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Executive Function in Fibromyalgia: Comparing Subjective and Objective Measures

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... In clinical settings, patients suffering from chronic pain often reported difficulty in carrying out daily tasks involving cognitive functions such as memory and attention. This has prompted a variety of studies to examine the cognitive performance of patients with chronic pain (Dick & Rashiq, 2007;Esteve, Ram ırez & L opez-Mart ınez, 2001;Landrø, Fors, V apenstad, Holthe, Stiles & Borchgrevink 2013;Oosterman, Derksen, Van Wijck, Veldhuijzen, & Kessels, 2011), and more specifically, with back pain (Jorge, Gerard & Level, 2009;Ling, Campbell, Heffermnan & Greenough, 2007), musculoskeletal pain (S€ oderfjell, Molander, Johansson, Barnekow-Bergkvist & Nilsson, 2006), neuropathic pain (Povedano, Gasc on, G alvez, Ruiz & Rejas, 2007), or fibromyalgia (Bell et al., 2018;Dick, Verrier, Harker & Rashiq, 2008;Gelonch, Garolera, Valls, Li & Pifarr e, 2017;Gelonch, Garolera, Valls, Rossell o & Pifarr e, 2016;Glass, 2006Glass, , 2008Glass, , 2009Kim et al., 2012;Pidal-Miranda, Gonz alez-Villar, Carrillode-la-Peña, Andrade & Rodr ıguez-Salgado, 2018;Tesio, Torta, Colonna et al., 2015;Wu, Huang, Fang, Ko & Tsai, 2018). ...
... Memory complaints in chronic pain patients have also attracted considerable research attention (Castel, Casc on, Salvat et al., 2008;Dufton, 1989;Gelonch et al., 2017;Katz, Heard, Mills & Leavitt, 2004;Muñoz & Esteve, 2005;Park et al., 2001;Schnurr & McDonald, 1995;Suhr, 2003, Walitt et al., 2016. In this regard, although some studies indicate depressive symptoms as the best single contributor to memory complaints in chronic pain patients (McCracken & Iverson, 2001;Pidal-Miranda et al., 2018;Roth, Geisser, Theisen-Goodvich & Dixon, 2005), more recent findings have also demonstrated the relevance of some cognitive functions in the perception of cognitive impairment (Gelonch et al., 2016(Gelonch et al., , 2017Landrø et al., 2013;Tesio et al., 2015). ...
... Despite the growing interest in these issues, there are still relatively few studies which have jointly focused on both cognitive performance and the perception of cognitive problems in patients with fibromyalgia and chronic pain from different aetiologies (Castel et al., 2008;Gelonch et al., 2016Gelonch et al., , 2017Grace et al., 1999;Landrø et al., 2013;Park et al., 2001;Pidal-Miranda et al., 2018;Suhr, 2003;Tesio et al., 2015;Walitt et al., 2016). Therefore, this study attempts to address the lack of comprehensive studies in this regard, by jointly focusing on cognitive performance and memory complaints in different samples of patients and control subjects, taking into account the possible influence of variables such as depression, catastrophizing, pain intensity or medication. ...
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Aims 1) To compare memory complaints and cognitive performance (verbal memory, attention and information processing) in chronic pain patients with and without fibromyalgia. 2) To compare those processes in patients with primary fibromyal- gia and concomitant fibromyalgia. Subjetcs One hundred and ten female patients [21-64 years old]. Mean age 47.6 years. 68 patients with fibromyalgia [28 with primary fibromyalgia, 40 with concomitant fibromyalgia] and 42 with others chronic pain conditions. Material and methodsNeuropsychological tests were individually performed. Memory complaints were assessed with the Memory Failures in Everyday Memory (MFE), memory with the Verbal Learning Test (TAVEC), attention and perceptual skills with the Tou- louse-Piéron Test (TP) and interference with the Stroop Color and Word Test (STROOP). The Hospital Anxiety and Depression Scale (HADS) was also applied. Results No differences were obtained between groups in duration of pain, pain intensity, educational level and work occupation. Neither difference was obtained between patients with fi- bromyalgia and without fibromyalgia in TAVEC, TP, STROOP and anxiety scale of the HADS. At the contrary, significant differences were obtained in memory complaints (MFE- FBM = 100.4; MFE-NoFBM=77.9; F(1,106)=7,754, p<0,007)and depression (DepFBM=9,54; DepNoFBM=6,61; F(1,106)=9,770, p<0.002). No differences were obtained between patients with primary fibromyalgia and concomitant fi- bromyalgia. Depression was a significant variable related to performance in verbal memory and attention. Conclusions 1) Patients with fibromyalgia explained more memory complaints than patients without fibromyalgia. 2) Patients with fibromyalgia don't have a worse cognitive performance than patients without fibromyalgia. 3) No differences were found between patients with primary fibromyalgia and concomitant fibromyalgia. 4) Worse cognitive performance and more memory complaints were related to depression.
... 'number of categories completed', 'failure-to-maintain-set', 'trials to complete the first category' and 'non-perseverative errors' have also been used (e.g. Abbate-Daga, Buzzichelli, Marzola, Amianto, & Fassino, 2014;Aloi et al., 2015;Bischoff-Grethe et al., 2013;Dickson et al., 2017;Gelonch et al., 2016;Tchanturia et al., 2012;Wollenhaupt et al., 2019;Zmigrod, Rentfrow, & Robbins, 2018). This has led to criticism of the WCST for having too many outcome variables (Figueroa & Youmans, 2013), that are not clearly linked to particular cognitive domains (Greve, Stickle, Love, Bianchini, & Stanford, 2005). ...
... colour). Figure 1 provides an illustration of a potentially unambiguous response, in that the response card matches the last stimulus card on colour only (blue) Gelonch et al., 2016;Øverås, Kapstad, Brunborg, Landrø, & Lask, 2015;Strauss, Sherman, & Spreen, 2006), illustrating the potential for erroneous results for both variables. This problem even infiltrates the revised WCST manual (Heaton et al., 1993), which uses the terms interchangeably and fails to highlight whether perseverative responses, perseverative errors, or both, should be reported. ...
... Typically, perseverative responses and/or perseverative errors are presented as indicators of cognitive flexibility (e.g. Baker, Georgiou-Karistianis, et al., 2018a;Baker, Gibson, et al., 2018b;Dickson et al., 2017;Garcia-Willingham et al., 2018;Gelonch et al., 2016;Wollenhaupt et al., 2019). However, some research has also used other variables (e.g. the number of categories completed, the number of trials taken to complete the first category, non-perseverative errors, and failure-to-maintain-set) as indicators of cognitive flexibility (e.g. ...
Article
The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly, in research and clinical practice. Despite its widespread use and the development of an updated WCST manual in 1993, confusion remains in the literature about how to score the WCST, and importantly, how to interpret the outcome variables as indicators of cognitive flexibility. This critical review provides an overview of the changes in the WCST, how existing scoring methods of the task differ, the key terminology and how these relate to the assessment of cognitive flexibility, and issues with the use of the WCST across the literature. In particular, this review focuses on the confusion between the terms 'perseverative responses' and 'perseverative errors' and the inconsistent scoring of these variables. To our knowledge, this critical review is the first of its kind to focus on the inherent issues surrounding the WCST when used as an assessment of cognitive flexibility. We provide recommendations to overcome these and other issues when using the WCST in future research and clinical practice.
... Recent evidence raises the possibility that the same may also be true for assessments of cognitive flexibility. Preliminary findings in clinical cohorts (Gelonch et al., 2016;Johnco et al., 2014a;Lounes et al., 2011) and nonclinical cohorts (Gelonch et al., 2016;Gonzalez et al., 2013;Lounes et al., 2011) have cast doubt over whether self-report and neuropsychological tests of cognitive flexibility relate at all. Lounes et al. (2011) found no correlation between the CFS and the Brixton Spatial Anticipation Test in healthy controls (n = 49) and in people with anorexia nervosa (n = 45). ...
... Recent evidence raises the possibility that the same may also be true for assessments of cognitive flexibility. Preliminary findings in clinical cohorts (Gelonch et al., 2016;Johnco et al., 2014a;Lounes et al., 2011) and nonclinical cohorts (Gelonch et al., 2016;Gonzalez et al., 2013;Lounes et al., 2011) have cast doubt over whether self-report and neuropsychological tests of cognitive flexibility relate at all. Lounes et al. (2011) found no correlation between the CFS and the Brixton Spatial Anticipation Test in healthy controls (n = 49) and in people with anorexia nervosa (n = 45). ...
... Lounes et al. (2011) found no correlation between the CFS and the Brixton Spatial Anticipation Test in healthy controls (n = 49) and in people with anorexia nervosa (n = 45). Similarly, Gelonch et al. (2016) reported no relationship between the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) shift subscale and various outcomes on neuropsychological tests in healthy controls and in people with fibromyalgia. Johnco et al. (2014a) reported small correlations between particular self-report and neuropsychological tests of cognitive flexibility in their healthy control sample (n = 53), but no correlations were observed between any self-report and neuropsychological tests of cognitive flexibility in their clinical sample of older adults with comorbid anxiety and depression (n = 47). ...
Article
Objective: Cognitive flexibility has been previously described as the ability to adjust cognitive and behavioral strategies in response to changing contextual demands. Cognitive flexibility is typically assessed via self-report questionnaires and performance on neuropsychological tests in research and clinical practice. A common assumption among researchers and clinicians is that self-report and neuropsychological tests of cognitive flexibility assess the same or similar constructs, but the extent of the relationship between these two assessment approaches in clinical cohorts remains unknown. We undertook a systematic review and meta-analysis to determine the relationship between self-report and neuropsychological tests of cognitive flexibility in clinical samples. Method: We searched 10 databases and relevant gray literature (e.g., other databases and pearling) from inception to October 2020 and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Eleven articles including 405 participants satisfied our eligibility criteria. Results: A multilevel random-effects meta-analysis revealed no relationship between self-report and neuropsychological tests of cognitive flexibility (0.01, 95% CI [-0.16 to 0.18]). Individual random-effects meta-analyses between 12 different tests pairs also found no relationship. Conclusion: Based on our results, it is clear that the two assessment approaches of cognitive flexibility provide independent information-they do not assess the same construct. These findings have important ramifications for future research and clinical practice-there is a need to reconsider what constructs self-report and neuropsychological tests of "cognitive flexibility" actually assess, and avoid the interchangeable use of these assessments in clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Patients with fibromyalgia exhibit clinical heterogeneity, which is related to variables such as age, sex, disease duration, pain severity, and mood status (17,18). Cognitive dysfunction is associated with mood status in patients with fibromyalgia (14,(19)(20)(21). Age and disease severity are associated with cognitive function in patients with chronic pain (22). ...
... Thirteen studies reported the pain score, which was determined using various scales. Ten studies excluded patients with psychiatric disorders (9,11,21,(50)(51)(52)(57)(58)(59)61), and 13 studies excluded patients with cognitive impairments (9,11,14,21,(51)(52)(53)(54)(55)57,60,61,65). Moreover, 15 and 9 studies reported depression and anxiety scores (Table 2), respectively. ...
... Thirteen studies reported the pain score, which was determined using various scales. Ten studies excluded patients with psychiatric disorders (9,11,21,(50)(51)(52)(57)(58)(59)61), and 13 studies excluded patients with cognitive impairments (9,11,14,21,(51)(52)(53)(54)(55)57,60,61,65). Moreover, 15 and 9 studies reported depression and anxiety scores (Table 2), respectively. ...
... FMS patients displayed lower performance than healthy controls in tasks measuring attention and memory functions (Dick et al., 2008;Duschek et al., 2013;Montoro et al., 2015;Bar-On Kalfon et al., 2016) and cognitive processing speed (Veldhuijzen et al., 2012;Cherry et al., 2014;Reyes del Paso et al., 2015;Bar-On Kalfon et al., 2016). Deficits have also been documented in higher cognitive domains, including planning abilities (Cherry et al., 2014), decision making (Walteros et al., 2011), abstract thinking (Verdejo-García et al., 2009), cognitive flexibility (Gelonch et al., 2016), arithmetic processing (Reyes del Paso et al., 2012) and language-related skills (Park et al., 2001;Leavitt and Katz, 2008;Bennett et al., 2009). ...
... Theoretical models and empirical observations suggest negative impact of aversive mood states on cognition (Eysenck et al., 2007;Snyder, 2013). Accordingly, various studies demonstrated stronger cognitive impairments in FMS patients exhibiting more severe symptoms of depression and anxiety (Hassett et al., 2008;Munguía-Izquierdo et al., 2008;Gelonch et al., 2016Gelonch et al., , 2017. However, some FMS studies directly comparing the impacts of depression and anxiety with the impact of pain severity revealed the closest connection between pain and performance (Reyes del Paso et al., 2012Duschek et al., 2013;Weiss et al., 2013). ...
