Lewis, Ieuan, Pairman, Jessie, Spickett, Gavin et al. · European journal of clinical investigation · 2013 · DOI
This study compared ME/CFS symptoms and nervous system function in older patients (age 50+) versus younger patients (ages 16-29). Researchers found that older patients experienced more severe fatigue and depression, along with greater imbalance in their autonomic nervous system—the system that controls heart rate, blood pressure, and other automatic body functions. The results suggest that ME/CFS may present differently and more severely in older adults.
Many clinicians and researchers assume ME/CFS is primarily a disease of mid-life adults, potentially leading to delayed or missed diagnoses in older populations. This study demonstrates that older patients may experience a distinct, more severe disease variant with measurable autonomic nervous system abnormalities, highlighting the need for age-appropriate diagnostic and management approaches.
This cross-sectional study cannot establish causality or determine whether observed autonomic differences are disease-specific or attributable to normal aging, comorbidities, or medications. The small sample size (n=25 per group) limits generalizability, and the study does not track whether these differences persist or predict patient outcomes over time.
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
Lewis, Ieuan, Pairman, Jessie, Spickett, Gavin, & Newton, Julia L (2013). Is chronic fatigue syndrome in older patients a different disease? -- a clinical cohort study.. European journal of clinical investigation. https://doi.org/10.1111/eci.12046
BibTeX
@article{mecfsatlas-lewis-2013-chronic-fatigue,
author = {Lewis, Ieuan and Pairman, Jessie and Spickett, Gavin and Newton, Julia L},
title = {Is chronic fatigue syndrome in older patients a different disease? -- a clinical cohort study.},
journal = {European journal of clinical investigation},
year = {2013},
doi = {10.1111/eci.12046},
note = {PubMed: 23397955},
url = {https://www.mecfsatlas.com/evidence/lewis-2013-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/lewis-2013-chronic-fatigue
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