Preprint Fatigue >12 weeks after coronavirus disease COVID is associated with reduced reward sensitivity during effort-based decision making, 2024, Scholing+

Fatigue >12 weeks after coronavirus disease COVID is associated with reduced reward sensitivity during effort-based decision making
Judith M. Scholing; Britt I.H.M Lambregts; Ruben van den Bosch; Esther Aarts; Marieke E. van der Schaaf

BACKGROUND
Fatigue and depressive mood is inherent to acute disease, but a substantial group of people report persisting disabling fatigue and depressive symptoms long after a COVID infection. Acute infections have shown to change decisions to engage in effortful and rewarding activities, but it is currently unclear whether fatigue and depressive symptoms similarly affect decision making during acute and persistent phases of a COVID infection. Here, we investigated whether fatigue and depressive mood are associated with altered weighting of effort and reward in decision-making during different timepoints after COVID infection.

METHODS
We conducted an online cross-sectional study between March 2021 and March 2022. 242 participants 18-65 years) with COVID <4 weeks ago (n=62), COVID >12 weeks ago (n=81), or no prior COVID (self-reported) (n=90) performed an effort based decision-making task, in which they decided whether they wanted to exert physical effort (ticking boxes on screen, 5 levels) for reward (money to be gained in a voucher-lottery, 5 levels). State fatigue and depressive mood was measured by the Profile of Mood States (POMS) prior to the task. We used multilevel binomial regression analysis to test whether fatigue and depressive mood were related to acceptance rates for effort and reward levels and whether this differed between the groups.

RESULTS
Compared with no COVID and COVID <4 weeks groups, the COVID >12 weeks group reported higher state fatigue scores (mean±SD: 20±7 vs. 14±7 and 12±6 POMS-score, respectively; both p<0.001) and was less sensitive to rewards (Reward*Group: OR: 0.35 (95%CI 0.20, 0.62), p<0.001 and OR: 0.38 (95%CI 0.20, 0.72), p=0.003). In the COVID >12 weeks group, fatigue was more negatively associated with reward sensitivity compared with the COVID <4 weeks group (Reward*Fatigue*Group: OR 0.47 (95%CI 0.25, 1.13), p=0.022) and the no COVID group (Reward*Fatigue*Group: OR 0.48 (95%CI 4.01, 0.92), p=0.029). No group differences were observed for the relationship between fatigue and effort sensitivity. No group differences were observed for the relationship between depressive mood and effort or reward sensitivity. Higher age, lower BMI, unhealthy lifestyle, and worrying during the acute phase of COVID each predicted decreased reward sensitivity in the >12 weeks group (Age*Reward: OR 0.30 (95%CI 0.19, 0.48), p<0.001; BMI*Reward: OR 1.43 (95%CI 1.01, 2.00), p=0.047); Lifestyle*Reward: OR 1.50 (95%CI 1.06, 2.14), p=0.022; Worrying*Reward: OR 0.59 (95%CI 0.38, 0.94), p=0.025, respectively).

CONCLUSIONS
The finding that fatigue is related to lower reward sensitivity >12 weeks after COVID, suggesting potential reward deficits in post-covid fatigue. These findings are in line with previous observations that long-term inflammation can induce dysregulations in neural reward processing, which should be further investigated in future studies.

HIGHLIGHTS:
• We tested if fatigue and mood were related to altered decision making post COVID

• Participants post-COVID >12wks ago were more fatigued and less reward sensitive

• Post-COVID-related fatigue was associated with reduced reward sensitivity

• Post-COVID-related depressive mood was not associated with altered decision making

• Higher age, unhealthy lifestyle, and worrying predicted reward deficits

Link | PDF (Preprint: BioRxiv) [Open Access]

 

Am I the only one thinking it’s a bit strange we have another one suddenly deciding to do this new fangled angle of ‘effort-based’ when the decision for this can’t have been preceded by NIH results (too close) and I don’t know how they’d have known about its inclusion before their release.

When was the effort preference idea and task even introduced by Wallit into the NIH thing? Do we know? Was everything signed off from the start or bits introduced over those years?

And that I’m guessing these are just general psychosomaticists not people who done effort preference for a living and found a new illness to try.

it just seems too obscure a new angle to have two suddenly deciding to use as their new big thing bith at the same time without it being ‘put there’


Though useful that hopefully both failing to find much and then struggling to scratch around for something to scrape from it as a claim might put of those who are just looking for a low-hanging fruit new way of doing money for old rope realise this isn’t the ‘elsewhere’ to look for easy inferences even if these tasks are ready-made seemingly

 

So they separated out the decision phase from the execution phase

and us this what they think means there is now such a thing as having reward sensitivity without effort sensitivity ie no difference in effort?