... Moreover, the lower number of correct responses and longer execution time during the ZMS, and the performance reduction in the R-SAT, point toward planning and organizational deficits in FMS. This supports the notion that higher cognitive, i.e., executive, functions are also affected in FMS (Park et al., 2001;Verdejo-García et al., 2009;Walteros et al., 2011;Gelonch et al., 2016). ...
Article
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Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain accompanied by symptoms like depression, anxiety, sleep disturbance and fatigue. In addition, affected patients frequently report cognitive disruption such as forgetfulness, concentration difficulties or mental slowness. Though cognitive deficits in FMS have been confirmed in various studies, not much is known about the mechanisms involved in their origin. This study aimed to investigate the contribution of affect-related variables to cognitive impairments in FMS. For this purpose, 67 female FMS patients and 32 healthy control subjects completed a battery of cognitive tests measuring processing speed, attention, visuospatial and verbal memory, cognitive flexibility and planning abilities. In addition, participants completed self-report questionnaires pertaining to positive and negative affect, alexithymia, pain catastrophizing and self-esteem. Clinical characteristics including pain severity, symptoms of depression and anxiety, insomnia and fatigue were also assessed. FMS patients showed markedly poorer performance than healthy controls in all of the cognitive domains assessed, in addition to greater levels of depression, anxiety, negative affect, alexithymia and pain catastrophizing, and lower self-esteem and positive affect. In exploratory correlation analysis in the FMS sample, lower cognitive performance was associated with higher pain severity, depression, anxiety, negative affect, alexithymia and pain catastrophizing, as well as lower self-esteem and positive affect. However, in regression analyses, pain, self-esteem, alexithymia, and pain catastrophizing explained the largest portion of the variance in performance. While interference effects of clinical pain in cognition have been previously described, the present findings suggest that affective factors also substantially contribute to the genesis of cognitive impairments. They support the notion that affective disturbances form a crucial aspect of FMS pathology, whereas strategies aiming to improve emotional regulation may be a beneficial element of psychological therapy in the management of FMS.
... Several studies have investigated the incidence of cognitive dysfunction in chronic pain syndromes, particularly in FM . Most research efforts have focused on attention and memory processes, in which FM patients rather consistently show poorer performance than healthy controls (Grace et al., 1999;Glass and Park, 2001;Park et al., 2001;Dick et al., 2002;Dick et al., 2008;Cherry et al., 2009;Berryman et al., 2013;Landrø et al., 2013;Gelonch et al., 2016). Nevertheless, some reports failed to confirm cognitive deficits in FM patients performing neuropsychological tests of attention and memory (Suhr, 2003;Walitt et al., 2008;Glass et al., 2011;Walitt et al., 2016). ...
... In 2014, Berryman et al. conducted a metaanalysis of 22 studies and reported that in patients with chronic pain there is a small impairment of executive function evaluated in a complex way, a result that the authors explain by the large variability of the tests used in the studies (Berryman et al., 2014). In view of the inconsistencies, some authors argue that the cognitive complaints made by FM patients are disproportionate to the actual performance displayed (Grace et al., 1999;Suhr, 2003;Castel et al., 2008;Schmidt-Wilcke et al., 2010) or may be explained by depression symptoms (Gelonch et al., 2016;Gelonch et al., 2017;Ojeda et al., 2017). ...
... Nevertheless, there is some controversy about this idea, because the interactions between pain and cognition are poorly defined. Some researchers have observed poorer performance of patients with FM in neuropsychological tests of attention and memory Park et al., 2001;Dick et al., 2002Dick et al., , 2008Landrø et al., 2013;Tesio et al., 2015;Gelonch et al., 2016;Ojeda et al., 2017) and cognitive control tasks (Verdejo-García et al., 2009;Cherry et al., 2012;Berryman et al., 2013;Gelonch et al., 2016), while others have not (Suhr, 2003;Glass et al., 2011;Walitt et al., 2016). The discrepancies between studies may stem from the different nature of the tests used to assess cognitive abilities, differences in the samples and other methodological issues. ...
Article
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Objectives: Fibromyalgia (FM) is a generalized chronic pain syndrome of unknown aetiology. Although FM patients frequently complain of cognitive dysfunction, this is one of the least studied symptoms. Research on brain activity associated with the perceived cognitive impairment is particularly scarce. To address this gap, we recorded the brain electrical activity in participants during a cognitive control task. Methods: Electroencephalograms (EEGs) were recorded in 19 FM patients and 22 healthy controls (all women) while they performed the Multi-Source Interference Task (MSIT). We analyzed the amplitude of the frontal N2 and parietal P3 components elicited in control and interference trials and their relation with reaction times. We also explored the relationship of perceived cognitive dysfunction, assessed using visual analogue scales (VAS) and the Memory Failures of Everyday (MFE-30) test, with N2 and P3 amplitudes. Results: The N2 amplitudes were smaller in FM patients than in controls and were negatively associated with cognitive complaints. Unlike patients, healthy controls showed significant differences in the amplitude of P3 obtained from control vs. interference trials of the MSIT. Smaller N2 and P3 amplitudes were associated to longer reaction times. Conclusions: The findings suggest a reduction in frontal brain activity during performance of an interference task, which was associated with the patients' cognitive complaints. Findings on P3 suggest altered modulation of attention according to the task demands in FM patients. Deficits in flexibility in the allocation of attentional resources and cognitive control during complex tasks may explain the dyscognition reported by chronic pain patients.
... Despite the fact that some previous studies have shown no alteration in cognitive functioning in fibromyalgia [5,6] or just the presence of a subtle discognition effect [7], there is growing scientific evidence confirming that patients with fibromyalgia not only have complaints about cognition [7][8][9][10] but also exhibit objective impairments in different cognitive functions [11,12], such as short-term memory [13], speed processing [14], task-switching [15 ], cognitive flexibility [16], emotional decision-making [17], and cognitive control [18], among other cognitive processes. It has been suggested that these impairments might be explained by alterations in working memory processes [8,[19][20][21][22][23][24], where findings are particularly robust [25]. ...
... In line with previous studies exploring cognitive dysfunctions in fibromyalgia, we observed that patients showed signs of poor performance (i.e., a great number of mistakes and omissions) compared with the control group. Clear impairments in working memory functions have been replicated in different studies using n-back tasks [9,20], also highlighting worse performance for patients with fibromyalgia than for control participants in other tasks involving updating processes (e.g., digit span) [22]. A recent meta-analysis has supported the presence not only of self-reported complaints but also of objective neuropsychological deficits in fibromyalgia. ...
... Nonetheless, it should be remarked that behavioral measures are the final single output of a large set of neural processes (or stages) that may not always be convergent. Therefore, with previous evidence taken into account [9,23,67,68], the question that arises is which working memory stage would be contributing to a greater extent to the cognitive impairment seen in these patients. As previously mentioned, the ERP methodology is a tool particularly suitable for examining the temporal dynamics of cognitive functions and allows for establishing a correspondence between different components, or waves, and specific stages of a given cognitive process (e.g., working memory). ...
Article
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Objective Cognitive dysfunction in fibromyalgia has become a key symptom considered by patients as more disabling than pain itself. Experimental evidence from neuropsychological and neuroimaging studies indicates that such cognitive impairments are especially robust when patients need to set in motion working memory processes, suggesting the existence of an altered functioning underlying the cerebral cortices of the frontoparietal memory network. However, the temporal dynamics of working memory sub-processes have not yet been explored in fibromyalgia. Subjects Thirty-six right-handed women participated in the experiment: comprising eighteen patients with fibromyalgia and eighteen healthy controls. Methods Event-related potentials (ERPs) and behavioural responses were recorded while participants were engaged in a 2-back working memory task. Principal Component Analyses (PCA) were used to define and quantify the ERP components associated with working memory processes. Results Fibromyalgia patients exhibited worse performance than the control group, as revealed by their number of errors in the working memory task. Moreover, both scalp parieto-occipital P2 and parieto-occipital P3 amplitudes were lower for patients than for healthy control participants. Regression analyses revealed that lower P3 amplitudes were observed in those patients with fibromyalgia reporting higher pain ratings. Conclusions Current results suggest that both encoding of information (as reflected by P2) and subsequently, context updating and the replacement (as seen in lower P3 amplitudes), as a part of working memory sub-processes, are impaired in fibromyalgia. Studying the temporal dynamics of working memory using ERP methodology is a helpful approach to detect specific cognitive impaired mechanisms in this chronic pain syndrome. These new data could be used to develop more specific treatments adapted for each patient.
... Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain and associated symptoms such as fatigue, sleep disturbance, affective disorders and cognitive complaints (Perrot and Russell 2014;Wolfe et al. 2010). Although perceived cognitive dysfunction is a key symptom of FM with important functional consequences (McCracken and Iverson 2001;Roth et al. 2005), there is still some debate about the causes and whether the dysfunction corresponds to objective deficits ( Bar-On Kalfon et al. 2016;Gelonch et al. 2016). ...
... The most frequent cognitive complaint in FM patients is related to working memory (Park et al. 2001). Several studies have found that FM patients also display objective working memory deficits, as evaluated by neuropsychological tests (Gelonch et al. 2016;Glass 2009;Seo et al. 2012;Tesio et al. 2014). These deficits seem to be related to difficulties in attentional control processes rather than to limitations in storage capacity (Glass 2009). ...
Article
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Fibromyalgia (FM) is a chronic syndrome involving widespread pain of unclear pathophysiology. FM patients frequently complain about cognitive symptoms that interfere with their daily life activities. Several studies have reported attentional deficits and working memory impairment in FM patients. Nevertheless, the mechanisms involved in these alterations are still poorly understood. In this study we recorded electroencephalographic activity in 32 women with FM and 30 matched controls while they performed a 2-back working memory task. We analyzed behavioural data, posterior alpha and midfrontal theta frequency power, and theta phase synchronization between midfrontal locations and the remaining scalp-recorded areas. Task performance was similar in patients and controls; however, time–frequency analysis showed a smaller decrease in the amplitude of the posterior alpha (related to attentional processing) and a smaller increase in midfrontal theta power (related to mental effort) in FM patients than in healthy controls. The FM patients also showed lower functional connectivity between midfrontal locations and rest of the scalp-recorded areas in the theta band (related to information transfer across distant brain regions when top-down control is required). To our knowledge, this is the first study relating alterations in oscillatory activity and impaired connectivity to attentional working memory complaints in FM patients. Reduced power in the theta band during performance of the task suggests that the medial frontal cortex may play an important role in the attentional deficits reported in FM.
... [7][8][9] In fibromyalgia patients, dysfunctions with losses of memory and in various cognitive fields known as fibrofog are seen. 10,11 It is a disorder with cognitive deficits similar to attention-deficit hyperactivity disorder (ADHD). Impairments are seen in many cognitive areas including concentration, attention span, and working memory. ...
... This may indicate a relationship between these disorders. [9][10][11][12]14,15 Total scores obtained from WURS in our study were higher in the fibromyalgia group, similar to the study by Reyero et al. 27 Moreover, in another study with a comparatively small number of subjects, total mean scores obtained from WURS in a fibromyalgia group were higher than those from an ADHD group. 34 The fibromyalgia group had significantly higher ASRS total, attention, and hyperactivity/impulsivity score than the control group, suggesting higher presence of ADHD features. ...
Article
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Objective Data which indicate a greater role of the central nervous system in the etiology of fibromyalgia are increasing. The goal of the present study is to determine the link between fibromyalgia and attention-deficit hyperactivity disorder (ADHD) and, in addition, to reveal the relevance of impulsivity dimension. Methods The study included 78 females with fibromyalgia who applied to a physical medicine and rehabilitation polyclinic in Ceyhan State Hospital and 54 healthy females. The diagnosis of fibromyalgia was made by an experienced specialist of physical medicine and rehabilitation based on the American Rheumatology Association Diagnostic Criteria (2010). The diagnosis of ADHD was by an experienced psychiatrist using Diagnostic and Statistical Manual of Mental Disorders-5. The following inventories were used: adult ADHD self-report scale, Wender Utah rating scale, and Barratt impulsivity scale short form. Results Adult ADHD was detected in 29.5% of the fibromyalgia group and 7.4% of the control group; childhood and adolescent attention hyperactivity disorder ratios in these groups were 33.3% and 11.1%, respectively. The differences were statistically significant (P=0.002, P=0.003). Scores of the fibromyalgia group on the Wender Utah rating scale, adult ADHD self-report scale, attention subscale, hyperactivity–impulsivity subscale, and the Barratt impulsivity scale for non-planning and attentional impulsivity were found to be significantly higher than the control group (P<0.05, P<0.01, P<0.01, P<0.05, P<0.01, P<0.05, respectively). Conclusion The present study has shown that both adult and childhood ADHD are quite common in female fibromyalgia patients. There was a link between fibromyalgia and impulsivity. Certain subtypes of fibromyalgia and attention-deficit hyperactivity deficit disorder could be sharing the common etiological pathways.
