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August 30, 2002
August T'N'T: TIPS AND TECHNIQUES FOR TREATING CFS/ME
By Dr. Richard L. Bruno
Do Chronic Fatigue Syndrome (CFS) patients have progressive memory loss? When I am very fatigued or stressed I am unable to remember the word I was going to say. I'm frightened. Am I getting Alzheimer's disease along with CFS?
No, what you describe isn't Alzheimer's. You are experiencing word-finding difficulty which has nothing to do with memory loss or Alzheimer's disease. Like so many fatigue-related problems in people with CFS/ME, word-finding difficulty is also reported by polio survivors with "brain fatigue." In our 1990 International Survey 79% of polio survivors reported difficulty "thinking of words I want to say."
Thirty-seven percent reported frequent, moderate-to-severe word-finding difficulty. Polio survivors and CFS patients have difficulty naming objects and sometimes even getting out the names of people they know well! But word-finding difficulty is not associated with memory loss or thinking problems, symptoms of Alzheimer's disease. It is related to trouble focusing attention and a decrease in branactivation, the fundamental problem we think underlies "brain fatigue."
In one study we found that difficulty with word-finding and focusing
attention were related to polio survivors' brains making less dopamine.
Recent studies have found that CFS and fibromyalgia patients make less
dopamine, too. (Neurons that make dopamine are killed by a number of
encephalitis-causing viruses in addition to the polioviruses.) Why is too little Dopamine related to trouble "finding" words? Dopamine is not only the main brain activating neurochemical. Dopamine also connects the two "talking" parts of the brain: the part that thinks of the word you want to say and the part that "says" it. If you have too little dopamine you can think of a word but you can't get it out.
Knowing the word you want to say but not being able to say it is called the "tip-of-the-tongue" experience and is a common Parkinson's disease symptom. And that makes sense. Low dopamine is the cause of Parkinson's disease. We found that word-finding difficulty was as severe in polio survivors as it was in Parkinson's patients, even though polio survivors do not experience the tremor and rigidity of Parkinson's disease. However, there have been some CFS patients who, at least immediately after they became ill, did have some Parkinson's-like tremor and rigidity.
In 1996 we published a study showing that bromocriptine, a dopamine-replacing drug, reduced word-finding difficulty, attention problems and fatigue in polio survivors. However, medication is not necessary to treat word-finding difficulty. Reducing physical and emotional stress decreases fatigue, word-finding difficulty and all brain symptoms in polio survivors and CFS patients.
If you're having trouble thinking of a word that you want to say, take a rest break, a deep breath and try to "talk around" the word by describing the thing you're trying to name. If you are forgetting your friends and relatives names, just call everyone "Buddy" or "Honey."
Dr. Richard Bruno is Director of Fatigue Management Programs and The
Post-Polio Institute at Englewood (NJ) Hospital and Medical Center. His new book, THE POLIO PARADOX: UNCOVERING THE HIDDEN HISTORY OF POLIO TO UNDERSTAND TREAT "POST-POLIO SYNDROME" AND CHRONIC FATIGUE, is published by Warner Books. (AOL Keyword POLIO PARADOX.) E-mail questions to him at PolioParadox@aol.com.
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