blood flow (CBF), brain ventricular lactate and cortical glutathione (GSH). The results of the study did not show any differences in any of the outcome measures between CFS patients with and without psychiatric comorbidity, thus indicating that psychiatric status may not be an exacerbating factor in CFS. Importantly, significant differences were found between the pooled samples of CFS compared to controls. These included lower GSH and CBF and higher ventricular lactate and rates of spinal fluid abnormalities in CFS patients compared to healthy controls. Thirteen of 26 patients had abnormal values on two or more of these 4 brain-related variables. These findings, which replicate the results of several of our prior studies, support the presence of a number of neurobiological and spinal fluid abnormalities in CFS. These results will lead to further investigation into objective biomarkers of the disorder to advance the understanding of CFS."
- 2015, Effect of Milnacipran Treatment on Ventricular Lactate in Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Trial
- 2013, Attention network test: assessment of cognitive function in chronic fatigue syndrome
- 2011, Safety and efficacy of vagus nerve stimulation in fibromyalgia: a phase I/II proof of concept trial
- 2005, Objective evidence of cognitive complaints in Chronic Fatigue Syndrome: a BOLD fMRI study of verbal working memory
Abstract - "Individuals with Chronic Fatigue Syndrome (CFS) often have difficulties with complex auditory information processing. In a series of two Blood Oxygen Level Dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) studies, we compared BOLD signal changes between Controls and individuals with CFS who had documented difficulties in complex auditory information processing (Study 1) and those who did not (Study 2) in response to performance on a simple auditory monitoring and a complex auditory information processing task (mPASAT). We hypothesized that under conditions of cognitive challenge: (1) individuals with CFS who have auditory information processing difficulties will utilize frontal and parietal brain regions to a greater extent than Controls and (2) these differences will be maintained even when objective difficulties in this domain are controlled for. Using blocked design fMRI paradigms in both studies, we first presented the auditory monitoring task followed by the mPASAT. Within and between regions of interest (ROI), group analyses were performed for both studies with statistical parametric mapping (SPM99). Findings showed that individuals with CFS are able to process challenging auditory information as accurately as Controls but utilize more extensive regions of the network associated with the verbal WM system. Individuals with CFS appear to have to exert greater effort to process auditory information as effectively as demographically similar healthy adults. Our findings provide objective evidence for the subjective experience of cognitive difficulties in individuals with CFS."
- 2004, Cognitive Function Index for Patients with Chronic Fatigue Syndrome
"Abstract - Background: A comprehensive approach to assessing neuropsychological deficits in CFS patients is developed by assessing cognitive function across a number of domains using a battery of tests, rather than relying on any single instrument. Objective: A factor analytic approach was employed to examine the underlying dimensionality of 15 standard cognitive function related test variables in CFS patients. A cognitive function index (CFI) was then developed using appropriately weighted and interpreted factors. Methods: Factor analysis was applied to an initial sample of 65 CFS patients, identifying eight factors accounting for over 70% of total variation. This factor structure was then independently verified on a separate sample of 124 CFS patients. An overall combined CFS sample of 212 was then used to derive the CFI using an appropriately interpreted and weighted average of the derived factors. Results: After including age and education as separate factors, the CFI consists of nine factors accounting for 70% of total variation in the overall CFS group. The CFI was not affected by the presence of current psychiatric comorbidity. A cut-off score for cognitive dysfunction was established using the lower quartile value of a group of sedentary controls on the same index. Conclusions: The CFI will provide a useful summary measure for researchers investigating cognitive function performance in CFS patients. It does not replace existing individual specialized tests."
- 2002, A status report on chronic fatigue syndrome (FULL TEXT)
"Abstract - Medical history has shown that clinical disease entities or syndromes are composed of many subgroups--each with its own cause and pathogenesis. Although we cannot be sure, we expect the same outcome for chronic fatigue syndrome (CFS), a medically unexplained condition characterized by disabling fatigue accompanied by infectious, rheumatological, and neuropsychiatric symptoms. Although the ailment clearly can occur after severe infection, no convincing data exist to support an infectious (or immunologic) process in disease maintenance. Instead, data point to several possible pathophysiological processes: a covert encephalopathy, impaired physiological capability to respond to physical and mental stressors, and psychological factors related to concerns about effort exacerbating symptoms. Each of these is under intense investigation. In addition, some data do exist to indicate that environmental agents also can elicit a state of chronic fatigue. We expect data to accumulate to support the belief that CFS has multiple causes."