... Test, which measures cognitive flexibility in terms of the ability to rapidly detect and adjust to, changing rules in a categorization task [13]. Moreover, FMS patients showed a smaller shifting index in the Five Digits Test, reflecting problems in quickly shifting between different task modes ( [15]; however, see [46] for negative findings pertaining to impaired flexibility in FMS). The lack of any group differ-ence in false alarm rate in this study suggests intact response inhibition in FMS. ...
... Previous studies on this component of executive function in FMS revealed inconsistent results. While lower performance on the Stroop test in patients pointed towards reduced inhibition capacity ( [15,46]; however, see [19] for a divergent finding), patients did not differ from controls in false alarms on a Go/No-Go task [18], nor in performance on the Multisource Interference Test [19]. Therefore, further research is warranted to achieve clarity regarding the inhibition impairments in FMS. ...
Article
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In addition to chronic widespread pain and depression and anxiety symptoms, patients with fibromyalgia frequently experience cognitive problems. This study investigated executive functions in fibromyalgia via a Go/No-Go task. To obtain comprehensive information about performance, traditional and ex-Gaussian parameters of reaction time (RT) variability were used, in addition to speed and accuracy indices. Ex-Gaussian parameters show an excellent fit to empirical RT distributions. Fifty-two female fibromyalgia patients and twenty-eight healthy controls participated. The task included 60 visual stimuli, which participants had to respond to (Go stimuli) or withhold the response to (No-Go stimuli). After 30 trials, the task rule changed, such that previous No-Go stimuli had to be responded to. Performance was indexed by the hit rate, false alarm rate, and mean (M) and intraindividual standard deviation (SD) of RT and the ex-Gaussian parameters mu, sigma, and tau. Mu and sigma indicate the M and SD of the Gaussian distribution; tau reflects the M and SD of the exponential function. Patients exhibited a lower hit rate, higher M RT, and higher tau than controls. Moreover, patients showed greater decrease of the hit rate after the change of task rule. In the entire sample, SD, sigma, and tau were inversely associated with the hit rate and positively associated with the false alarm rate. While the greater decline in hit rate after the change in task rule indicates deficient cognitive flexibility, the lack of any difference in false alarm rate suggests intact response inhibition. Higher M RT reflects reduced cognitive or motor speed. Increased tau in fibromyalgia indicates greater fluctuations in executive control and more frequent temporary lapses of attention. For the first time, this study demonstrated that indices of RT variability, in particular those derived from the ex-Gaussian function, may complement speed and accuracy parameters in the assessment of executive function impairments in fibromyalgia. Optimized assessment may facilitate the personalization of therapies aimed at improving the cognitive function of those with the disorder.
... Concerning subjective cognitive complaints, our study demonstrated that patients with FM faced difficulties in memory, executive, and language domains. In agreement with our findings, subjective complaints in memory 40,41 , executive 42 , and language domains 43 have been reported in patients with FM. A recent review summarizing 52 studies on cognitive function in FM also concluded that memory, attention (executive), and word-finding difficulty (language and semantic memory) are the principal subjective and objective cognitive deficits in these patients 17 . ...
... In addition to neuroimaging, an association between subjective cognitive complaints and FIQR was demonstrated in the present study and the study conducted by Gelonch, et al. 42 . As reported by Williams, et al. 43 , this association may imply that the subjective cognitive dysfunction in patients with FM may additionally result from pain severity, fatigue, mood, sleep, and other insidious clinical factors that interactively affect the overall perception of functional disability. ...
Article
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Fibromyalgia (FM) is a stress-related chronic pain disorder with common cognitive complaints. This study characterized cognitive dysfunction in patients with FM and explored whether these changes are linked to altered cortisol levels. Consecutive 44 patients with FM and 48 healthy controls were enrolled for the assessments of subjective and objective cognitive functions and diurnal levels of salivary cortisol (sampled at awakening, 30 min after awakening, 3 pm, and bedtime). All measurements were compared between the groups and evaluated for clinical correlation. The FM group had more subjective cognitive complaints and performed poorer in objective cognitive testing in memory (delayed recall in Chinese Version Verbal Learning Test and Taylor Complex Figure Test), language (Boston Naming Test), and executive domains (Wisconsin Card Sorting Test) after adjustments for education. The diurnal cortisol levels of patients with FM tended to be lower, especially at 30 min after awakening and bedtime. Moreover, moderate positive correlations existed between the Chinese Version Verbal Learning Test, Boston Naming Test and the morning cortisol levels within the FM group. We suggested the altered cognitive function in FM may be linked to stress maladaptation. Future studies are warranted to elucidate whether stress management improves cognitive performance in patients with FM.
... Related to mood changes, it is known that musculoskeletal disorders become more disabling when they coexist with depression and/or anxiety, even when each of them could act independently [11]. Mood disorders contribute to a worsening of the global executive dysfunction suffered by FM patients and have a negative impact on their daily functioning [12]. Women with FM have a less psychological well-being than healthy controls and patients with rheumatoid arthritis [13]. ...
... However, depression was a predictor of cognitive disability and personal relations, similar to the reported by Silva et al. [56], who revealed depression as the most important predictor for cognition, personal relations and social participation in patients with musculoskeletal pain. The influence of mood symptoms in subjective ratings of cognitive functioning has also been reported in patients with FM [12]. In contrast, Arnstein et al. [57] reported that depression was not a significative predictor of disability, after adjusting the effect by pain intensity and self-efficacy beliefs. ...
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Background: The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient's perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia. Methods: One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability. Results: Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire. Conclusions: Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).
... In this study, we did not find any relationship between cognitive performance in FM patients and the clinical and selfreported scales used to assess anxiety and depression (HADS, BDI-1A, Mood VAS), and therefore we cannot corroborate results obtained in other studies on chronic pain syndromes Gelonch et al., 2013Gelonch et al., , 2016Gelonch et al., , 2017Gelonch et al., , 2018Walitt et al., 2016;Pidal-Miranda et al., 2018). ...
... The study findings also failed to confirm any relationship between subjective cognitive complaints and objective WM performance in the FM patients. This is consistent with the results of previous studies suggesting a disconnection between neuropsychological performance and subjective complaints in FM patients (Gelonch et al., 2016;Walitt et al., 2016;Pidal-Miranda et al., 2018). It is also consistent with studies showing altered brain activity in FM patients performing WM tasks, even in the absence of behavioral impairment (Luerding et al., 2008;Glass et al., 2011;Ceko et al., 2012;Seo et al., 2012;Schmidt-Wilcke et al., 2014;Walitt et al., 2016;González-Villar et al., 2017). ...
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Working memory (WM) is a critical process for cognitive functioning in which fibromyalgia (FM) patients could show cognitive disturbances. Dyscognition in FM has been explained by interference from pain processing, which shares the neural substrates involved in cognition and may capture neural resources required to perform cognitive tasks. However, there is not yet data about how pain is related to WM performance, neither the role that other clinical variables could have. The objectives of this study were (1) to clarify the WM status of patients with FM and its relationship with nociception, and (2) to determine the clinical variables associated to FM that best predict WM performance. To this end, 132 women with FM undertook a neuropsychological assessment of WM functioning (Digit span, Spatial span, ACT tests and a 2-Back task) and a complete clinical assessment (FSQ, FIQ-R, BDI-1A, HADS, PSQI, MFE-30 questionnaires), including determination of pain thresholds and tolerance by pressure algometry. Patients with FM seem to preserve their WM span and ability to maintain and manipulate information online for both visuospatial and verbal domains. However, up to one-third of patients showed impairment in tasks requiring more short-term memory load, divided attention, and information processing ability (measured by the ACT task). Cognitive performance was spuriously related to the level of pain experienced, finding only that pain measures are related to the ACT task. The results of the linear regression analyses suggest that sleep problems and fatigue were the variables that best predicted WM performance in FM patients. Future research should take these variables into account when evaluating dyscognition in FM and should include dynamic measures of pain modulation.
... Firstly, the few studies that have examined the link between SCCs and cognitive performance in this group have shown no or low correlations between these measures [9,[11][12][13][14]. Notably, a weak relationship between SCCs and cognitive performance is not exclusive for ED and has been highlighted in several other clinical groups, for example in chronic fatigue syndrome, mood disorders, and in healthy and pathological aging [15][16][17][18]. Secondly, in several populations, SCCs have been found highly correlated with psychological and demographic factors such as anxiety, depression, age and sex and it has been suggested that SCCs reflect these phenomena rather than objective cognitive dysfunction [19][20][21]. ...
... This aligns with the results of previous studies that have found no or low correlations between test performance and SCCs in patients with stress-related exhaustion [9,[11][12][13][14]. Such weak relationship between subjectively and objectively measured cognition has been shown in several populations, for example aging [19], fibromyalgia [15] and chronic fatigue syndrome [18], with explanations varying among authors, often involving specific traits of the studied clinical population, such as depression, poor cognitive appraisal ability, memory perfectionism, overinterpretation of everyday distractibility or enhanced self-monitoring [e.g., 9,14,45,46]. ...
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Background Stress-related exhaustion is associated with cognitive impairment as measured by both subjective cognitive complaints (SCCs) and objective cognitive test performance. This study aimed to examine how patients diagnosed with exhaustion disorder differ from healthy control participants in regard to levels and type of SCCs, and if SCCs are associated with cognitive test performance and psychological distress. Methods We compared a group of patients with stress-related exhaustion disorder ( n = 103, female = 88) with matched healthy controls ( n = 58, female = 47) cross-sectionally, concerning the type and magnitude of self-reported SCCs. We furthermore explored the association between SCCs and cognitive test performance as well as with self-reported depression, anxiety and burnout levels, in the patient and the control group, respectively. Results Patients reported considerably more cognitive failures and were more likely than controls to express memory failures in situations providing few external cues and reminders in the environment. In both groups, SCCs were associated with demographic and psychological factors, and not with cognitive test performance. Conclusion Our findings underline the high burden of cognitive problems experienced by patients with exhaustion disorder, particularly in executively demanding tasks without external cognitive support. From a clinical perspective, SCCs and objective cognitive test performance may measure different aspects of cognitive functioning, and external cognitive aids could be of value in stress rehabilitation. Trial registration Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) study (ClinicalTrials.gov: NCT03073772). Date of registration: 8 March 2017
... The known link between fibromyalgia and impaired cognitive performance in domains such as attention, memory, and executive processing 16,26,29,68 provides a rationale to investigate a form of endogenous analgesia that is driven by cognitive focus, ie, attentional analgesia. We hypothesised that there would be a demonstrable deficiency in attentional analgesia in patients with fibromyalgia and further that whole-brain/brainstem-optimised functional magnetic resonance imaging (fMRI) could determine where any deficit originated within the descending pain modulatory system or the attentional network. ...
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Fibromyalgia is a prevalent pain condition that is associated with cognitive impairments including in attention, memory, and executive processing. It has been proposed that fibromyalgia may be caused by altered central pain processing characterised by a loss of endogenous pain modulation. We tested whether attentional analgesia, where cognitive engagement diminishes pain percept, was attenuated in fibromyalgia patients (n=20) compared to matched healthy controls (n=20). An individually calibrated, attentional analgesia paradigm with a 2x2 block design was used with brain and brainstem-focussed fMRI. Fibromyalgia patients had both lower heat pain thresholds and speeds in a visual attention task. When this was taken into account for both attentional task and thermal stimulation, then both groups exhibited an equivalent degree of attentional analgesia. fMRI analysis showed similar patterns of activation in the main effects of pain and attention in the brain and brainstem (with the sole exceptions of increased activation in the control group in frontopolar cortex and the ipsilateral locus coeruleus). The attentional analgesic effect correlated with activity in the periaqueductal grey and rostroventromedial medulla. These findings indicate that fibromyalgia patients can engage the descending pain modulatory system if the attentional task and noxious stimulus intensity is appropriately titrated.
