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Licensed Unlicensed Requires Authentication Published by De Gruyter October 10, 2022

Orthostatic intolerance and neurocognitive impairment in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

  • Caroline L. Gaglio , Mohammed F. Islam , Joseph Cotler and Leonard A. Jason EMAIL logo
From the journal Epidemiologic Methods



The Institute of Medicine (IOM 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington: The National Academies Press) suggested new criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), which requires an endorsement of either neurocognitive impairment or orthostatic intolerance (OI) in addition to other core symptoms. While some research supports the inclusion of OI as a core symptom, others argue that overlap with neurocognitive impairment does not justify the either/or option. The current study assessed methods of operationalizing OI using items from the DePaul Symptom Questionnaire (DSQ-1 and -2) as a part of the IOM criteria. Evaluating the relationship between OI and neurocognitive symptoms may lead to a better understanding of diagnostic criteria for ME/CFS.


Two-hundred and forty-two participants completed the DSQ. We examined how many participants met the IOM criteria while endorsing different frequencies and severities of various OI symptoms.


Neurocognitive impairment was reported by 93.4% of respondents. OI without concurrent neurocognitive symptoms only allowed for an additional 1.7–4.5% of participants to meet IOM criteria.


Neurocognitive symptoms and OI overlap in ME/CFS, and our results do not support the IOM’s inclusion of neurocognitive impairment and OI as interchangeable symptoms. Furthermore, our findings highlight the need for a uniform method of defining and measuring OI via self-report in order to accurately study OI as a symptom of ME/CFS.

Corresponding author: Leonard A. Jason, Center for Community Research, DePaul University, Chicago, USA, E-mail:

Approved by DePaul University Institutional Review Board - Chronic Illness Symptom Study, #PF020317PSY.

Award Identifier / Grant number: 1R01NS111105-01A1


The authors would like to thank Karl E. Conroy for his assistance in the preparation of this manuscript.

  1. Research funding: The authors appreciate the funding provided by the National Institute of Neurological Disorders and Stroke (project number 1R01NS111105-01A1)

  2. Author contribution: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.


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Received: 2021-08-24
Revised: 2022-06-30
Accepted: 2022-09-15
Published Online: 2022-10-10

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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