I’ll take a closer look when I can but intrigued on what they’ve assumed they can tell this From - looks like fishing for finding anything once they realised there weren’t the differences they wanted anywhere

but I haven’t looked at the hypothesis design and nulls to see if this was specifically included and if these were signed off before etc

Was it something like the decision screen of whether you play high or low effort vs the number of times high effort selected they are talking about?

Even if not it’s very useful we have that NIH full data forevermore now to inform analysis of all future tests like this even if they don’t - because I think it’s given a very good understanding of where the different elements lie snd patterns etc to cross-compare even across studies?

 

They don't seem to reference Walitt et al or mention EEfRT as far as I could see on a quick skim.

 

I guess you could call PEM a "reward deficit".

(See also the thread on "Do you recover AND improve from exercise?")

 

I too was struck by how this seems to be related to "effort preference." Also, I wondered how they could separate out fatigue from "depressive symptoms" since they are both characteristic of acute illness. More psychologizing, I guess, to no useful purpose..

 

At least there were 75 participants smarter than the researchers by boycotting this way of testing. BPS still runs rampant here.
When LC came up fysiotherapists, psychologists (CBT) and occupational therapist lined up to "help". No clue about LC and the "help" they could offer.
Those "therapies" are not paid for by insurance anymore, because they were not effective.

 

A little compare-and-contrast with the EEfRT in the NIH study by Walitt et al:

Unlike Walitt et al, Scholing et al calibrated:

Ability did not differ between groups in the calibration phase (not assessed by Walitt et al):

Ability did not differ between groups in the execution phase either (unlike in Walitt et al):

Scholing et al's interpretation of their task-that-was-not-EEfRT findings is that fatigue was associated with reduced reward sensitivity, but not reduced effort sensitivity. Walitt et al's interpretation of their EEfRT findings was that ME/CFS was associated with reduced effort sensitivity, but not reward sensitivity.

Other interesting tidbits:
Selection in Scholing et al (patients were not diagnosed with anything or seen by a doctor):

SF36 Physical Function subscale scores for Scholing et al's subgroups:
no COVID group: 91±13
COVID less than 4 weeks prior: 74±24
COVID more than 12 weeks prior: 51±27

Medium intensive exercising, pre-pandemic (h per week) p=0.001 (no difference in high intensive exercise)
no COVID group: 2.90±1.73
COVID less than 4 weeks prior: 3.19±1.56
COVID more than 12 weeks prior: 3.94±1.67

Alcohol use, pre-pandemic (times per month) p=0.035
no COVID group:3.7±4.6
COVID less than 4 weeks prior: 5.7±6.0
COVID more than 12 weeks prior:3.8±4.7

Edited to fix spelling.

 

Well, thanks for muddying this up. Because of course everyone has the same baseline of those to begin with. And for a mere chance of a few bucks. Dance, monkey, dance for a few cents. Come on, show some enthusiasm here! Let's see that big smile of yours and you may get enough to buy a... stick of gum or whatever. It's not as if this is a valid way of testing for anything but whatever. Up? Also down. And left. And mauve. Also, umami and a bit of the 3rd track of Pink Floyd's 4th album.

I don't see how it makes sense to have people studying illness when they clearly have no relevant concept of what illness is or does. It's completely alien to them. Their model of illness is one where people can basically function completely normally with zero impairment in performance or quality of life if they just don't let it bother them. Only disease matters. Illness is a state of mind with zero physical properties or relevance in the real world.

I don't think we'd regress significantly if things just went back to 16th century medical practices. It would just be a lateral move. The only real difference is the rest of society having made significant technological progress, allowing social safety nets and basic needs to be more easily fulfilled. Their understanding of illness has not progressed one bit since then. The only actual difference is everything else, they are completely stuck in time.

 

The "effort preference" term appears to be a newly coined label -quite possibly inspired by Van der Schaaf, Knoop & co's writings- put on Walitt's old belief on fibromyalgia (and ME) that they are "interoceptive disorders" by which he means a disorder of subjective perception.

Walitt got to do the thing he's been doing for at least the past 15 years (I'm out of the topic, but he opened his first unit on "interoceptive disorders" in 2010 before he pursued the topic and got to educate his colleagues at the NIH have-you-tried-yoga department.).

It could be a strategic choice for the moment. Either way, Walitt referenced them - and they said the same thing just in other words.

Walitt and Van der Schaaf similarities discussed (by me) here, here and here.

Walitt also used work by Chalder and White on this topic. (It's quite the rage among the CBT gang.)

 

All the mentions of "effort" make me think that doctors assume the patient isn't trying hard enough.