... It is worth noting that during this part of the research patients experiencing pain often complained about the arduousness of the research process and declared an intention to give up the task if it lasted longer than five repetitions as planned. Such conclusions would be consistent with earlier research devoted to patients experiencing chronic pain [47,48]. However, tiredness of the treatment group, appearing with time, cannot be ignored, as another, parallel explanation for the differences observed. ...
Article
Introduction: Physical examination of patients suffering from temporomandibular disorders is increasingly accompanied by monitoring their psychological functioning. It includes basic diagnostics of the emotional and motivational sphere as well as, although rarely, the social sphere. Analysis of the pain profile changing under the influence of the therapeutic process and including the psychoneurophysiological aspect of the phenomenon suggests the need to extend the scope of assessment. Specific aspects of cognitive functioning covered by the research are mental activities that allow to create and modify knowledge about the environment and to control one's own reactions. Objectives: The aim of this article is to describe in detail the cognitive functioning of patients suffering from temporomandibular disorders at various stages of prosthetic treatment, with particular emphasis on the experience of chronic pain. Material and methods: The study included 45 patients, 23 were diagnosed with myofascial pain form of temporomandibular disorders and 22 diagnosed with temporomandibular disorders showing the same pathomechanism, but not reporting pain. Scheduled analysis included a number of inter-group comparisons based on the data obtained by using selected psychological tests and neuropsychological clinical trials. Results: Statistically significant differences in cognitive functioning of patients suffering from pain due to temporomandibular disorders and those patients who did not experience pain, although were diagnosed with temporomandibular disorders, were observed. Conclusions: It is important to take into account the psychological functioning of patients in a broader sense, including the neuropsychological mechanism of temporomandibular disorders myofascial pain.
... Here, it is worth considering the fact that actual day-to-day functioning includes a number of complex information processing demands that require the execution of multiple cognitive functions and that many of these are linked to the components of the executive functions (working memory, divided attention, initiative, planning) and not just to mnemonic functions. This could be specially relevant in fibromyalgia patients given the results of several studies that have reported an impairment in executive functions and, more specifically, in working memory performance (Cherry et al., 2014;Gelonch, Garolera, Valls, Rosselló, & Pifarré, 2016;Seo et al., 2012;Tesio et al., 2015). Our findings showed that the increase in the number of cognitive complaints was associated with poorer performance on working memory, with this persisting even after controlling for depression. ...
Article
Introduction: Cognitive complaints are common in fibromyalgia, but it is unclear whether they represent an objective cognitive dysfunction or whether they could be explained by depressive symptoms. Here, we aim to elucidate the frequency of subjective cognitive complaints in a sample of women with fibromyalgia, in addition to analyzing associations between these subjective complaints and objective measures linked to the attention and executive cognitive domains. Finally, we aim to investigate the ability of demographic, clinical, and psychological variables to explain the subjective complaints observed. Method: One hundred and five women aged 30-55 years diagnosed with fibromyalgia completed a neuropsychological assessment, which included measures of attention and executive functions. They also completed self-report inventories of subjective cognitive complaints, depression, anxiety, intensity of pain, sleep quality, everyday physical functioning, and quality of life. Results: Eighty-four percent of the patients reported subjective cognitive complaints. Depression scores, everyday physical functioning, and working memory performance were most strongly associated with subjective cognitive complaints. These three variables were significant predictors for subjective cognitive complaints with a final model explaining 32% of the variance. Conclusions: Cognitive complaints are very frequent in patients with fibromyalgia, and these are related to functional and cognitive impairment as well as to depressive symptoms.
... Although our FM patients with and without a diagnosis of depression or anxiety did not differ in cognitive performance, the regression analysis showed that state anxiety was a positive predictor of some TAVEC verbal memory variables. This association of cognitive improvement with state anxiety is striking, as other studies either suggested a negative influence of anxiety on working memory, attention, and general cognitive function [42,43,105], or no effect of anxiety [16,19,28,29,39]. This result is difficult to explain, but it is possible that higher state anxiety promotes greater arousal, where increased activation can lead to improved performance [106,107]. ...
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Abstract: The high prevalence of obesity and overweight in fibromyalgia (FM) may be an important factor in the well-known cognitive deficits seen in the disorder. This study analyzed the influence of body mass index (BMI) and primary clinical symptoms of FM (pain, fatigue, insomnia, anxiety, and depression) on attention, memory, and processing speed in FM. Fifty-two FM patients and thirty-two healthy participants completed cognitive tasks assessing selective, sustained, and divided attention; visuospatial and verbal memory; and information processing speed. Furthermore, they were evaluated in terms of the main clinical symptoms of the disorder. FM patients showed a marked reduction of cognitive performance in terms of selective, sustained, and divided attention; visuospatial memory; and processing speed, but no group differences were observed in verbal memory. BMI negatively affects sustained and selective attention, verbal memory, and processing speed and is the main predictor of performance in these basic cognitive domains. Our findings confirm the presence of cognitive deficits with respect to attention and visual memory, as well as slower processing speed, in FM. Moreover, the results support a role of BMI in the observed cognitive deficits. Interventions increasing physical activity and promoting cognitive stimulation could be useful for strengthening cognitive function in FM patients.
... Many chronic pain patients present impaired cognitive functioning 1, 2 , as indicated by poorer performance and slower reaction times in neuropsychological tasks [3][4][5] . These alterations occur more frequently in patients with generalized pain 6 such as fibromyalgia (FM), in which cognitive dysfunction has recently been recognized as one of its core symptoms 7 . ...
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Fibromyalgia (FM) and other chronic pain syndromes are associated with cognitive dysfunction and attentional deficits, but the neural basis of such alterations is poorly understood. Dyscognition may be related to high levels of neural noise, understood as increased random electrical fluctuations that impair neural communication; however, this hypothesis has not yet been tested in any chronic pain condition. Here we compared electroencephalographic activity (EEG) in 18 FM patients-with high self-reported levels of cognitive dysfunction-and 22 controls during a cognitive control task. We considered the slope of the Power Spectrum Density (PSD) as an indicator of neural noise. As the PSD slope is flatter in noisier systems, we expected to see shallower slopes in the EEG of FM patients. Higher levels of neural noise should be accompanied by reduced power modulation and reduced synchronization between distant brain locations after stimulus presentation. As expected, FM patients showed flatter PSD slopes. After applying a Laplacian spatial filter, we found reduced theta and alpha power modulation and reduced midfrontal-posterior theta phase synchronization. Results suggest higher neural noise and impaired local and distant neural coordination in the patients and support the neural noise hypothesis to explain dyscognition in FM.
... Although mood symptoms such as depression are common features in patients suffering from fibromyalgia [30], it has not been consistently demonstrated that depression mediates cognitive dysfunction [2]. A recent study conducted by Gelonch et al. found impairment in the working memory in FM patients after controlling the severity of mood symptoms [31]. To exclude potential confounding effects of depression, we recruited equally BDI-II scored healthy controls and FM patients, and we still detect a reduction in the brain activity in the frontal region during a VFT in FM patients, even though there were no significant differences between the groups in VFT performances. ...
Article
Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and associated sleep problems and cognitive dysfunction. However, only few studies focusing on cognitive dysfunction in FM are available so far. In the present study, we aimed to use near infrared spectroscopy (NIRS) to evaluate the brain function in FM patients subjected to a verbal fluency test (VFT). A total of 11 primary FM patients and 13 healthy individuals (HC) underwent NIRS while performing a VFT. The Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate the symptom severity of FM and Beck Depression Inventory II (BDI) was used to evaluate the severities depression symptoms in study participants. Five regions of interests (ROIs) were defined: the frontal-, bilateral inferior frontal gyrus (IFG), and temporal regions. Brain activities of ROIs between the two groups were compared. In addition, we investigated the relationship between clinical symptoms and brain cortical activity in FM patients. Our results showed that there were no significant differences between HC and FM patients in age, sex, and BDI scores. We found significantly reduced brain activity over the frontal regions during a VFT in FM patients (p = .026). In addition, we found decreased frontal activity was associated with BDI scores (rho = -0.755, p = .007). Furthermore, there were no significant correlations between frontal activity and FIQ subscales. In conclusion, our study demonstrated a reduced frontal cortical activity during VFT in FM patients, and that NIRS could be a potential tool for evaluating brain function in FM patients in clinical settings.
... This significance was not detected between fatigue level and RT values. Gelonch et al. [32] found a relationship between cognitive test results and anxiety and depression. Veldhuijzen et al. [25] reported a relationship between cognitive performance and pain level but did not suggest any significant correlation with fatigue scores and psychosocial measures. ...
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Fibromyalgia syndrome (FMS) has previously been linked to cognitive dysfunction. The aim of this study was to compare visual reaction time (RT) between FMS patients and healthy subjects. The relationship was examined between RT and clinical parameters in FMS patients, and it was aimed to evaluate the effect of drugs used in the treatment of FMS on RT. A total of 112 FMS patients and 110 healthy volunteers were included in this cross-sectional research. Cognitive performance was evaluated with visual RT measurements. FMS patients were assessed using the Fibromyalgia impact questionnaire (FIQ), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS) and Pittsburgh Sleep Quality Index (PSQI). The drugs used in the treatment of FMS were recorded. Significantly prolonged visual RT measurements were detected in FMS patients (p < 0.001). There was no significant difference in RT measurements between the patients who did not use drugs and those who were treated with serotonin noradrenaline reuptake inhibitor, gabapentinoid and combination therapy (p > 0.05). RT was significantly correlated with FIQ, BDI and PSQI scores in FMS patients (rho: 0.290, p = 0.002 for FIQ; rho: 0.253, p = 0.007 for BDI and rho: 0.312, p = 0.001 for PSQI). No significant correlation was detected between RT scores and FSS values (p > 0.05). Visual RT measurements were seen to be deteriorated in FMS patients. As the disease severity, depression level, and sleep disturbance increased, so the impairment in visual RT values became more prominent. The drugs used in the FMS treatment did not influence the RT scores. Cognitive performance tests should be incorporated in the physical examination and follow-up courses of FMS patients.
... There was not, however, an association between subjective dyscognition and objective dyscognition identified on neuropsychological testing, suggesting that patient self-report of dyscognition may not be adequate in identifying neurocognitive impairment in this patient population. Our findings are in line with previous research in adults with fibromyalgia syndrome suggesting that characteristic symptoms of the disease, such as depression and fatigue, have an impact on subjective dyscognition (3,(67)(68)(69)(70). This relationship can be explained by the fact that affective and physical variables of fibromyalgia syndrome may exacerbate the amount of perceived effort required to perform the cognitive task, however, when confronted with the task, patients have the cognitive skills necessary to perform satisfactorily (9). ...
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Objectives Our understanding of brain fog, or dyscognition, among youth with juvenile fibromyalgia syndrome is limited. We aimed to determine the prevalence of subjective (self-reported) and objective dyscognition, as well as factors associated with subjective dyscognition in juvenile fibromyalgia syndrome. Methods A cross-sectional cohort study of patients ( n = 31) 12-17 years old diagnosed with primary juvenile fibromyalgia syndrome and one of their parents from 2017 to 2019. Subjects completed a series of survey measures and patients completed a brief neurocognitive battery. Subjective dyscognition was determined based on scores on the Pediatric Quality of Life Inventory (PedsQL) Cognitive Functioning Scale and Behavior Rating Inventory of Executive Function (BRIEF-2) global executive composite (GEC). Objective dyscognition was defined as impairment of more than two standard deviations in any of the neurocognitive domains. We used Fisher's exact test or Wilcoxon rank-sum test, as appropriate, to compare clinical patients based on the presence of dyscognition. Multivariable logistic regression modeling was performed to determine factors associated with subjective dyscognition. Results Of the 31 subjects, 65% reported subjective dyscognition and 39% had objective dyscognition, primarily in the domains of psychomotor speed (23%), executive function (23%), and attention (3%). Subjective dyscognition was not indicative of objective dyscognition. Subjective dyscognition was independently associated with functional disability (OR: 1.19 [95% CI: 1.02-1.40]) and anxiety (OR: 1.12 [95% CI: 1.02-1.24]). Discussion Adolescents with fibromyalgia predominantly experience subjective dyscognition but more than 1/3 also experience objective dyscognition. Future research should explore the impact of interdisciplinary rehabilitation programs on the treatment of dyscognition in youth with JFMS.
