Stewart, Julian M, Medow, Marvin S, Messer, Zachary R et al. · American journal of physiology. Heart and circulatory physiology · 2012 · DOI
When people with ME/CFS try to stand upright or tilt backward, their brain doesn't get enough blood flow to think clearly, and their thinking problems get worse as their body position changes. In healthy people, brain blood flow increases during hard thinking tasks, but in ME/CFS patients, this normal response is broken—their brains don't increase blood flow when doing difficult mental tasks.
This study provides mechanistic evidence that cognitive dysfunction in ME/CFS is linked to abnormal brain blood flow regulation during postural stress, suggesting the problem is not purely psychological. Understanding this neurovascular coupling defect could guide future targeted therapies aimed at restoring blood flow regulation in the brain.
This study does not prove that abnormal brain blood flow causes cognitive impairment—it only shows the two occur together. It also does not establish whether the vasomotor abnormality is a primary defect or a secondary response to another underlying problem. The findings are specific to patients with both CFS and postural tachycardia syndrome, so they may not apply to all ME/CFS patients.
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
Stewart, Julian M, Medow, Marvin S, Messer, Zachary R, Baugham, Ila L, Terilli, Courtney, & Ocon, Anthony J (2012). Postural neurocognitive and neuronal activated cerebral blood flow deficits in young chronic fatigue syndrome patients with postural tachycardia syndrome.. American journal of physiology. Heart and circulatory physiology. https://doi.org/10.1152/ajpheart.00994.2011
BibTeX
@article{mecfsatlas-stewart-2012-postural-neurocognitive,
author = {Stewart, Julian M and Medow, Marvin S and Messer, Zachary R and Baugham, Ila L and Terilli, Courtney and Ocon, Anthony J},
title = {Postural neurocognitive and neuronal activated cerebral blood flow deficits in young chronic fatigue syndrome patients with postural tachycardia syndrome.},
journal = {American journal of physiology. Heart and circulatory physiology},
year = {2012},
doi = {10.1152/ajpheart.00994.2011},
note = {PubMed: 22180650},
url = {https://www.mecfsatlas.com/evidence/stewart-2012-postural-neurocognitive},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/stewart-2012-postural-neurocognitive
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