[Cognitive impairment in patients suffering from fibromyalgia. An underestimated problem].

Neurologische Klinik der Universität Regensburg, Regensburg.
Der Schmerz (Impact Factor: 1.02). 02/2010; 24(1):46-53.
Source: PubMed

ABSTRACT The primary symptom of fibromyalgia (FM) is chronic, widespread pain accompanied by diffuse tenderness to light palpation. However, many patients report a multitude of additional complaints and symptoms. Besides fatigue, exhaustibility and stiffness, a decrease in concentration and memory are further complaints that add significantly to the degree of suffering. This complaint, often termed "fibrofog", is increasingly recognised as an independent symptom that has made its way into the medical literature under the term "dyscognition". Nonetheless there are only a few studies that have specifically investigated neuropsychological deficits in FM patients in order to further specify clinical complaints. The studies performed so far have provided increasing evidence that FM patients have attention and working memory deficits, which are most prominent when patients have to cope with an additional source of distraction. With this review we intend to give an overview of the neuropsychological studies in FM performed so far and to assess possible implications for the underlying pathophysiology. In addition, we discuss potential clinical approaches to these symptoms. A systematic literature review up to June 2009 was carried out using the keywords (pairs) "fibromyalgia" and "cognition", "fibromyalgia" and "dyscognition", "fibromyalgia" and "cognitive deficits".

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    • "FM patients frequently display greater impairments in the ability to actively retrieve past episodic events in the absence of a cue (free recall) than on recognition tests, which serve to evaluate the retrieval of remembered information and are more resistant to the effects of impaired attention and concentration [43, 44, 48, 51]. It has thus been proposed that memory impairments in FM are more highly related to attentional factors that modulate the efficiency of memory functioning than to primary memory processes per se [48] [60] [61]. Thus, the inability to manage distraction seems to be a particular problem in fibromyalgia patients and is reflected in patients' reports of difficulty concentrating and dealing with complex, rapidly changing environments [61] and by memory tests showing performance decrements in the presence of distraction. "
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    ABSTRACT: Fibromyalgia is characterized by chronic widespread pain, clinical symptoms that include cognitive and sleep disturbances, and other abnormalities such as increased sensitivity to painful stimuli, increased sensitivity to multiple sensory modalities, and altered pain modulatory mechanisms. Here we relate experimental findings of fibromyalgia symptoms to anatomical and functional brain changes. Neuroimaging studies show augmented sensory processing in pain-related areas, which, together with gray matter decreases and neurochemical abnormalities in areas related to pain modulation, supports the psychophysical evidence of altered pain perception and inhibition. Gray matter decreases in areas related to emotional decision making and working memory suggest that cognitive disturbances could be related to brain alterations. Altered levels of neurotransmitters involved in sleep regulation link disordered sleep to neurochemical abnormalities. Thus, current evidence supports the view that at least some fibromyalgia symptoms are associated with brain dysfunctions or alterations, giving the long-held "it is all in your head" view of the disorder a new meaning.
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    ABSTRACT: The primary symptom of fibromyalgia (FM) is chronic, widespread pain; however, patients report additional symptoms including decreased concentration and memory. Performance-based deficits are seen mainly in tests of working memory and executive function. Neural correlates of executive function were investigated in 18 FM patients and 14 age-matched healthy controls during a simple Go/No-Go task (response inhibition) while they underwent functional magnetic resonance imaging (fMRI). Performance was not different between FM and healthy control, in either reaction time or accuracy. However, fMRI revealed that FM patients had lower activation in the right premotor cortex, supplementary motor area, midcingulate cortex, putamen and, after controlling for anxiety, in the right insular cortex and right inferior frontal gyrus. A hyperactivation in FM patients was seen in the right inferior temporal gyrus/fusiform gyrus. Despite the same reaction times and accuracy, FM patients show less brain activation in cortical structures in the inhibition network (specifically in areas involved in response selection/motor preparation) and the attention network along with increased activation in brain areas not normally part of the inhibition network. We hypothesize that response inhibition and pain perception may rely on partially overlapping networks, and that in chronic pain patients, resources taken up by pain processing may not be available for executive functioning tasks such as response inhibition. Compensatory cortical plasticity may be required to achieve performance on a par with control groups. PERSPECTIVE: Neural activation (fMRI) during response inhibition was measured in fibromyalgia patients and controls. FM patients show lower activation in the inhibition and attention networks and increased activation in other areas. Inhibition and pain perception may use overlapping networks: resources taken up by pain processing may be unavailable for other processes.
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