... Research has shown that perceived dyscognition is related to objective cognitive impairments in memory, verbal fluency, attention/ concentration and executive functioning (Kravitz & Katz, 2015;Park, Glass, Minear, & Crofford, 2001;Tesio et al., 2015). However, in addition to objective cognitive difficulties, other contributing factors, such as emotional distress, have demonstrated appreciable effects on fibrofog (Ambrose, Gracely, & Glass, 2012;Gelonch, Garolera, Valls, Rosselló, & Pifarré, 2016;Glass, Park, Minear, & Crofford, 2005). Core FM symptoms such as fatigue, unrefreshing sleep and mood alterations may contribute to fibrofog (Williams, Clauw, & Glass, 2011). ...
Article
Purpose: Perceived dyscognition or fibrofog has been ranked as one major contributor of distress in fibromyalgia (FM). The Multidimensional Inventory of Subjective Cognitive Impairment (MISCI) was devised as a brief and comprehensive self-report measure of cognitive function in FM. The main objective of the present study was to assess the psychometric properties of the Spanish version of the MISCI. Methods: 120 patients with FM were included and dimensionality, reliability, and validity of the MISCI were evaluated. Data from brain imaging (N=61) was also used in validity analyses. Known-groups validity was evaluated by including a subset of 45 patients without FM in partial/total remission from depression. Sensitivity to change was assessed after a mindfulness-based intervention. Results: Spanish version of the MISCI exhibited a one-factor structure, excellent internal consistency, and good convergent validity with symptomatology and grey matter volumes in anterior and middle cingulate cortices. Significant improvements in MISCI scores after a mindfulness-based intervention were reported. An additive effect of FM and depression regarding MISCI scores was also observed. Self-reported depression, anxiety and problems in balance predicted the 38% of the MISCI variance. Conclusions: the Spanish version of the MISCI is a valuable instrument to include in FM research and clinical practice.
... La presencia reiterada de dolor se ha asociado, además, con un deterioro significativo de las funciones cognitivas, lo cual puede verse afectado por la concurrencia de los síntomas afectivos como ansiedad y depresión asociadas 10 . Diversas investigaciones han evidenciado que los pacientes con FM muestran mayores déficits en atención, memoria de trabajo, memoria episódica y funciones ejecutivas (control inhibitorio, velocidad de procesamiento de información y toma de decisiones), lo que también ha sido denominado en la literatura como "Fibrofog", entendiéndose como una variedad de quejas cognitivas que incluyen precisamente dificultades en memoria, concentración y confusión mental [11][12][13] . Otros investigadores han encontrado dificultades en la respuesta de inhibición y control atencional medido por potenciales evocados durante la ejecución de una tarea de stroop emocional 14 . ...
Article
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Objective. To describe the relationship between neuropsychological variables and serum cortisol levels as a measure of physiological stress in patients with fibromyalgia. Methodology. A sample of 60 women was intentionally selected: 30 with Fibromyalgia diagnosis and 30 with normal controls. Cortisol levels were determined using two blood samples (AM and PM) and a neuropsychological and emotional battery was applied with a standardized protocol in Colombian population to evaluate different cognitive domains. Comparative and correlational non-parametric analyzes were performed, a multiple regression analysis to determine influences between variables. Results. Significant differences between the study groups in the neuropsychological variables (attention, memory, language, visual-constructive praxis and executive functions (EF), (p<0.05) were found, obtaining better scores in the control group. Significant correlations between the cortisol profile, with false acknowledgments of Rey auditory- verbal learning test, and with perseverative errors of the Wisconsin test were found. Multiple regression analysis predicts the influence of memory and EF variables on the cortisol profile in an 88.7%. Conclusions. The findings show that, in patients with FM, there are neuropsychological alterations, mainly in executive functioning (cognitive flexibility) and episodic memory (evocation and storage). Likewise, executive dysfunction is related to physiological stress reciprocally and in turn are conditioned by emotional alterations such as symptoms of depression, which supports the neurophysiological model that compromises the hypothalamic-pituitary-adrenal axis and the prefrontal cortex, rich in corticosteroid receptors.
... Although self-reported cognitive disturbances are widely recognised in patients with fibromyalgia, there is no absolute consensus among researchers regarding patient performance with respect to objective cognitive measures [2]. As a result, many studies have evidenced cognitive impairment in patients with fibromyalgia compared with control groups, with fibromyalgia patients mainly exhibiting problems with working memory processes and/or in their attentional and executive domains, as well as in processing speed [3][4][5][6][7][8]. However, other studies have failed to find any impaired performance in the cognitive functions of these patients [9][10][11][12]. ...
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Fibromyalgia (FM) patients frequently complain of cognitive problems, but it remains unclear whether these cognitive complaints can be attributed to a dysfunction of the central nervous system or if they can be explained by other factors associated with the disease, such as depression, anxiety and sleep dysfunction.One hundred and ten patients with FM were compared with thirty-three patients diagnosed with a depressive disorder (DD) and fifty healthy controls (HC). Several measures of attention and executive functions were used to make these comparisons and the patients were also asked to complete questionnaires on depression, anxiety and sleep quality. Univariate analyses of covariance (ANCOVA) were performed to identify and control confounders and multiple linear models were used to examine the effects of fibromyalgia and depression on cognitive measures.FM and HC differed significantly with respect to depression, anxiety and sleep dysfunction, whereas FM and DD did not differ in terms of symptoms of depression and anxiety. However, FM was associated with a worse quality of sleep than DD. Comparisons of cognitive performance between groups showed that short-term and working memory and inattention measures were only associated with symptoms of depression, whereas selective attention was associated with both depression and fibromyalgia, and processing speed, cognitive flexibility and inhibitory control showed a significant interaction between depression and fibromyalgia. Moreover, cognitive flexibility and inhibition abilities were specifically associated with FM.FM patients show a cluster of cognitive impairment in the attentional and executive domains, although some of the symptoms observed could be explained by the severity of the symptoms of depression, while others seem to depend on the effects of fibromyalgia. Implications of the findings for the understanding and management of cognitive impairment of FM patients are discussed.
... This subjective measure probably assessed a different concept of executive functioning than the more objective measures (i.e. neurocognitive tests) since self-report and neurocognitive assessments of executive functioning appear not to correlate in many studies (Buchanan, 2016;Dingemans et al., 2019;Gelonch et al., 2016;Johnco et al., 2014;Lounes et al., 2011;Toplak et al., 2013). ...
Article
Several studies have shown that obsessive-compulsive disorder (OCD), eating disorders (ED), autism spectrum disorders (ASD) and body dysmorphic disorder (BDD) share obsessive-compulsive (OC) symptoms and often co-occur, which could be seen as indicative of a common etiological basis. In addition, they also appear to have similarities in executive functioning. The present study investigated disorder-specific symptoms and executive functioning as a possible joint factor in individuals with OCD (n=53), BDD (n=95), ED (n=171) and ASD (n=73), and in healthy controls (n=110). The participants completed online questionnaires measuring OCD, ED, ASD and BDD related symptoms as well as executive functioning. The clinical groups were first compared to the healthy controls. Subsequently, a network analysis was performed only with the OC-groups. This network approach assumes that psychopathological disorders are the result of causal symptom interactions. As expected, the healthy controls reported less severe symptoms compared to the OC patient groups. The network analysis suggested that the executive functioning skill set shifting/attention switching and the ASD symptoms, social and communication skills were the most central nodes in the model. Difficulty with cognitive flexibility and social factors are central in OC-spectrum disorders and may be perpetuating factors and thus a relevant focus of treatment.
... Previous studies regarding the correlation between subjective and objective cognitive impairment in FM patients have not been entirely consist- ent. Thus, Gelonch et al. have recently reported that although much of the ex- ecutive dysfunction could be explained by mood disturbances, impairment in working-memory and inhibition (pre- sented in the interference effect of the Stroop Test) correlated with subjective report (13). The results of "objective" cognitive evaluation in FM patients have also recently been shown to be significantly effort-dependent (14), further complicating the assessment of the relationship between patient- reported cognitive impairment and ob- jective findings. ...
Article
OBJECTIVES: The current provisional diagnostic criteria for the fibromyalgia syndrome (FM) include a cognitive index score (SSS-Cog), which constitutes a part of the Symptom Severity Scale (SSS). The current study aimed at assessing the validity of the cognitive index score, by comparing this subjective measure of cognitive impairment with an objective measure of cognitive functioning, collected through comprehensive computerised cognitive testing and assessment. METHODS: 50 FM patients underwent a computerised cognitive assessment battery, including testing in domains of memory, executive function, attention and information processing speed (NeuroTraxCorp.). Age and education standardised scores were computed. FM symptoms were assessed by the Fibromyalgia Impact Questionnaire (FIQ), Widespread Pain Index (WPI) and Symptom Severity Scale (SSS), a Visual Analog Scale (VAS) of clinical pain and the Beck Depression inventory (BDI-II). RESULTS: The index score for subjective assessment of cognitive decline (SSS-Cog) was not correlated with any of the objective cognitive measures. However, a positive correlation was found between the SSS-Cog and the FIQ, the WPI and the VAS measures, all reflecting subjective overall functional ability. CONCLUSIONS: No significant relationship was found between FM patients' subjective appraisal of cognitive deficit and objective cognitive scores on all computerised subtests. However, subjective appraisal of cognitive impairment was found to be strongly and significantly related to patients' functional ability. Therefore, we suggest reconsidering the definition of this index score (SSS-Cog) and propose developing novel and more accurately defined tools in order to measure cognitive impairment in FM patients, for both diagnostic and epidemiological purposes. PMID: 30299249
... Finally, it should be pointed out that the educational level among patients was medium to high (38% secondary education and 35% university education), which should also be taken into account when comparing the results here presented to other studies where educational level in the sample is lower and worse cognitive functioning has been found among patients (Gelonch, Garolera, Valls, Rosselló, & Pifarré, 2016;Tesio et al., 2015). Regarding olfaction, the results here suggest that patients with fibromyalgia present an olfactory deficit, as scores for smell discrimination, threshold and total CCCRC were significantly lower in comparison to women without a chronic pain disease. ...
Article
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Fibromyalgia is a complex syndrome characterized by chronic musculoskeletal pain. Previous research has found impaired olfactory function and cognitive deficits in patients with fibromyalgia. In non-clinical population (middle-aged and elderly populations) an association has been found between olfactory function and cognitive impairment. Therefore, olfactory impairment identification could be considered as a reliable and early marker predicting the decline of cognitive function in mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease. Nevertheless, the relationship between cognitive and olfactory functioning has not been studied in fibromyalgia patients. The aims of the study have been to analyze the cognitive and olfactory functioning and their association in a sample of women with fibromyalgia in comparison to women without a chronic pain disease. A transversal study was conducted with fibromyalgia patients (n = 146) and women without a chronic pain disease (n = 122). Data were collected using the WAIS-III (cognitive functioning) and the CCCRC test (olfactory functioning). Descriptive analysis, Student’s t test and chi-square tests were conducted. There were significant differences in perceptive organization and processing speed, and in odour identification, odour threshold and total CCCRC score; the lower scores were for fibromyalgia patients. Among the fibromyalgia patients there were significant differences in the verbal scale, the manipulative scale, the total scale and processing speed between normosmic and hyposmic patients, the lowest scores were for hyposmic patients. Although previous literature has shown that self-reports by fibromyalgia patients inform about an enhanced olfactory acuity, the current study suggests that there are deficits in olfactory functioning in these patients. Also, the relationship between olfactory and cognitive functioning in fibromyalgia patients, due to the lack of previous studies, suggests a new line of research. Taken together, these results suggest that olfactory functioning could be included in a bio-psycho-social approach of fibromyalgia patients, because of the association with cognitive functioning.
... The manifestations of the disease are responsible for a consistent clinical burden that severely affects life quality of FMS patients. Indeed, aside pain, patients are disabled by sleep disturbances, anxiety and depression and by a complex cognitive dysfunctioning picture characterized by disturbance in attention, working memory and executive functions globally known as "fibrofog" often referred by the patients as a sense of confusion, slowing down and clumsiness that can severely impact the ability to effectively plan and perform daily activities (Tesio et al., 2015;Gelonch et al., 2016). ...
