Quality of Life Research

, Volume 25, Issue 5, pp 1257–1263 | Cite as

Neurocognitive complaints and functional status among patients with chronic fatigue syndrome and fibromyalgia

  • Karen B. SchmalingEmail author
  • Karran L. Betterton



The purpose of this study was to conduct a longitudinal examination of cognitive complaints and functional status in patients with chronic fatigue syndrome (CFS) alone and those who also had fibromyalgia (CFS/FM).


A total of 93 patients from a tertiary care fatigue clinic were evaluated on four occasions, each 6 months apart. Each evaluation included a tender point assessment, and self-reported functional status and cognitive complaints.


Patients with CFS/FM reported significantly worse physical functioning, more bodily pain, and more cognitive difficulties (visuo-perceptual ability and verbal memory) than patients with CFS alone. Over time, bodily pain decreased only for participants with CFS alone. Verbal memory problems were associated with more bodily pain for both patient groups, whereas visuo-perceptual problems were associated with worse functional status for patients with CFS alone.


This study adds to the literature on functional status, longitudinal course, and cognitive difficulties among patients with CFS and those with CFS and FM. The results suggest that patients with CFS/FM are more disabled, have more cognitive complaints, and improve more slowly over time than patients with CFS alone. Specific cognitive difficulties are related to worse functional status, which supports the addition of cognitive difficulties to the FM case criteria.


