title: Does neuropsychological test performance predict outcome of cognitive behavior therapy for Chronic Fatigue Syndrome and what is the role of underperformance?
abstract: OBJECTIVE
  A subgroup of patients with Chronic Fatigue Syndrome (CFS) has cognitive impairments, reflected by deviant neuropsychological test performance. However, abnormal test scores can also be caused by suboptimal effort. We hypothesized that worse neuropsychological test performance and underperformance were related to each other and to a smaller reduction in fatigue, functional impairments, physical limitations and higher dropout rates following cognitive behavior therapy (CBT) for CFS.
  
  
  METHODS
  Data were drawn from a previous trial, in which CFS patients were randomized to two conditions; 1) guided self-instruction and additional CBT (n=84) or 2) waiting period followed by regular CBT for CFS (n=85). Underperformance was assessed using the Amsterdam Short Term Memory Test (<84). To test neuropsychological test performance, the Symbol Digit Modalities Task, a simple reaction time task and a choice reaction time task were used. Interaction effects were determined between underperformance and neuropsychological test performance on therapy outcomes.
  
  
  RESULTS
  Underperformance was associated to worse neuropsychological test performance, but there were no significant interaction effects of these two factors by therapy on fatigue severity, functional impairments and physical limitations, but there was a significant main effect of underperformance on functional impairments, physical limitations and dropout rates.
  
  
  CONCLUSIONS
  Underperformance or neuropsychological test performance was not related to the change in fatigue, functional impairments, and physical limitations following CBT for CFS. However, underperforming patients did drop out more often. Therapists should pay attention to beliefs and behavioral or environmental factors that might maintain underperformance and increase the risk of dropout.
authors: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands. m.m.goedendorp@umcg.nl
authors: Martine M
authors: MM
authors: Goedendorp
authors: Sieberen P
authors: SP
authors: van der Werf
authors: Gijs
authors: G
authors: Bleijenberg
authors: Marcia
authors: M
authors: Tummers
authors: Hans
authors: H
authors: Knoop
mesh_terms: D000328:Adult; D001288:Attention; D015928:Cognitive Behavioral Therapy; D015673:Fatigue Syndrome, Chronic / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011930:Reaction Time; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Chronic Fatigue Syndrome; Cognitive behavior therapy; Dropout; Functional impairments; Neuropsychological tests; Underperformance