- 2001, Health-Related Personality Variables in Chronic Fatigue Syndrome and Multiple Sclerosis
"Summary - This study investigated personality variables in patients with Chronic Fatigue Syndrome (CFS) and Multiple Sclerosis (MS), with healthy, sedentary subjects as controls. CFS and MS groups were higher on alexithymia, characterized as difficulty in describing and differentiating emotions and marked externalization. CFS and MS groups reported a more depressive attributional style than healthy participants, reflecting beliefs that causes for good events are not diffused into other areas of life while causes for bad events will always be present. The CFS group was significantly lower on doctors/others locus of control indicating lack of trust in medical professionals. Results indicate that CFS and MS are similar to each other while different from the healthy group on certain personality variables that likely reflect the demoralizing effects of coping with a chronic, disabling illness marked by uncertainty."
- Phillips Ambulatory Care Center, Suite 5D
- Beth Israel Medical Center
- 10 Union Square East
- New York, NY 10003-3314
Talks and interviews
- 2009, 9th International IACFS/ME Research and Clinical Conference: Talk Title - Assessing ME/CFS Brain Functioning
- Unger, Elizabeth R.; Lin, Jin-Mann S.; Tian, Hao; Natelson, Benjamin H; Lange, Gudrun; Vu, Diana; Blate, Michelle; Klimas, Nancy G.; Balbin, Elizabeth G.; Bateman, Lucinda; Allen, Ali; Lapp, Charles W.; Springs, Wendy; Kogelnik, Andreas M.; Phan, Catrina C.; Danver, Joan; Podell, Richard N.; Fitzpatrick, Trisha; Peterson, Daniel L.; Gottschalk, C. Gunnar; Rajeevan, Mangalathu S.; MCAM Study Group (2017), "Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM): Design and Implementation of a Prospective/Retrospective Rolling Cohort Study.", American Journal of Epidemiology, 1–10, doi:10.1093/aje/kwx029
- Natelson, B.H., M. Xiangling, A.J. Stegner, G. Lange, D. Vu, M. Blate, G. Kang, E. Soto, T. Kapusuz, D.C. Shungu. (2017). Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity. Journal of the Neurological Sciences, 375:411–416. http://dx.doi.org/10.1016/j.jns.2017.02.046
- Natelson, B.H., D. Vu, X. Mao, N. Weiduschat, F. Togo, G. Lange, M. Blate, G. Kang, J.D. Coplan and D.C. Shungu. Effect of milnacipran treatment on ventricular lactate in fibromyalgia: A randomized, double-blind, placebo-controlled trial. Journal of Pain, 16(11:)1211-1219, 2015.
- Togo, F., G. Lange, B.H. Natelson, and K.S. Quigley. Attention network test: assessment of cognitive function in chronic fatigue syndrome. Journal of Neuropsychology, 2013 Sep 24. doi: 10.1111/jnp.12030.
- Lange, Gudrun; Janal, Malvin N.; Maniker, Allen; Fitzgibbons, Jennifer; Fobler, Malusha; Cook, Dane; Natelson, Benjamin H. (September 2011), "Safety and efficacy of vagus nerve stimulation in fibromyalgia: a phase I/II proof of concept trial", Pain Medicine (Malden, Mass.), 12 (9): 1406–1413, ISSN 1526-4637, PMC , PMID 21812908, doi:10.1111/j.1526-4637.2011.01203.x
- Lange, G; Steffener, J; Cook, DB; Bly, BM; Christodoulou, C; Liu, WC; Deluca, J; Natelson, BH (2005), "Objective evidence of cognitive complaints in Chronic Fatigue Syndrome: a BOLD fMRI study of verbal working memory", NeuroImage, 26 (2): 513-24, PMID 15907308, doi:10.1016/j.neuroimage.2005.02.011
- Michael Brimacombe, Gudrun Lange, Kim Bisuchio, Donald S. Ciccone & Benjamin Natelson. (2004). Cognitive Function Index for Patients with Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome, Vol. 12, Iss. 4, pp. 3-23. http://dx.doi.org/10.1300/J092v12n04_02
- Natelson, Benjamin H; Lange, Gudrun (2002), "A status report on chronic fatigue syndrome", Environmental Health Perspectives, 110 (Supp 4): 673–677
- Susan K. Johnson, Gudrun Lange, Lana Tiersky, John Deluca & Benjamin H. Natelson. (2001). Health-Related Personality Variables in Chronic Fatigue Syndrome and Multiple Sclerosis. Journal of Chronic Fatigue Syndrome, Vol. 8, Iss. 3-4, pp. 41-52. http://dx.doi.org/10.1300/J092v08n03_05