Functional status Neurocognitive symptoms Fibromyalgia Chronic fatigue syndrome 



This study was funded by the National Institute of Allergy and Infectious Disease (U19AI38429, Project 4 (Project PI, K. Schmaling).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Fukuda, K., Strauss, S. E., Hickie, I., Sharpe, M. C., Dobbins, J. G., Komaroff, A., et al. (1994). The chronic fatigue syndrome: A comprehensive approach to its definition and study. Annals of Internal Medicine, 121, 953–959.CrossRefPubMedGoogle Scholar
  2. 2.
    Cockshell, S. J., & Mathias, J. L. (2013). Cognitive deficits in chronic fatigue syndrome and their relationship to psychological status, symptomatology, and everyday functioning. Neuropsychology, 27, 230–242.CrossRefPubMedGoogle Scholar
  3. 3.
    Friedberg, F., Dechene, L., McKenzie, M. J, I. I., & Fontanetta, R. (2000). Symptom patterns in long-duration chronic fatigue syndrome. Journal of Psychosomatic Research, 48, 59–68.CrossRefPubMedGoogle Scholar
  4. 4.
    Hickie, I., Lloyd, A., Hadzi-Pavlovic, D., Parker, G., Bird, K., & Wakefield, D. (1995). Can the chronic fatigue syndrome be defined by distinct clinical features? Psychological Medicine, 25, 925–935.CrossRefPubMedGoogle Scholar
  5. 5.
    Aaron, L. A., Burke, M. M., & Buchwald, D. (2000). Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Archives of Internal Medicine, 160, 221–227.CrossRefPubMedGoogle Scholar
  6. 6.
    Brown, M. M., & Jason, L. A. (2007). Functioning in individuals with chronic fatigue syndrome: Increased impairment with co-occurring multiple chemical sensitivity and fibromyalgia. Dynamic Medicine, 6, 6.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ciccone, D. S., & Natelson, B. H. (2003). Comorbid illness in women with chronic fatigue syndrome: A test of the single syndrome hypothesis. Psychosomatic Medicine, 65, 268–275.CrossRefPubMedGoogle Scholar
  8. 8.
    Gotts, Z. M., Ellis, J. G., Deary, V., Barclay, N., & Newton, J. L. (2015). The association between daytime napping and cognitive functioning in chronic fatigue syndrome. PLoS ONE, 10, 1–12.CrossRefGoogle Scholar
  9. 9.
    Schmaling, K., Lewis, D. H., Fiedelak, J. I., Mahurin, R., & Buchwald, D. S. (2003). Single-photon emission computerized tomography and neurocognitive function in patients with chronic fatigue syndrome. Psychosomatic Medicine, 65, 129–136.CrossRefPubMedGoogle Scholar
  10. 10.
    Ickmans, K., Meeus, M., Kos, D., Clarys, P., Meersdom, G., Lambrecht, L., et al. (2013). Cognitive performance is of clinical importance, but is unrelated to pain severity in women with chronic fatigue syndrome. Clinical Rheumatology, 32, 1475–1485.CrossRefPubMedGoogle Scholar
  11. 11.
    Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P., et al. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research, 62, 600–610.CrossRefGoogle Scholar
  12. 12.
    Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., et al. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis and Rheumatism, 33, 160–172.CrossRefPubMedGoogle Scholar
  13. 13.
    Aaron, L. A., Herrell, R., Ashton, S., Belcourt, M., Schmaling, K., Goldberg, J., et al. (2001). Comorbid clinical conditions in chronic fatigue: A co-twin control study. Journal of General Internal Medicine, 16, 24–31.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Goldenberg, D. L., Simms, R. W., Geiger, A., & Komaroff, A. L. (1990). High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis and Rheumatism, 33, 381–687.CrossRefPubMedGoogle Scholar
  15. 15.
    Jason, L. A., Taylor, R. R., & Kennedy, C. L. (2000). Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities in a community-based sample of persons with chronic fatigue syndrome-like symptoms. Psychosomatic Medicine, 62, 655–663.CrossRefPubMedGoogle Scholar
  16. 16.
    Yunus, M. B. (2013). Fibromyalgia: A central sensitivity syndrome. In M. B. Goldman, R. Troisi, & K. M. Rexrode (Eds.), Women and health (2nd ed., pp. 1331–1340). New York: Academic Press.CrossRefGoogle Scholar
  17. 17.
    Tesio, V., Torta, D. M., Colonna, F., Leombruni, P., Ghiggia, A., Fusaro, E., et al. (2015). Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care & Research, 67, 143–150.CrossRefGoogle Scholar
  18. 18.
    Leavitt, F., Katz, R. S., Mills, M., & Heard, A. R. (2002). Cognitive and dissociative manifestations in fibromyalgia. Journal of Clinical Rheumatology, 8, 77–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Ware, J. E, Jr, Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health survey: Manual and interpretation guide. Boston: The Health Institute, New England Medical Center.Google Scholar
  20. 20.
    Komaroff, A. L., Fagiolo, L., Doolittle, T. H., Gandek, B., Gleit, M. A., Guerriera, R. T., et al. (1996). Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups. American Journal of Medicine, 101, 281–290.CrossRefPubMedGoogle Scholar
  21. 21.
    Seidenberg, M., Haltiner, A., Taylor, M., Hermann, B., & Wyler, A. (1994). Development and validation of a multiple ability self-report questionnaire. Journal of Clinical and Experimental Neuropsychology, 16, 93–104.CrossRefPubMedGoogle Scholar
  22. 22.
    Boomershine, C. S. (2012). A comprehensive evaluation of standardized assessment tools in the diagnosis of fibromyalgia and in the assessment of fibromyalgia severity. Pain Research and Treatment, 2012, 653714.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Williams, D. A., & Arnold, L. M. (2011). Measures of fibromyalgia. Arthritis Care & Research, 63, S86–S97.CrossRefGoogle Scholar
  24. 24.
    Robins, L., & Helzer, J. (1985). Diagnostic interview schedule (DIS): Version III-A. St. Louis, MO: Department of Psychiatry, Washington University School of Medicine.Google Scholar
  25. 25.
    Schmaling, K. B., Fiedelak, J. I., Katon, W. J., Bader, J. O., & Buchwald, D. S. (2003). Prospective study of the prognosis of unexplained chronic fatigue in a clinic-based cohort. Psychosomatic Medicine, 65, 1047–1054.CrossRefPubMedGoogle Scholar
  26. 26.
    Branco, J. C., Zachrisson, O., Perrot, S., & Mainguy, Y. (2010). A European multicentre double-blind placebo-controlled monotherapy clinical trial of milnacipran in treatment of fibromyalgia. Journal of Rheumatology, 37, 851–859.CrossRefPubMedGoogle Scholar
  27. 27.
    Williams, D. A., Clauw, D. J., & Glass, J. M. (2011). Perceived cognitive dysfunction in fibromyalgia syndrome. Journal of Musculoskeletal Pain, 19(1), 66–75.CrossRefGoogle Scholar
  28. 28.
    Kratz, A. L., Schilling, S., Goesling, J., & Williams, D. A. (2015). Development and initial validation of a brief self-report measure of cognitive dysfunction in fibromyalgia. Journal of Pain, 16(6), 527–536.CrossRefPubMedGoogle Scholar
  29. 29.
    Raftery, A. E. (1996). Bayesian model selection in social research. In P. V. Marsden (Ed.), Sociological Methodology (Vol. 26, pp. 111–163). Oxford: Blackwell.Google Scholar
  30. 30.
    Wiborg, J. F., van der Werf, S., Prins, J. B., & Bleijenberg, G. (2010). Being homebound with chronic fatigue syndrome: A multidimensional comparison with outpatients. Psychiatry Research, 177(120), 246–249.CrossRefPubMedGoogle Scholar
  31. 31.
    Cockshell, S. J., & Mathias, L. J. (2010). Cognitive functioning in chronic fatigue syndrome: A meta-analysis. Psychological Medicine, 40, 1253–1267.CrossRefPubMedGoogle Scholar
  32. 32.
    Cockshell, S. J., & Mathias, L. J. (2014). Cognitive functioning in people with chronic fatigue syndrome: A comparison between subjective and objective measures. Neuropsychology, 28, 394–405.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of PsychologyWashington State UniversityVancouverUSA

Personalised recommendations