Sick and tired of being tired and forgetful?

Two letters I received recently from readers asked about two quite common complaints of patients: fatigue and forgetfulness. These problems affect many people and I know that they are of interest to many Filipinos based on the letters we receive. These symptoms may mean nothing much to worry about, but they could also be precursors to something more serious.

Q. I have recently been diagnosed to have Chronic Fatigue Syndrome. My mind had been whirling since then trying to get information about it. I have many questions but seem unable to get answers. Help!

S.E., Manila

A. Chronic Fatigue Syndrome (CFS) is defined as persistent fatigue that has lasted at least six months and is not caused by any other known condition, such as depression or anxiety, alcohol abuse, underactive thyroid, chronic hepatitis B or C, HIV, multiple sclerosis, Parkinson’s Disease, fibromyalgia, or sleep disorders such as obstructive sleep apnea. The fatigue is not relieved by rest and it significantly reduces the ability to pursue normal activities. In addition to chronic fatigue, CFS is accompanied by at least four of the following eight primary symptoms: 1) substantial impairment in memory or concentration; 2) sore throat; 3) muscle pain; 4) pain in multiple joints; 5) tender lymph nodes; 6) headache of a new type, pattern or severity; 7) sleep disturbance; or 8) extreme fatigue lasting 24 hours or longer following physical or mental exercise.

Although researchers are working to understand CFS, no single cause is yet clear and no cure has been found. But progress is being made in identifying issues contributing to its development, thanks to recent studies that are helping to fill in missing pieces of the CFS puzzle. The condition is very complex and the physical and mental symptoms differ from patient to patient. It may well be that the syndrome results from more than one cause or a combination of causes. What brings about the condition in one group of patients may not be what causes it in another. Still, there is no doubt that patients experience a real set of symptoms, and treatment is based on a careful assessment of each individual’s condition.

Because scientists have yet to find a diagnostic or laboratory test for CFS, the condition is diagnosed largely by ruling out other physical and psychological causes. Diagnosis can be difficult and time-consuming: The US Centers for Disease Control and Prevention (CDC) estimates that only 20 percent of people who have CFS are ever diagnosed.

 Since there is as yet no agreement on the underlying cause of the condition, treatment focuses on managing symptoms, and if possible, relieving them (medications such as antidepressants, and nonsteroidal pain medications are sometimes helpful), and avoiding stress and overexertion that might lead to relapse. The illness may last months or years, but most patients eventually recover.

More than 4,000 published studies have turned up a number of biological factors that may be associated with the development of CFS. Many of these affect subsets of patients but not all individuals with the condition. Possible causes of CFS include:

• Genetic factors. Some studies suggest that people with CFS have certain genes that affect the brain’s response to stress and reduce the body’s ability to adapt to physical and psychological challenges.

• Viruses. CFS often begins shortly after exposure to one of several viruses, including the Epstein-Barr virus, parvovirus, cytomegaloviruses and enteroviruses.

• Hypotension (mild chronic low blood pressure). CFS patients experience a greater likelihood of disturbances in the autonomic regulation of blood pressure and pulse (neurally mediated hypotension or NMH), according to some recent studies.

• Immune irregularities linked to stress hormones. Studies suggest people with CFS produce lower levels of the stress hormone cortisol, which normally suppresses inflammation and immune cell activation, resulting in a hyperactive immune system.

Patients seem to do best by seeing a doctor who takes a detailed history and conducts a complete physical and medical evaluation, which should include a careful comprehensive psychological assessment and consideration of the factors that may perpetuate the condition. Treatment for CFS usually consists of a combination of exercise and cognitive behavioral techniques, so that patients can tackle the difficult things in life that sap their energy. The treatment should be tailored to each patient as an individual.

Q. I am a 65-year-old woman who is in relative good health. However, more and more, I am losing track of my keys, bag, and checkbook. Are these only minor memory lapses or am I getting Alzheimer’s? I am very much afraid. How can I tell?   J.A., Iloilo City.

A. Most of us worry about memory loss as we age, fearing that our bouts of forgetfulness may be the first signs of dementia. But a new study of the prevalence of dementia among older people is reassuring. Researchers supported by the US National Institutes of Health, who analyzed data on a nationally representative group of older adults, found that just five percent of people in their 70s have actual dementia. Although risk rises in the 80s, it is still low — about 24 percent — while only about 37 percent of people in their 90s have dementia, according to a report in the October 29, 2007 issue of Neuroepidemiology.

Although these findings suggest that the majority of us can expect our memories to serve us well into our later years, it is still advisable to know the symptoms of serious memory problems. Confusion and forgetfulness can be caused by a number of conditions, many of which can be successfully treated. Even if symptoms indicate the beginning stages of Alzheimer’s disease (AD) or another type of dementia, early treatment may be able to help slow down cognitive decline.

Some memory difficulties, such as trouble remembering names of people or places, or forgetting where you put your glasses, are associated with normal aging. We may misplace our car keys, but we find them eventually. Forgetfulness may be associated with depression or stress, as well, and these memory problems often can be resolved by treating the depression or reducing the stress levels.

However, it’s not normal to have more extensive memory problems, especially when these problems are consistent, get worse over time, or make it difficult to pursue normal activities. These serious symptoms require a thorough medical evaluation so that other possible contributing factors — such as thyroid abnormalities, depression, vitamin deficiency or sleep deprivation — can be ruled out. If memory problems are associated with a memory disorder such as AD, prompt treatment may slow its progress or ease its symptoms.

While occasional forgetfulness is normal, here are 10 symptoms that may indicate that memory lapses may be serious. Very often, these problems are noticed by friends and family first.

1. Memory loss that affects lifestyle or ability to fulfill responsibilities. Experiencing increasing difficulty performing familiar tasks such as driving or cooking a meal; having increasing difficulty responding to problems at home or elsewhere that in the past were handled without trouble.

2. Disorientation to time and place. Having trouble recognizing familiar places or faces; getting lost; frequent confusion over date and time.

3. Misplacing things. Having difficulty remembering the proper place for common objects; constantly losing track of possessions.

4. Language difficulty. Having difficulty finding the right words to express thoughts; having trouble conversing or following a conversation.

5. Problems with abstract thinking. Having difficulty with spatial relationships and complex intellectual tasks, such as reading a map; having increasing difficulty grasping new ideas or learning new skills, such as how to operate a new appliance; displaying poor or decreased judgment.

6. Inability to focus. Having increasing difficulty concentrating on specific tasks or activities.

7. Failing short-term memory. Having difficulty following directions; asking the same question repeatedly.

8. Loss of initiative. Displaying increasing passivity, apathy; loss of energy; lack of motivation; sleeping more; showing indifference to what’s going on in your surroundings.

9. Personality and mood changes. Showing changes in behavior, such as greater irritability or more aggressive conduct, suspicion, anxiety, and/or depression; mood swings.

10. Neglecting personal hygiene. Resisting dental care and showering or bathing, displaying increasingly unsafe behavior, such as leaving a stove burner turned on.