Teodoro, Tiago, Edwards, Mark J, Isaacs, Jeremy D · Journal of neurology, neurosurgery, and psychiatry · 2018 · DOI
Many people with ME/CFS report cognitive problems like brain fog, forgetfulness, and difficulty concentrating. This review of 95 studies found that while patients consistently describe these symptoms, standard memory and thinking tests often show normal or only mild problems. The authors suggest that pain, fatigue, and the body's excessive self-monitoring may force the brain to work harder on everyday tasks, making thinking feel more exhausting even when test results look relatively normal.
This study provides a unifying neurobiological framework for understanding cognitive dysfunction in ME/CFS, moving beyond dismissive interpretations that attribute symptoms purely to effort or psychiatric causes. It validates that cognitive complaints in ME/CFS are real and mechanistically linked to core disease features (fatigue, pain, interoception), which could improve clinical recognition and guide treatment strategies targeting attention reallocation and symptom monitoring.
This systematic review does not establish causation or prove that the proposed mechanism (interoceptive hypermonitoring causing attention shift) actually occurs in patients; it is a theoretical model based on observational patterns. The review does not provide direct evidence of brain imaging abnormalities, biomarkers, or structural changes underlying cognitive dysfunction. It also does not determine whether cognitive deficits are reversible or how they relate to post-exertional malaise specifically.
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
Teodoro, Tiago, Edwards, Mark J, & Isaacs, Jeremy D (2018). A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review.. Journal of neurology, neurosurgery, and psychiatry. https://doi.org/10.1136/jnnp-2017-317823
BibTeX
@article{mecfsatlas-teodoro-2018-unifying-theory,
author = {Teodoro, Tiago and Edwards, Mark J and Isaacs, Jeremy D},
title = {A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review.},
journal = {Journal of neurology, neurosurgery, and psychiatry},
year = {2018},
doi = {10.1136/jnnp-2017-317823},
note = {PubMed: 29735513},
url = {https://www.mecfsatlas.com/evidence/teodoro-2018-unifying-theory},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/teodoro-2018-unifying-theory
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