Abstract
ImportanceChronic fatigue syndrome (CFS) is characterised by a constellation of symptoms diagnosed with a number of different polythetic criteria. Heterogeneity across these diagnostic criteria is likely to be confounding research into the as-yet-unknown pathophysiology underlying this stigmatised and debilitating condition and may diagnose a disease spectrum with significant implications for clinical management. No studies to date have objectively investigated this possibility using a validated measure of CFS symptoms–the DePaul Symptom Questionnaire (DSQ).ObjectiveTo examine whether current CFS diagnostic criteria are identifying different disease phenotypes using the DSQ.DesignCase control study.SettingClinical Research Facility of the Royal Victoria Infirmary, Newcastle upon Tyne, UK.Participants49 CFS subjects and ten matched, sedentary community controls, excluded for co-morbid depression.Main outcomes and measuresSelf-reported autonomic and cognitive features were assessed with the Composite Autonomic Symptom Score (COMPASS) and Cognitive Failures Questionnaire (COGFAIL) respectively. Objective autonomic cardiovascular parameters were examined using the Task Force® Monitor and a battery of neuropsychological tests administered for objective cognitive assessment.ResultsSelf-reported autonomic and cognitive symptoms were significantly greater in CFS subjects compared to controls. There were no statistically significant differences in objective autonomic measures between CFS and controls. There were clinically significant differences between DSQ subgroups on objective autonomic testing. Visuospatial memory, verbal memory and psychomotor speed were significantly different between DSQ subgroups.Conclusions and relevanceThe finding of no significant differences in objective autonomic testing between CFS and control subjects may reflect the inclusion of sedentary controls or exclusion for co-morbid depression. Consistent exclusion criteria would enable better delineation of these two conditions and their presenting symptoms. Findings across CFS subgroups suggest subjects have a different disease burden on subjective and objective measures of function, autonomic parameters and cognitive impairment when categorised using the DSQ. Different CFS criteria may at best be diagnosing a spectrum of disease severities and at worst different CFS phenotypes or even different diseases. This complicates research and disease management and may contribute to the significant stigma associated with the condition.
Highlights
Chronic fatigue syndrome (CFS) is a disabling and stigmatising illness of unknown aetiology
Self-reported autonomic and cognitive symptoms were significantly greater in CFS subjects compared to controls
The finding of no significant differences in objective autonomic testing between CFS and control subjects may reflect the inclusion of sedentary controls or exclusion for co-morbid depression
Summary
Chronic fatigue syndrome (CFS) is a disabling and stigmatising illness of unknown aetiology. CFS is a diagnosis of exclusion based on a number of different sets of polythetic diagnostic criteria developed empirically over the last three decades to reflect the many presenting symptoms. The diagnostic and prognostic salience of the different signs and symptoms is unknown and this inclusion of multiple symptoms involving many body systems complicates clinical diagnosis and is likely to add to the stigma associated with the condition. It is widely recognised that there are limitations to these diagnostic sets and that there is disparity between them[3,4,5,6,7]. The different sets may identify different categorical groups differing in phenotypic pattern and which can be conceptualised as subtypes of CFS or even different disorders or may relate to a continuum across which different thresholds are arbitrarily met dependent on diagnostic schedule used[8, 9]
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