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Fibromyalgia syndrome (FMS) is a complex disorder where widespread musculoskeletal pain is associated with many heterogenous symptoms ranging from affective disturbances to cognitive dysfunction and central fatigue. FMS is currently underdiagnosed and often very poorly responsive to pharmacological treatment. Pathophysiology of the disease remains still obscure even if in the last years fine structural and functional cerebral abnormalities have been identified, principally by neurophysiological and imaging studies delineating disfunctions in pain perception, processing and control systems. On such basis, recently, neurostimulation of brain areas involved in mechanism of pain processing and control (primary motor cortex: M1 and dorsolateral prefrontal cortex: DLPFC) has been explored by means of different approaches and particularly through non-invasive brain stimulation techniques (transcranial magnetic and electric stimulation: TMS and tES). Here we summarize studies on tES application in FMS. The great majority of reports, based on direct currents (transcranial direct currents stimulation: tDCS) and targeting M1, showed efficacy on pain measures and less on cognitive and affective symptoms, even if several aspects as maintenance of therapeutical effects and optimal stimulation parameters remain to be established. Differently, stimulation of DLPFC, explored in a few studies, was ineffective on pain and showed limited effects on cognitive and affective symptoms. Very recently new tES techniques as high-density tDCS (HD-tDCS), transcranial random noise stimulation (tRNS) and tDCS devices for home-based treatment have been explored in FMS with interesting even if very preliminary results opening interesting perspectives for more effective, well tolerated, cheap and easy therapeutic approaches.
... Its prevalence is around 2-3% worldwide 2 . Regarding cognition, impairments of executive functions, specifically selective attention, inference inhibition and processing speed, assessed by the Stroop Color and Word Test (SCWT) have been shown in people with FM [3][4][5] . In connection with this behavioral result, people with FM showed a reduced grey matter of numerous brain structures related to executive functions like anterior cingulate [6][7][8] , prefrontal cortex 6 , amygdala 6 , or hippocampus [9][10][11] . ...
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Physical exercise is one of the treatment approaches with the most robust evidence against fibromyalgia (FM) symptoms. This study aimed to investigate the impact of being physically active on the Stroop Color and Word Test (SCWT) performance as well as to investigate and compare the brain electrocortical activity during SCWT. A total of 31 women completed the SCWT while EEG was recorded. People with FM were divided into two groups (physically and non-physically active) according to the WHO guidelines. Furthermore, magnetic resonance imaging was acquired and health-related quality of life, the impact of the disease, and the six-minute walking test were administered. Physically active group showed better performance in the SCWT, exhibiting less error in name different color patches condition (C), more correct responses in named color-word condition (CW) and higher interference score than non-physically active group. Moreover, a significantly higher theta power spectrum in the Fp1 during the condition C in the SCWT and a higher volume in the right rostral middle frontal gyrus have been found in the physically active group. Furthermore, physically active women with FM showed positively correlations between correct responses in names of colors printed in black condition (W) in the SCWT and theta power in the F3, Fz, Fp2 and F4 scalp positions. Regarding non-physically active women with FM, errors in condition CW negatively correlated with the volume of left superior frontal gyrus, left rostral middle frontal gyrus, right rostral middle frontal gyrus, left caudal middle frontal gyrus and right caudal middle frontal gyrus. Furthermore, physically active group showed increased performance in the 6 min walking test and lower disease impact. Fulfil the physical activity recommendation seems to protect brain health since better SCWT performance, greater frontal theta power and higher volume in the right rostral middle frontal gyrus have been found in physically active women with FM.
... As we discussed, FM, aside pain, is characterized by anxiety, depression and sleep disturbances, and by a complex cognitive dysfunctioning status known as "fibrofog" which is characterized by disturbance in working memory, attention and executive functions globally often referred by the patients as a sense of slowing down, clumsiness and confusion that have a profound impact on the ability to perform and effectively plan daily activities [102,103]. Besides stimulation with acupuncture, the effective modulation of brain areas has been obtained through non-invasive brain stimulation by magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation. ...
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Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules.
... In clinical practice, the assessment of cognitive impairments related to FM relies almost exclusively on selfreported symptoms. However, previous studies exploring the correlations between subjective and objective measures of cognitive impairment in FM patients have been inconclusive and contradictory (10). For example, Gelonch et al. reported correlations between subjective reports of cognitive decline and objective measures of working memory and response inhibition. ...
... In clinical practice, the assessment of cognitive impairments related to FM relies almost exclusively on selfreported symptoms. However, previous studies exploring the correlations between subjective and objective measures of cognitive impairment in FM patients have been inconclusive and contradictory (10). For example, Gelonch et al. reported correlations between subjective reports of cognitive decline and objective measures of working memory and response inhibition. ...
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Objective. In a previous study, we showed that the subjective item assess�ing cognitive impairment (SSS-Cog) for fibromyalgia (FM) did not corre�late with the objective cognitive meas�ures. In the current study we describe two modifications designed to enhance this correlation: extending the SSS-cog scale from 0-3 to 1-5, and administra�tion of a new questionnaire that specifi�cally targets the cognitive impairments associated with FM. Methods. Sixty-two FM patients un�derwent a computerised cognitive as�sessment battery. FM symptoms were assessed on the Fibromyalgia Impact Questionnaire (FIQ); the Widespread Pain Index (WPI); the Symptom Sever�ity Scale (SSS), the new SSS-Cog scale ranging from 1 to 5, the Beck Depres�sion Inventory (BDI) and the new cog�nitive questionnaire developed by the authors. Results. Significant correlations were found between the new SSS-Cog, the global cognitive score and all indices [Global Score r=-.532, p=.00; Indices: Memory r=-.305, p=.01; Executive function r=-.514, p=.00; Attention r=- .471, p=.00; Processing Speed r=-.468, p=.00; Motor Skills r=-.495, p=.00]. Significant correlations were found be�tween the new questionnaire and the global cognitive score on all indices except the memory index [Global Score r=-. 522, p=.00; Indices: Memory r=- .163, p=.212; Executive function r=- .477, p=.00; Attention r=-.439, p=.00; Processing Speed r=-.496, p=.00; Mo�tor Skills r=-.532, p=.00]. Conclusion. Given the simplicity in�volved in extending the scale, we sug�gest incorporating this modification into the FM diagnostic criteria of the American College of Rheumatology (ACR)
... In clinical practice, the assessment of cognitive impairments related to FM relies almost exclusively on selfreported symptoms. However, previous studies exploring the correlations between subjective and objective measures of cognitive impairment in FM patients have been inconclusive and contradictory (10). For example, Gelonch et al. reported correlations between subjective reports of cognitive decline and objective measures of working memory and response inhibition. ...
Article
Objectives: In a previous study, we showed that the subjective item assessing cognitive impairment (SSS-Cog) for fibromyalgia (FM) did not correlate with the objective cognitive measures. In the current study, we describe two modifications designed to enhance this correlation: extending the SSS-cog scale from 0-3 to 1-5, and administration of a new questionnaire that specifically targets the cognitive impairments associated with FM. Methods: Sixty-two FM patients underwent a computerised cognitive assessment battery. FM symptoms were assessed on the Fibromyalgia Impact Questionnaire (FIQ); the Widespread Pain Index (WPI); the Symptom Severity Scale (SSS), the new SSS-Cog scale ranging from 1 to 5, the Beck Depression Inventory (BDI) and the new cognitive questionnaire developed by the authors. Results: Significant correlations were found between the new SSS-Cog, the global cognitive score and all indices [Global Score r=-0.532, p=0.00; Indices: Memory r=-0.305, p=.01; Executive function r=-0.514, p=0.00; Attention r=-0.471, p=0.00; Processing Speed r=-0.468, p=0.00; Motor Skills r=-0.495, p=.00]. Significant correlations were found between the new questionnaire and the global cognitive score and all indices except the memory index [Global Score r=-0.522, p=0.00; Indices: Memory r=-0.163, p=0.212; Executive function r=-0.477, p=0.00; Attention r=-0.439, p=0.00; Processing Speed r=-0.496, p=0.00; Motor Skills r=-0.532, p=0.00]. Conclusions: Given the simplicity involved in extending the scale, we suggest incorporating this modification into the FM diagnostic criteria of the American College of Rheumatology (ACR).
... It is believed that the inability to sleep would lead to daytime excessive sleepiness and easy fatiguability. Several attempts have been made to document cognitive decline [5,6,[14][15][16][17][18][19] and disrupted sleep [20][21][22][23][24][25][26]; however, the cognitive decline in relation to sleep has not been extensively studied yet. ...
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Background: Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality - all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls. Methods: Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure. Results: Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls. Conclusions: Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.
... In this regard, the elbow's range of motion has been suggested to be an innovative method to identify frailty under ST condition (Toosizadeh et al., 2015) and cognitive function under DT condition (Toosizadeh et al., 2016) in older adults. The evaluation of elbow's range of movement under DT condition may also be relevant in patients with FM since they often suffer from cognitive impairment, such as reduced memory (Duschek et al., 2013), lower processing speed (Reyes Del Paso et al., 2015), executive dysfunction (Gelonch et al., 2016), altered associative learning (Walteros et al., 2011) or reduced attention (Glass, 2009). However, to our knowledge, there are no studies focused on the evaluation of the elbow's range of movement under DT in women with fibromyalgia. ...
Article
Background: Fibromyalgia symptoms cause a significant reduction in the ability to perform daily life activities. These activities require the ability to perform more than one task simultaneously. The main objective of this study was to evaluate how dual-task could modify range of movement, duration of repetitions and performance in the arm curl test in healthy controls and patients with fibromyalgia. Methods: Twenty women participated in this study, divided into two groups: 1) patients with fibromyalgia (N = 10, age = 52.00 [5.08]) and 2) age- and gender-matched healthy controls (N = 10; age = 51.60 [4.09]). The participants had to perform the arm curl test in two conditions: single test condition and performing a dual-task. The dual-task condition consisted of remembering three random unrelated words. Results: Patients with fibromyalgia completed fewer repetitions than controls during dual-task condition (p-value = 0.015). Furthermore, both groups showed a significant decrease in the range of movement in the dual-task condition when comparing the mean of the three first repetitions with the three last ones (p-value < 0.05). Interpretation: The motor task might be prioritized over the cognitive task at the beginning of the test. However, at the end of the test, the cognitive task could require more attention due to the increased time since the words were heard, and also the motor task could require less attention after some repetitions have been performed. Thus, the addition of a cognitive task could lead to a less conscious execution of the motor task at the end of the test, which may be consistent with a reduced range of movement.
... Surprisingly, we are among the first to ask this question and the first to seek out all available data in order to answer it. We are not the first to observe the lack of relationship however: Lounes et al. (2011), Gelonch, Garolera, Valls, Rosselló, andPifarré (2016), Hertzberg (2017) (Sample A and B) and Gonzalez et al. (2013) reported no relationship between self-report and neuropsychological tests of cognitive flexibility in any of their samples: females with and without anorexia nervosa, people with and without fibromyalgia, alcohol-abusing individuals, and undergraduate students, respectively. Johnco et al. (2014) found a small relationship between some self-report and neuropsychological tests of cognitive flexibility but no relationship for others, in their non-clinical sample of older adults. ...
Article
Cognitive flexibility can be thought of as the ability to effectively adapt one's cognitive and behavioural strategies in response to changing task or environmental demands. To substantiate the common inference that self-report and neuropsychological tests of cognitive flexibility provide ‘different windows into the same room’, we undertook a systematic review and meta-analysis to determine whether self-report and neuropsychological tests of cognitive flexibility are related in healthy adults. Ten databases and relevant grey literature were searched from inception. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to. Twenty-one articles satisfied our inclusion criteria. A multi-level random-effects meta-analysis revealed no relationship (0.05, 95% CI = −0.00 to 0.10). Random-effects meta-analyses raised the possibility that the Cognitive Flexibility Scale and the Trail Making Test – part B (time) may be related (0.19, 95% CI = 0.06 to 0.31). We conclude that the relationship between self-report and neuropsychological tests of cognitive flexibility is not large enough to be considered convincing evidence for the two assessment approaches sharing construct validity. These results have clear implications for assessing and interpreting cognitive flexibility research and clinical practice.
... Discrepancies between BRIEF-A scores and performance-based tests of executive function have been observed in several clinical populations (e.g. Donders et al., 2015;Gelonch et al., 2016), though this has not been investigated in patients with MDD. A number of studies have noted, however, a dissociation between subjective and objective functioning in MDD in other cognitive domains such as memory (Fava et al., 2018;Mohn & Rund, 2016;Petersen et al., 2019;Serra-Blasco et al., 2019), as well as in executive function using a subjective measure other than the BRIEF-A (Schwert et al., 2018). ...
