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Forum Name: Neurology Topics

Question: Cognitive Decline, Chronic Fatigue, Fluctuating Heart Beat


 wrxn240sx - Sat Jan 17, 2009 7:53 pm

Most doctors first thoughts would be Depression. My PD told me everything I felt was caused by depression, and frankly, I will never see him again. For the past year or so I have had progressive cognitive decline to the point where I can hardly function. My memory, attention, and intellect are at its lowest points. I don't even know how to express how bad it has gotten. My language skills have dropped significantly. I have a very hard time finding words. My mind feels blank or in poverty of thought all the time. I was born with some intelligence, so I am able to be kind of aware of what's going on. I can't interact socially anymore, I simply don't know what to do! If I am depressed, I feel it was brought on because of my cognitive decline.

I need at least 12 hours of sleep to make it through the day. Even then I am chronically fatigued throughout the day.

My heartbeat is usually always in the range of what would be considered "tachycardia". If not while sitting, it will jump up high when I stand up. That scares me that whenever I'm up on my feet moving around, my heart is always in overtime. Very rarely will my heartbeat be normal, but it is sometimes which is weird.

I am only 19 years old. I have friends that are very depressed are function ALOT better than me. As far as their social skills and language skills, they are not as affected. I feel it's something physical, because the only mental condition that I've seen that can cause this bad of a decline is schizophrenia, which I don't think I have, but I don't know.
 John Kenyon, CNA - Tue Jan 20, 2009 11:05 pm

User avatar Hello -

While depression can cause the symptoms you describe, I tend to believe, as you do, that there's something else going on. Of course situational depression can develop due to a chronic problem, and this can only serve to cloud the picture further, but there are so many other things that could be causing this that depression really needs to be set aside until and unless everything else has been ruled out. I certainly don't hear anything that suggests schizophrenia.

To start with, you also describe a classic case of chronic fatigue syndrome (CFS), which of course is often mistaken for depression, which is too easy a mistake to make. Your memory, cognitive faculty deficit, fatigue, etc., all fit perfectly with CFS. Some others that should be ruled out are liver disease, kidney disease, Lyme disease, fibromyalgia and hypothyroidism. So you see, a summary diagnosis of depression, especially without any significant attempt at laboratory testing to rule out physical causes, suggests need of a second opinion at least. Since you've effectively "fired" your doctor of record, the next one you see will hopefully go about this methodically and order appropriate tests to see just what's going on.

Since there is such a broad spectrum of possible causes, and because your symptoms most closely resemble CFS, one might think this would be the first cause investigated. However, since the cause of CFS is unclear at present, those other conditions mentioned must be ruled out (or in) by laboratory testing and overall good detective work (including intelligent questioning by the attending physician), and CFS is often the default diagnosis (not depression); when it is, it is treated symptomatically and supportively, since there is neither a clear cause nor a definitive therapy for most cases (some are linked to a form of pneumonia and respond to antibiotic therapy, but this is a small subset of patients).

Hopefully you'll find an interested doctor who will go after this aggressively. Meanwhile, try and get as much (gradual) exercise, as you find it tolerable, rest but don't become depressed and inactive if you can help it (I know, some of this sounds contradictory, but you have to pretty much play this by ear while remembering that there is a certain amount of work involved that doesn't seem right), eat as well and as healthily as you can, and remain persistent as your own advocate. You might also want to take notes or keep a journal and take a list of questions, symptoms, etc., with you to your next medical appointment, in order to make certain you remember all you want to mention, since it's very easy under these conditions to forget much of what you meant to say, and it often can be important.

I hope this is helpful to you. It is of course impossible to diagnose what's going on at a distance, but I think support is definitely in order and I can give you that as well as the above suggestions as to differential diagnosis, and my opinion regarding anyone leaping to an unfounded conclusion about the cause of these very frustrating symptoms. Best of luck to you and please follow up with us as needed.
 Jessizh - Tue Jan 27, 2009 6:06 pm

I read on the net somewhere about POTS, Postural orthostatic tachycardia syndrome, dizzy when stanging, heart pounding, look it up, it might help =)

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