Normalizing Memory Recall in Fibromyalgia With Rehearsal: A Distraction-Counteracting Effect

Rush Medical College, Chicago, Illinois, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 06/2009; 61(6):740-4. DOI: 10.1002/art.24559
Source: PubMed


To examine the impact of distraction on the retention of rehearsed information in patients with fibromyalgia syndrome (FMS).
Data refer to the neurocognitive examination of 134 patients (91 with FMS and 43 control subjects) presenting with memory loss. Four neurocognitive measures free of distraction, along with 2 measures with added distraction, were completed. Differences in the retention of rehearsed and unrehearsed information with a source of distraction present were calculated.
Patients with FMS showed normal cognitive functioning on verbal memory tests free of distraction. Adding a source of distraction caused unrefreshed information to be lost at a disproportionate rate in patients with FMS. Over 87% of patients with FMS scored in the impaired range on a task of unrehearsed verbal memory. Adding a source of distraction to well-rehearsed information produced a normal rate of recall in FMS.
Rehearsal mechanisms are intact in patients with FMS and play beneficial roles in managing interference from a source of distraction. In the absence of rehearsal, a source of distraction added to unrefreshed information signals a remarkable level of cognitive deficit in FMS that goes undetected by conventionally relied-upon neurocognitive measures. We present a theory to promote understanding of the cognitive deficit of people with FMS based on reduced speed of lexical activation and poor recall after distraction.

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    • "In her review, Glass (2009) suggested that cognitive deficits in FM are more marked in tasks involving distraction by a competing source of information. Similarly, Leavitt and Katz (2009) showed that adding a source of distraction that interferes with a memory task caused most difficulties retaining new information in patients with FM. This suggests that executive problems may be key for understanding FM memory deficits. "
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    ABSTRACT: Objectives This study was the first to explore whether individuals with fibromyalgia (FM) have different cognitive alterations (i.e., in alertness, orienting, and executive control) depending on their sex. We also analysed possible gender differences in the relationships between cognitive functioning and some of the main symptoms of FM. DesignCross-sectional study. Methods Two clinical groups with FM (n=58 women and n=20 men) and two healthy control groups (n=21 women and n=27 men) aged between 30 and 60years old participated in this study. Pain intensity, sleep disturbance, depression, anxiety, pain catastrophizing, and daily functioning were evaluated with self-report measures. Attentional function was assessed with the ANT-I task (Attentional Network Test-Interactions). ResultsMixed ANOVAs showed impairment in vigilance and executive control in both male and female patients with FM compared with controls. Control men were faster than control women, but FM eliminated sex differences. In addition, attention deficit was associated with worse daily functioning in women but not in men with FM. Emotional distress and sleep disruption seemed to contribute differently to these cognitive alterations in both sexes. Conclusions Therapy strategies aimed at reducing emotional distress and sleep disruption are likely to improve cognitive function by enhancing vigilance. Therapies aimed at reducing emotional distress seem to improve attentional function more in women than in men; those aimed at improving sleep quality are likely to reduce a vigilance/alertness deficit in women and executive problems in men.
    Full-text · Article · Dec 2014 · British Journal of Health Psychology
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    • "The most robust deficits in tests of memory and attention have so far been observed in paradigms involving a prominent distraction from a competing source of information, wherein FM patients are less capable than healthy controls to retain new information when rehearsal is prevented by a distraction [49] [50] [57]. Milder deficits have been observed in memory free of distraction at encoding [43] [44] [48] [49] [51] [58] [59]. 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]. "
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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.
    Full-text · Article · Jan 2012 · Pain Research and Treatment
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    • "In the present study, it was found that all 3 clock drawing scores and the MMSE score were significantly impaired in FM patients than in healthy controls. In previous studies, it has been shown that 50% to 80% of FM patients suffered from cognitive decline [4] [24]. The prevalence of cognitive impairment according to recommended cutoff points was found to be 58% for the MMSE, 60% for the Watson, 48% for the Shulman, and 50% for the Sunderland scoring method in FM patients. "
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    ABSTRACT: The objective of the study was to assess the validity and reliability of the clock drawing test (CDT) in comparison with the Mini-Mental State Examination (MMSE) as a screening tool for cognitive impairment in patients with fibromyalgia (FM). Fifty female patients with FM and 51 healthy female controls were enrolled in the study. Cognitive functioning of the subjects was evaluated by the CDT and the MMSE. Each CDT was scored according to 3 different clock scoring methods (Shulman, Sunderland, and Watson). Two experienced clinicians scored the CDTs to evaluate the interrater reliability. Validity, sensitivity, specificity, and predictive accuracy of each clock scoring method were analyzed. The Shulman score had the highest correlation with the MMSE score (r =0.65, P < .01). The Shulman and Sunderland methods had significantly the largest areas under the receiver operating characteristic curve (0.82 and 0.81, respectively; P = .000). They also had the highest sensitivity (68.8% and 65.5%, respectively) and specificity (84.2%, and 84.1%, respectively). The interrater correlation coefficients were high for all 3 clock scoring methods. The CDT has been proven to be a valid and reliable tool for screening cognitive impairment in FM patients. The Shulman or Sunderland scoring methods are more appropriate than the Watson scoring method. Further studies are needed for using the CDT to detect cognitive impairment in patients with FM.
    Preview · Article · May 2011 · Comprehensive psychiatry
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