Article
Major depressive disorder is the most common psychiatric illness in Iran, and depression is common among university students in the country. The presence of depression is frequently associated with problems in executive functioning. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a questionnaire measure designed to assess executive functioning in everyday life in clinical and non-clinical populations. Currently, there is limited empirical validation of the measure for use in Iran. This study evaluated the psychometric properties of a Persian-language BRIEF-A in a sample of Iranian university students (n = 300). The factor structure of the BRIEF-A was examined via a confirmatory factor analysis. We also evaluated whether BRIEF-A scores differed among university students varying in severity of depressive symptoms (Minimal, Mild, Moderate, Severe) as measured by the Beck Depression Inventory – II. Results indicated that a two-factor model structure best fit the data for the BRIEF-A. Acceptable internal consistency was also observed. Furthermore, poorer subjective executive functioning was endorsed by the three depressive subgroups relative to the Minimal symptoms group. Together, these findings support a two-factor model for the Persian translation of the BRIEF-A, and indicate that more severe depressive symptoms in Iranian university students is associated with worse subjective executive functioning.
... In addition, results also showed that scores on subjective and objective measures of executive functioning were not significantly correlated. This finding replicates previous research that did not find associations with subjective and objective measures of executive functioning in medical populations [39,40]. Therefore, both objective tests and subjective rating scales of executive functioning should be included in future studies, as they may be measuring separate constructs and cannot be substituted for each other. ...
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Sleep disturbance is common among children with sickle cell disease (SCD) and is related to neurocognitive difficulties. However, research on sleep disturbances and related variables among adults with SCD is extremely limited. The present study examined the relationship between sleep, executive functioning, and emotional functioning among 62 adults (29 females; M age = 32 years, SD = 7.79) with SCD preparing to undergo a stem cell transplant. Participants were administered a neurocognitive evaluation that included objective and subjective measures of executive functioning, and they completed PROMIS self-report measures of anxiety, depression, and pain intensity. Results showed that about 17% of participants endorsed clinically significant sleep disruptions, while 16.1% and 8% endorsed clinically significant symptoms of anxiety and depression, respectively. Sleep disturbance in these adults was not significantly correlated with objective or subjective measures of executive functioning. Moreover, anxiety, but not depression, was a significant mediator between self-reported sleep difficulties and both objective and subjective measures of executive functioning while controlling for pain intensity. Future research on sleep interventions will be essential for ameliorating the effects of sleep disturbance on executive functioning and anxiety among adults with SCD.
... WCST failure implies some difficulties with executive dysfunction, which CONTACT Elio A. Soria easoria@fcm.unc.edu.ar compromises the patient's activities of in their day-to-day life (Snyder, Miyake, & Hankin, 2015) and impairs relevant ecological interactions (Gelonch, Garolera, Valls, Rosselló, & Pifarré, 2016), with executive dysfunction having been shown in Parkinson's, schizophrenia, bipolar disorder, autistic disorder and attention deficit and hyperactivity disorder (Bora, Veznedaroğlu, & Vahip, 2016;Craig et al., 2016;Josev & Anderson, 2017;Lange, Brückner, Knebel, Seer, & Kopp, 2018). The development of normative data for neuropsychological instruments is useful in clinical and research practice to determine whether a subject's performance is within or outside the normal range (Shan et al., 2008), and must take into account cultural and sociodemographic factors of the population. ...
Article
The Wisconsin Card Sorting Test (WCST) is a widely used neuropsychological assessment of executive functioning. The aim of this study was to provide norm values and analyze the psychometric properties of WCST in healthy Argentinian adults aged from 18 to 89 years old (N = 235). Descriptive statistics are reported as means, standard deviations and percentiles, with the effects of age, education and gender being investigated by ANOVA, and with the effect sizes being calculated. The psychometrics were studied using the WCST structure, reliability, convergent validity, and discriminant validity, and WCST norms adjusted for age and educational level are proposed. This instrument is a reliable and valid tool for the assessment of executive functions. However, as the age- and educational-related effects were demonstrated, these characteristics need to be considered before interpreting WCST scores. Regarding gender, no differences were found. Our results expand the geographical and sociocultural applicability of WCST.
... Patients with chronic pain also frequently report cognitive problems (Baker et al, 2016;Iverson and McCracken, 1997;Sallinen and Marit Mengshoel, 2018;Schnurr and MacDonald, 1995). When objectively measured, neuropsychological deficits can be verified, even if anxiety and depression moderate the association between pain level and cognitive function impairment (Baker et al, 2018;Gelonch et al, 2016). A number of reviews have emphasized that chronic pain can be associated with objective deficits in memory (Berryman et al, 2013;Liu et al, 2014;Mazza et al, 2018) and even executive function-the cognitive processes enabling the execution of complex cognitive tasks, such as reasoning, planning, and problem solving (Diamond, 2013). ...
Article
Objective: To investigate the specific effect of insomnia on neuropsychological functioning in patients with very complex chronic pain. Background: Individuals with insomnia disorder or chronic pain often experience cognitive deficits, with both conditions appearing to correlate with impairments in neuropsychological functions. As insomnia often occurs comorbid with chronic pain, distinguishing the differential effects of these two syndromes on an individual's neuropsychological functioning can be challenging. Comorbid depressive symptoms in these individuals, which may also affect cognitive function, may further obscure the associations between chronic pain, insomnia, and the neuropsychological profile. Methods: The neuropsychological function of 22 individuals with very complex chronic pain was assessed using specialized tests examining aspects of memory and executive functioning. The severity of insomnia, depression, and anxiety was measured using questionnaires, and pain levels were assessed using a visual analog scale. Pain medications were transformed to the morphine-equivalent daily dose. Results: Insomnia severity was found to predict memory function, accounting for 32.4% of the variance: A 1 SD increase in insomnia severity decreased memory function by 0.57 SD. The negative correlation between insomnia and memory was significant even after controlling for pain level, morphine-equivalent daily dose, and comorbid levels of anxiety and depression. Conclusions: Insomnia severity independently predicted memory function in patients with very complex chronic pain, even after controlling for other factors known to impair cognitive function. Insomnia may possibly explain some of the cognitive impairments related to chronic pain; thus, screening for, and treating, sleep disturbances may be a central aspect of chronic pain rehabilitation.
... Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain accompanied by fatigue, stiffness, sleep disturbance, and cognitive impairments [1] in areas including memory [2], processing speed [3], cognitive flexibility [4], and decision making [5]. Fibromyalgia leads to a reduction in the ability to perform activities of daily life [6] and in the quality of life [7]. ...
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Background: Exergames are non-immersive versions of virtual reality that involve physical exercise and have shown several benefits on physical fitness and quality of life in women with fibromyalgia. However, the effects on brain dynamics are still unknown. Aim: the aim was to evaluate the effects of a 24-week exergame intervention on resting brain dynamics in women with fibromyalgia in a single-blinded, randomized controlled trial. Methods: Fifty-six women with fibromyalgia were assessed for eligibility; 55 fulfilled the inclusion criteria. The exercise group completed a 24-week exergame-based intervention that focused on mobility, postural control, upper and lower limb coordination, aerobic fitness, and strength. This group received two 60-min sessions per week. We measured electroencephalographic (EEG) signals from 19 channels. Participants were also divided into two subgroups according to the duration of their symptoms. The intervention was more effective in the group with a shorter duration of symptoms, showing between-group differences in F8, T5 and T4. Conclusion: Exergames may lead to changes in brain dynamics that could be related to increased cerebral blood flow.
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Background Several investigations suggest the presence of deterioration of executive function in fibromyalgia syndrome (FMS). The study quantified executive functions in patients with FMS. A wide array of functions was assessed, including updating, shifting and inhibition, as well as decision making and mental planning. Moreover, clinical variables were investigated as possible mediators of executive dysfunction, including pain severity, psychiatric comorbidity, medication and body mass index (BMI). Methods Fifty-two FMS patients and 32 healthy controls completed a battery of 14 neuropsychological tests. Clinical interviews were conducted and the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Fatigue Severity Scale and Oviedo Quality of Sleep Questionnaire were presented. Results Patients performed poorer than controls on the Letter Number Sequencing, Arithmetic and Similarities subtests of the Wechsler Adult Intelligence Scale, the Spatial Span subtest of the Wechsler Memory Scale, an N-back task, a verbal fluency task, the Ruff Figural Fluency Test, the Inhibition score of the Stroop Test, the Inhibition and Shifting scores of the Five Digits Test, the Key Search Test and the Zoo Map Task. Moreover, patients exhibited less steep learning curves on the Iowa Gambling Task. Among clinical variables, BMI and pain severity explained the largest proportion of performance variance. Conclusions This study demonstrated impairments in executive functions of updating, shifting inhibition, decision making and planning in FMS. While the mediating role of pain in cognitive impairments in FMS had been previously established, the influence of BMI is a novel finding. Overweight and obesity should be considered by FMS researchers, and in the treatment of the condition.
Article
Objective: The ability to accurately identify facial expressions of emotions is crucial in human interaction. While a previous study suggested deficient emotional face recognition in patients with fibromyalgia, not much is known about the origin of this impairment. Against this background, this study investigated the role of executive functions. Executive functions refer to cognitive control mechanisms enabling implementation and coordination of basic mental operations. Deficits in this domain are prevalent in fibromyalgia. Methods: Fifty-two fibromyalgia patients and thirty-two healthy individuals completed the Ekman-60 Faces Test, which requires classification of facial displays of happiness, sadness, anger, fear, surprise and disgust. They also completed eight tasks assessing the executive function components of shifting, updating and inhibition. Effects of comorbid depression and anxiety disorders, and medication use, were tested in stratified analyses of patient subgroups. Results: Patients made more errors overall than controls in classifying the emotional expressions. Moreover, their recognition accuracy correlated positively with performance on most of the executive function tasks. Emotion recognition did not vary as a function of comorbid psychiatric disorders or medication use. Conclusions: The study supports impaired facial emotion recognition in fibromyalgia, which may contribute to the interaction problems and poor social functioning characterizing this condition. Facial emotion recognition is regarded as a complex process, which may be particularly reliant on efficient coordination of various basic operations by executive functions. As such, the correlations between cognitive task performance and recognition accuracy suggest that deficits in higher cognitive functions underlie impaired emotional communication in fibromyalgia.
Article
To explore the relationship between perceived cognitive problems and cognitive performance in three different samples, taking into account the possible influence of depression, catastrophizing, pain intensity, or medication. Seventy individuals with fibromyalgia, 74 with non-malignant chronic pain and 40 pain-free controls, completed measures of verbal episodic memory, sustained attention, response inhibition, depression, catastrophizing, and pain intensity. Fibromyalgia and chronic pain patients performed worse than controls in verbal memory and sustained attention, but these differences disappeared when depressed participants were excluded from the analyses. Memory complaints were related with depression in all pain patients. However, in the case of fibromyalgia, memory complaints were also related by pain intensity and inversely related by short-term episodic memory. This case-control study shows the importance of jointly assessing cognitive performance and memory complaints and of controlling for variables such as depression, catastrophizing, pain intensity and medication in the studied samples. Accordingly, this study highlights the differences in memory complaints, between the patients with fibromyalgia and the patients with other chronic pain conditions. Finally, it has highlighted the important role played by depression in cognitive performance and memory complaints considering the Neurocognitive Model of Attention to pain.
Article
Background: Persons with chronic pain often report problems with cognitive abilities, such as memory or attention. There is limited understanding of whether objective performance is consistent with subjective reports, and how psychological factors contribute. We aimed to investigate these relationships in a group of patients expressing cognitive concerns, and evaluate the utility of self-report tools for pain management settings. Method: Participants with chronic pain (n = 41) completed standardized neuropsychological tests, and self-report measures of cognitive functioning, pain, mood and sleep, as part of a broader study investigating cognitive performance in pain. Results: Average neuropsychological test performance was subtly below normative means (within one standard deviation). Twenty-five percent of the sample scored substantially below age-adjusted norms on one or more objective tests. There were moderate-to-large associations between objective performance (e.g. Trail-Making B) and subjective cognitive complaints (e.g. Everyday Memory Questionnaire - Revised), controlling for age and education level. This was moderated by anxiety, such that subjective-objective relationships were particularly strong in those with higher anxiety. Poorer test performance was associated with higher pain intensity and catastrophizing. Subjective-objective cognition relationships remained after controlling for catastrophizing. Conclusion: Patients' self-reported cognitive concerns concurred with objectively measured performance, independent of age, education and catastrophizing. Moreover, those with severe anxiety were more accurate in predicting their cognitive performance. The findings highlight some interesting cognition-mood relationships, and suggest that easy-to-administer questionnaires, such as the Everyday Memory Questionnaire - Revised and the Behavior Rating Inventory of Executive Function - Adult Version, may be useful to capture cognitive concerns in clinical settings. Significance: Cognitive concerns in chronic pain reflected objective neurocognitive performance. This was moderated by anxiety, such that self-reported cognition was more consistent with objective performance in those with high anxiety. Our findings suggest that reported cognitive concerns should be heeded, and self-report measures may be used clinically to facilitate dialogue about cognitive functioning.
