Background & Aims
Fibromyalgia (FM) is a chronic pain syndrome featuring widespread musculoskeletal pain, fatigue, and sleep/mood disturbances[1]. Dyscognition, commonly known as ‘fibro fog,’ is a frequently overlooked symptom in FM that impacts psychosocial and occupational functioning in FM[2, 3]. Previous research has objectified these complaints but lacks a needed comprehensive assessment battery for a neuropsychological profile, with poorly understood factors in its genesis. The present study seeks to (1) characterize the neuropsychological profile of patients with FM by comparing their cognitive performance to an age- and sex-matched control group on a comprehensive assessment battery encompassing various domains of functioning, (2) explore whether such a profile can accurately differentiate patients from controls, and (3) identify the clinical, psychological, and pain variables that best predict cognitive performance in patients with FM.
Methods
33 patients with FM (x̄age = 49.7 + 9.22, x̄education = 14.9 + 2.61, 94% women) and 32 age- and sex-matched healthy control subjects (x̄age = 45.2 + 12.1, x̄education = 17.2 + 3.21, 78% women) completed a battery of 17 cognitive tests measuring executive function (processing speed, attention, mental switching, and response inhibition), language, learning and memory, visuospatial function, and perceptual reasoning. In addition, participants completed tests measuring pain hypersensitivity and endogenous pain modulation as well as self-report questionnaires examining symptoms of depression and anxiety, sleep disturbance, alexithymia, and pain catastrophizing. Clinical characteristics including pain severity and interference, quality of life and disease impact were also assessed.
Results
Patients exhibited greater levels of depression, anxiety, alexithymia, sleep disturbances, pain interference, and severity, coupled with lower levels of quality of life. Additionally, they demonstrated heightened pain sensitivity as well as a reduced capacity to modulate pain. While preserving functioning in most cognitive tasks, patients showed difficulties in verbal short-term memory and delayed recognition when contrasted with control subjects (η2: .003 – .07). A least absolute shrinkage and selection operator (LASSO) model revealed that measures of verbal short-term memory, delayed recognition, mental switching, response inhibition, and attention could effectively classify patients from controls with adequate discrimination (AUC-ROC: .72). Further, self-reported sleep disturbances and pain severity best predicted this cognitive profile among patients.
Conclusions
Using a comprehensive neuropsychological battery, the findings of the present study provide new insights into the cognitive profile of patients with FM, demonstrating selective difficulties in specific subdomains of executive functions and memory. These results also substantiate the existence of multiple factors in the development of dyscognition in FM.
References
- Ruschak, I., et al. Fibromyalgia Syndrome Pain in Men and Women: A Scoping Review. Healthcare. 2023. 11(2), p. 223.
- Bell, T., et al., Meta-analysis of cognitive performance in fibromyalgia. J Clin Exp Neuropsychol, 2018. 40(7): p. 698-714.
- Moriarty, O., B.E. McGuire, and D.P. Finn, The effect of pain on cognitive function: a review of clinical and preclinical research. Prog Neurobiol, 2011. 93(3): p. 385-404.
- Dworking, R.H., et al. Core outcomes measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 2005. 113(1): p. 9-19.
Presenting Author
Erika Gentile
Poster Authors
Topics
- Mechanisms: Psychosocial and Biopsychosocial