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This selfish protective inhibition may form the potential pathological foundation for the neurocognitive symptoms and delayed fatigue characteristic of PEM (147, 181).The interaction between energy depletion and neuroinflammation intensifies a potential cycle of energy depletion - inflammation amplification, clinically manifesting as delayed and persistent mental fatigue, cognitive dysfunction, and emotional disturbances

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Nature Reviews Endocrinology , 17(12), 757769