Article
The Stroop colour word test (SCWT) has been widely used to assess changes in cognitive performance such as processing speed, selective attention and the degree of automaticity. Moreover, the SCWT has proven to be a valuable tool to assess neuronal plasticity that is coupled to improvement in performance in clinical populations. In a previous study, we showed impaired cognitive processing during SCWT along with reduced task-related activations in patients with fibromyalgia. In this study, we used SCWT and functional magnetic resonance imagingFMRI to investigate the effects of a 15-week physical exercise intervention on cognitive performance, task-related cortical activation and distraction-induced analgesia (DIA) in patients with fibromyalgia and healthy controls. The exercise intervention yielded reduced fibromyalgia symptoms, improved cognitive processing and increased task-related activation of amygdala, but no effect on DIA. Our results suggest beneficial effects of physical exercise on cognitive functioning in FM.
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Background Cognitive dysfunction in fibromyalgia (FM) encompasses objective cognitive difficulties, as measured in neuropsychological tests, and self-reported cognitive complaints. Although it has been suggested that FM patients display problems in working memory, the data are inconsistent, and the overall working memory status of the patients is unclear. It is also not clear whether the working memory problems are related to cognitive complaints or how the dyscognition is affected by the characteristic clinical symptoms of FM. Methods To clarify these aspects, we explored the neuropsychological performance for different components of working memory and the subjective self-perception of cognitive status in a sample of 38 women with FM. They were compared with a matched group of 32 healthy women. Results Our findings suggested that the FM patients do not differ from healthy controls in their overall working memory functioning. Only a poor performance was found in a single task of visuospatial working memory, mediated by the presence of depressive symptoms, fatigue and pain. The FM patients also displayed a higher level of perception of cognitive difficulties than healthy controls, and this difference was mediated by depression and fatigue. Furthermore, cognitive complaints in FM patients were only associated with a lower verbal WM capacity. Discussion FM patients have a subtle specific impairment in their working memory functioning, as well as elevated concern about their cognitive status. These findings suggest a disconnection between neuropsychological performance and subjective complaints. In FM patients, clinical variables such as pain, fatigue, and depression play an important role in dyscognition, as assessed by both objective and subjective measures, and should be taken into account in future research.
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Este libro no es un protocolo ni una guía clínica que seguir, sino que contribuye al conocimiento de la fibromialgia desde una perspectiva bio-psico-social a través de diferentes investigaciones efectuadas por profesionales del ámbito sanitario y social. Se aportan mecanismos para que los clínicos puedan ayudar a mitigar el dolor, la depresión, los pensamientos de suicidio y observen la enfermedad bajo un paradigma constructivista donde lo social se vislumbra entre el estigma y el significado que la sociedad otorga al sujeto afecto de fibromialgia.
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In this era of unprecedented longevity, healthy aging is an important public health priority. Avoiding or shortening the period of disability or dementia before death is critical to achieving the defining objectives of healthy aging, namely to develop and maintain functional capabilities that enable wellbeing in older age. The first step is to identify people who are at risk and then to implement effective primary interventions. Geriatricians have identified a distinct clinical phenotype of concurrent physical frailty and cognitive impairment, which predicts high risk of incident dementia and disability and is potentially reversible. Differing operational definitions for this phenotype include “cognitive frailty”, “motoric cognitive risk syndrome” and the recently proposed “physiocognitive decline syndrome (PCDS)”. PCDS is defined as concurrent mobility impairment no disability (MIND: slow gait or/and weak handgrip) and cognitive impairment no dementia (CIND: ≥1.5 SD below the mean for age-, sex-, and education-matched norms in any cognitive domain but without dementia). By these criteria, PCDS has a prevalence of 10–15% among community-dwelling older persons without dementia or disability, who are at increased risk for incident disability (HR 3.9, 95% CI 3.0–5.1), incident dementia (HR 3.4, 95% CI 2.4–5.0) and all-cause mortality (HR 6.7, 95% CI 1.8–26.1). Moreover, PCDS is associated with characteristic neuroanatomic changes in the cerebellum and hippocampus, and their neurocircuitry, which are distinct from neuroimaging features in normal aging and common dementia syndromes. Basic research and longitudinal clinical studies also implicate a hypothetical muscle-brain axis in the pathoetiology of PCDS. Most important, community-dwelling elders with PCDS who participated in a multidomain intervention had significant improvements in global cognitive function, and especially in the subdomains of naming and concentration. Our proposed operational definition of PCDS successfully identifies an appreciable population of at-risk older people, establishes a distinct phenotype with an apparently unique pathoetiology, and is potentially reversible. We now need further studies to elucidate the pathophysiology of PCDS, to validate neuroimaging features and muscle-secreted microRNA biomarkers, and to evaluate the effectiveness of sustained multidomain interventions.
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Fibromyalgia is a disabling syndrome. Results obtained with different therapies are very limited to date. The goal of this study was to verify whether the application of a mindfulness-based training program was effective in modifying anger, anxiety, and depression levels in a group of women diagnosed with fibromyalgia. This study is an experimental trial that employed a waiting list control group. Measures were taken at three different times: pretest, posttest, and follow-up. The statistical analyses revealed a significant reduction of anger (trait) levels, internal expression of anger, state anxiety, and depression in the experimental group as compared to the control group, as well as a significant increase in internal control of anger. It can be concluded that the mindfulness-based treatment was effective after 7 weeks. These results were maintained 3 months after the end of the intervention.
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Introduction: Patients with fibromyalgia syndrome (FMS) generally present with chronic widespread pain, accompanied by a range of additional and non-specific symptoms, such as fatigue, disturbed sleep, and cognitive dysfunction, which tend to increase with overall severity. Previous studies have shown moderate cognitive impairment in patients with FMS, but there are few valid data explicitly assessing the relevance of these findings to everyday functions, such as driving ability. Therefore, we studied patients with FMS to assess the impact of FMS on tests that predict driving ability. Methods: Female patients with FMS were prospectively compared to a historical control group of healthy volunteers. The test battery comprised assessments of visual orientation, concentration, attention, vigilance, motor coordination, performance under stress, and reaction time. Results: A total of 43 patients were matched to 129 controls. The results indicated that the patients' psychomotor and cognitive performances were significantly non-inferior when compared to healthy controls (with 0.05% alcohol), with the exception of motor coordination. Patients and healthy controls showed an age-related decline in test performance. Correlations were smaller in patients and reversed for vigilance which was linked to a greater FMS symptom load in younger patients. Conclusion: The results of the present study demonstrate that, in general, the driving ability of patients with FMS was not inferior to that of healthy volunteers based on a standardized computer-based test battery. However, variables, such as younger age, depression, anxiety, fatigue, pain, and poor motor coordination, likely contribute to the subjective perception of cognitive dysfunction in FMS.
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Objectives Patients with Fibromyalgia Syndrome (FM) often complain about a cluster of cognitive disorders that strongly interferes with their work and daily life, but the relationship between impaired cognitive functions and self-reported dysfunctions remains unclear. We aimed to investigate the presence of cognitive impairments in FM patients and to analyze the relationship between the impairments and their evaluation by the patients by means of a comparison with a group of healthy controls.Methods30 FM patients and 30 healthy controls performed a neuropsychological and clinical evaluation of short-term, long-term and working memory, executive functions, and self-evaluation of cognitive impairment, depressive and anxiety symptoms. To thoroughly investigate the executive functions we adopted the model of Miyake and colleagues, which identifies four domains: shifting, inhibition, updating and access.Results and Conclusions Our results confirmed the presence of impairments of attention, long-term memory, working memory and shifting and updating executive functions in FM patients, compared to healthy controls.These impairments are reflected in subjective complaints independently of depressive symptoms. The use of a self-report questionnaire in clinical practice would provide a first and easy screen for the presence of cognitive impairment in FM patients and, in most cases, obviate the need for a time-consuming full neuropsychological test battery. © 2014 American College of Rheumatology.
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Evaluation of executive functions is a major issue of neuropsychological assessment, due to the role displayed by these on a cognitive, behavioural and emotional level, and the implication of these functions in daily life functioning. In order to perform a reliable assessment, the strategy traditionally followed for the evaluation of executive functions has been their atomization in different cognitive subprocesses, which is useful in a clinical or a research context. However, in clinical practice it is frequently artificial to disintegrate a global and complex cognitive process, such as executive functions, in a variety of related components; thus, tests designed according to these theoretical processes have low value in clinical procedures (diagnosis, rehabilitation design) due to their poor correspondence with the subject's or patient's clinical reality. The aims of the present work are to revise the concept of ecological validity applied to the evaluation of executive functions, and to perform a critical review of executive functions assessment by means of multitask paradigms as a way to increase the ecological validity and predictive value of the subject's functional performance. After a historical journey around the (low) ecological validity of single-task tests, and the bet in favour of a multitask paradigm for the evaluation of executive functions, up-to-date existing multitask tests are presented meticulously (with their respective advantages and disadvantages). Finally, concrete recommendations about how to develop multitask tests in the future are presented, attending to concrete parameters related to the context, tasks, objectives, rules and scoring.
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The high prevalence of emotional disorders (anxiety, chronic stress, mood depression) in patients with pain during rheumatologic diseases (particularly fibromyalgia) is closely related to the common pathogenic mechanisms concerning emotions and pain. Therefore a prompt identification of any psychic component of pain, also by means of specific tools, is a must, because it can require an adjustment of the therapeutic approach by combining both an analgesic treatment and antidepressants and/or psychotherapeutic strategies.
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Objectives: Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years). Method: Measures included explicit memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] immediate/delayed recall, delayed recognition), aspects of executive function including interference/inhibition (Stroop Color/Word test), working memory (Digit Span Forward/Backward), set-shifting/complex sequencing (Trails B), monitoring (verbal fluency: naming animals), processing speed (Trails A, Digit Symbol Substitution Coding), and problem solving (Everyday Problems Test). Results: Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding). Discussion: Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.
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The assessment of executive function (EF) and activities of daily living (ADL) are important elements in the diagnosis of Alzheimer's disease. Following a comprehensive search in three databases, a random-effects meta-analysis was used to investigate the association between ADL ability and seventeen tests of EF, three tests of attention and working memory and the Mini-Mental State Examination. The association between EF and ADL ability was further investigated in relation to four different methods of assessing ADL, and one specific ADL, driving. Forty-nine studies met the inclusion criteria, and a total of 3,663 participants were included, the majority of whom were diagnosed with Alzheimer's disease. Most of the individual tests, including commonly used tests of EF such as the Clock Drawing Test, Letter Fluency and the Trail Making Test Part B, showed a significant moderate association with ADL. Associations between EF and ADL ability were similar for all four methods of assessing ADL ability. Driving ability was also moderately associated with EF. The meta-analysis suggests a consistent moderate association between ADL and EF, supporting the growing evidence for a link between ADL and executive dysfunction in early dementia. full text (free access) available from here: http://www.karger.com/Article/Fulltext/338233
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Cognitive complaints are common among subjects with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints.
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Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n = 87) and a non-hypersexual community sample (n = 92) of men using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and the Hypersexual Behavior Inventory (HBI). Significant differences between the groups emerged on eight subscales and all of the general indices of executive functioning with the most dramatic differences on BRIEF-A's Shift, Emotional Control, Initiate, and Plan/Organize subscales. Hypersexual behavior was positively correlated (r = .37, p < .01) with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.
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The Behavior Rating Inventory of Executive Function (BRIEF) is commonly used in the assessment of children and adolescents presenting with a wide range of concerns. It is unclear, however, whether the questionnaire is more closely related to general measures of behavioral disruption and impairment or to specific measures of executive function. In the present study, associations between the Behavioral Regulation Index and Metacognition Index of the BRIEF and cognitive, behavioral, and academic measures were examined in a sample of clinic-referred youth (n = 60) and healthy youth (n = 37) 6-15 years of age. Measures included ratings of inattentive and hyperactive-impulsive symptoms in youth, ratings of how well youth functioned in their everyday environments, youth's scores on measures of reading and math, and youth's scores on measures of inhibition, performance monitoring, and working memory. Although both BRIEF indices were strongly related to parent and teacher ratings of behavioral disruption and impairment, neither was associated with youth's scores on the performance-based tasks of executive function. These findings support the use of the BRIEF as a clinical tool for assessing a broad range of concerns, but raise questions about the relation of the BRIEF to performance-based tasks that are commonly used to assess executive function.
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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".