Gaglio, Caroline L, Islam, Mohammed F, Cotler, Joseph et al. · Epidemiologic methods · 2022 · DOI
This study looked at how often people with ME/CFS experience two symptoms that doctors use to diagnose the condition: difficulty thinking clearly (brain fog, memory problems) and dizziness when standing up. The researchers found that nearly all participants reported thinking and memory problems, while only a small number had standing-up dizziness without also having cognitive problems. This suggests these two symptoms overlap heavily in ME/CFS patients.
This study challenges the current diagnostic framework used to identify ME/CFS by showing that the either/or approach to neurocognitive impairment and orthostatic intolerance may not accurately reflect how these symptoms occur in patients. Improving diagnostic criteria could help ensure more accurate diagnosis and better research comparability across studies.
This study does not establish causation or explain the biological mechanism linking neurocognitive impairment and orthostatic intolerance. As a cross-sectional survey study, it cannot determine whether one symptom causes the other or whether they stem from a common underlying dysfunction. The findings are also limited to patients who responded to the questionnaire and may not represent all ME/CFS presentations equally.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Gaglio, Caroline L, Islam, Mohammed F, Cotler, Joseph, & Jason, Leonard A (2022). Orthostatic intolerance and neurocognitive impairment in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).. Epidemiologic methods. https://doi.org/10.1515/em-2021-0033
BibTeX
@article{mecfsatlas-gaglio-2022-orthostatic-intolerance,
author = {Gaglio, Caroline L and Islam, Mohammed F and Cotler, Joseph and Jason, Leonard A},
title = {Orthostatic intolerance and neurocognitive impairment in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).},
journal = {Epidemiologic methods},
year = {2022},
doi = {10.1515/em-2021-0033},
note = {PubMed: 36310761},
url = {https://www.mecfsatlas.com/evidence/gaglio-2022-orthostatic-intolerance},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/gaglio-2022-orthostatic-intolerance
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