Are objective outcomes of cognitive function possible?

How have these measures been used with depression?

I think if they could ['relatively' objectively] measure cognitive fatigue and fatigability that would help with validating symptoms both in healthcare and in clinical trials.

My guess is that with ME/CFS you would see another pattern than with depression and also long term changes could be more pronounced in pwME.

(n= 1: I got so much slower on average both with thinking and movements during the last seven years of my 25 years with this illness but I still can think clearly and react not sooo slowly for some time when I get sufficient ( = a lot of/ abnormally high amount of ) rest. So I think the pre-/post exertion & pre-/post breaks measurements would be different compared to depression; also: even if tests don't show abnormal values in most pwME my guess is the pre/post pattern would be distinguishable both from healthy controls and people with depression. )

I think it would be interesting also to compare post-cognitve-exertion reaction time / other cognitive function and post-physical-exertion reaction time/ cognitive function. This I think is something that could have validated my symptoms even in the first years of being ill when I still was able to work part time.

 

It seems as though a neuropsychological assessment is used to objectively assess cognitive function.

https://www.advancedassessments.co.uk/Neuropsychologist/

 

I think that this could give false clues when applied in ME/CFS.

If it takes sufficient time to induce relevant cognitive fatigue, but that isn't taken into account by the assessor, you will then score better on the tests done earlier in the assessment session and worse later, not related to the kind of task but just to being more fatigued.

If it doesn't induce relevant cognitive fatigue, it will probably show no abnormalities.

It may still make sense for monitoring long-term changes.

I never had abnormal results in standard cognitive testing done by neurologists, only in a neuro rehab clinic where I was assessed for working ability.

The testing was 3.5 hours, with two short breaks (too late and too short for me), so in sum this was sufficient time to show a clear decline in alertness and other cognitive function (and also in my handwriting) but not the typical abnormalities you would see due to other cognitive impairment in established neurological or psychiatric disease.

In theory, it's still not an actual objective assessment as it could be manipulated [or as people said earlier in this thread, influenced by all other sorts of motivation] but I think most people don't want to (or perhaps even can't) pretend in such an assessment setting that they are less intelligent /cognitively fit than they actually are.

So I still would count that as a 'pretty objective' assessment, but would need to be adjusted to what's relevant to measure in ME/CFS.

 

The duration of testing is essential. We have seen multiple long Covid studies where two or three short tests from the NIH toolbox were used and revealed no cognitive impairment. In Norway, Wyller recently published a similar study in teenagers with ME/CFS.

My neuropsychological (cognitive) assessment was done by a neuropsychologist who specializes in ME/CFS and he ran a battery of tests that lasted 1h30, with no break. My performance declined as the testing went on and I was completely lost by the end.

If this is taken into account, then neuropsychological assessments may well be reliable tests of cognitive function for ME/CFS. Perhaps studies could include a 20 or 30 min preliminary “warm-up” period with tasks that would induce cognitive fatigue in ME/CFS but not in healthy controls. Only after this warm-up would results be compared between patients and controls.

 

I also came across this: https://med-mastodon.com/@CastlTrAstonDrs/109313935213337419

“#Neurology Increasing evidence suggests persistent cognitive dysfunction #LongCovid .In this cross-sectional study, frontal lobe function was assessed 12 months after the acute phase of the disease, using tailored eye tracking assessments. Individuals who recovered from #COVID19 made significantly more errors in all eye tracking tasks compared to age/sex-matched healthy controls.”

https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.51675

Edit: discussion here https://www.s4me.info/threads/cogni...e-from-eye-tracking-carbone-et-al-2022.30389/

 

My cognitive assessment would show huge differences from a lying down and upright position.

 

Yes, I'm sure mine too, and even sitting on a slightly declined chair with a long back- and headrest would show differences to sitting upright with a 'standard' backrest.

Just have thought I should add this and your post now made this easier @Mij

 

When you say standard cognitive testing done by neurologists, do you mean the brief questions they ask during their clinics, such as asking you to state the day, month, year and what hand you use?

When I underwent neuropsychological testing during the initial interview, I explained that some of my cognitive difficulties seem to fluctuate. The assessor asked me if fatigue/tiredness (I can't remember the exact wording) can make the difficulties worse. The way it was explained to me is that post-exertional functioning decline is not unheard of and although neuropsychological tests are not designed to pick that up, they can be used to inform other brain testing.

What I found was that, as you said, I performed very well in many parts of the test due to increased energy. I had severe brain fog earlier in the day, so I was sure I was going to score poorly overall, but with a stroke of typical luck, my symptoms fluctuated, and I had a lot of increased energy, and it felt like all my usual impairments disappeared until I was asked to perform actions that required the use of multiple cognitive abilities altogether.

My difficulties came to light when I was asked specific style questions, which made no difference to my fatigue levels or how much I exerted myself. I'm guessing the questions I struggled with are probably the same styled questions that neuropsychologists experienced with ME/CFS would concentrate on. My brain would be fried had I undergone 2 hours of joint multi-cog style questioning. So although the test is not ME/CFS or Long Covid specific, it can be used to highlight abnormalities that warrant further investigation that better assessment tools are geared towards. The added benefit is you are also screened for primary mental health conditions so the assessor can determine what the likely cause of the abnormalities is.

I agree, I don't think the test, in theory, is objective either, but as it stands, it's still a gold-standard brain test used to objectively evaluate injury/disorder/mental health. Until that changes, it counts as objective.

A form of cognitive postural testing is performed during Tilt Table testing.

 

I've been meaning to add to the chorus of people saying that standard, more extensive neurophsychiatric/psychometric testing will often pick up the cognitive problems pwME/CFS experience. When I first applied for disability benefits through Social Security, I was immediately packed off for a neuropsych evaluation. I was there for five hours, which included an hour-long psychological interview in addition to all the fancy cognitive testing. In her report to Social Security, the psychologist stated that my test results demonstrated moderate difficulties with short-term memory and concentration and that I was processing information significantly slower than my IQ would suggest I should be (and I could still drive at this point; I shudder to think what my processing speed would be now!). At the time (2001) it was the only "objective" evidence I had of ME/CFS and helped a great deal in winning my disability case.

I noticed that @livinglighter has mentioned their experience with such testing in this thread where a number of other people have said they too have had similar results. With regard to the OP, while I can't really answer the question of whether cognitive testing can ever be truly objective, I do think there are standard tools on the shelf, as it were, that can show cognitive deficits in pwME/CFS. They just aren't going to be simple enough to use during a GP visit.

 

Important for evidence that you actually have cognitive impairment, and it's not you "worrying" you have it, whatever the cause is.