Cognitive Dysfunction and fibromyalgia
When we are talking about the poor cognitive function we have to be precise and not confuse it with just being absentminded but studies have shown there are real cognitive dysfunctions occurring with fibromyalgia. What is the cause of the cognitive dysfunction seen in the syndrome though? Is the brain aging faster? Is it due to depression or anxiety? Or is it correlated to pain or lack of sleep?
There are many areas where people with fibromyalgia can point to there being a problem but not all of them have been specifically studied. There is what is called Fibrofog the term used to refer to poor concentration. Often people have problems with their short-term memory, their long-term memory, and their working memory. They have trouble remembering the names of objects, and people and have problems with facial recognition. When they speak the wrong words come out or they forget what they say in the middle or they cannot comprehend what the other person is saying. When they are writing they use the wrong words, mix up their letters, make odd grammar mistakes and forget how to spell a word altogether. It is the same with numbers; they transpose them and cannot copy them from one page to another without mistakes. They forget how to do simple routine tasks or forget the order to do them. It is scary and confusing when you do not know what is going on with your brain and what is to blame.
There have been more than a few studies looking into the fundamental aspects of cognition to figure out exactly where the cognitive dysfunctions are and how they compare to others of the same age. This helps determine whether the cause is brain aging or if the cause lies elsewhere.
Areas fibromyalgia patients perform lower than age control subjects
Free recall- such as having a list of words to remember at a later time.
Working memory- Working memory is quite important for everyday functionality. It is the ability to take information, hold it in your mind and use it in some mental process.
Vocabulary tests- Often people with fibromyalgia have problems accessing their vocabulary, not that they do not, in fact, have one. A test could ask a subject to come up with a list of words that start with the letter B quickly and accessing that knowledge would be problematic compared to age-controlled subjects.
The ‘Cognitive functioning in fibromyalgia patients’ study published in the journal of Arthritis & Rheumatism compared 23 FM patients with 23 healthy age-matched controls and 22 older control adults. The older control subjects were to compare the cognitive dysfunction reported in FM patients to the natural decline we have seen over time as we age. They measured “speed of information processing, working memory function, free recall, recognition memory, verbal fluency, and vocabulary. We correlated performance on cognitive tasks with FM symptoms, including depression, anxiety, pain, and fatigue. We also determined if memory complaints were correlated with cognitive performance.”
According to the study, the FM patients performed more poorly than their age counterparts on all aspects of the study such as working memory, free recall, recognition memory, verbal fluency, and vocabulary with the sole exception of information processing. The FM patients performed more like the older controls in the study except they had better information processing and poorer vocabulary. It also is suggested within this study that poor cognitive performance was correlated to pain and not depression or anxiety. The fact that “speed of processing was intact in FM patients suggests that the most basic and global information processing ability—how fast we process new information—is not a problem for FM patients. Our findings do indicate that FM patients have more limited working memory and long-term memory than do age-matched controls. The cognitive symptoms described by these patients are likely to be related to difficulties in these domains.”
The intact speed of processing is quite good news if this study can be validated because it is vital to most cognitive functions. The decline in the speed of processing, in fact, might indicate deterioration of cognitive functions, and “Speed decreases that occur with age have been hypothesized to be related to age-related declines in dopamine receptors, decreased brain weight, increased dendritic branching that leads to circuitous cognitive processing, or decreases in a myelin sheath.” However, functionally, on most other indicators, people with FM are operated cognitively twenty years age advanced and even more poorly indicated on vocabulary standards.
In the European Journal of Pain, a study was published to look at whether high or low blood pressure could be affecting the cognition of fibromyalgia patients. Indeed some people have speculated the lack of blood flow to certain areas of the brain is responsible for some of these symptoms. The study included 35 FM patients and a control group of 29 healthy people. This study saw the same cognitive impairment patterns seen in the study above.
One finding was that the study suggested that “pain plays an important role in the genesis of the cognitive deficits in FMS. Clinical pain ratings in terms of the number of words used to describe pain were inversely associated with the number of calculations in the FMS sample. Furthermore, when pain ratings were statistically controlled, the group difference in performance was no longer significant. This is in line with our finding that FMS patients using an analgesic medication, particularly opiates, performed better than patients not using these drugs. These results corroborate numerous studies supporting the interfering effects of pain on cognition. Pain is an attention-demanding condition that activates brain areas associated with cognitive processing such as the cingulate and the prefrontal cortex. One may thus speculate that central nociceptive processing detracts from cognition by requiring enhanced neural resources in the respective brain areas.”
In the control group, blood pressure was a factor in cognitive functioning however in the FM group “the inverse association between BP and performance was absent, which may indicate that the affected patients are protected against the negative effects of high BP on cognition. Taking the aforementioned mechanism into account, it may be hypothesized that the CNS inhibition due to baroreceptor stimulation is reduced or absent in FMS. This is in accordance with the observation that the frequently described reduction in pain experience following experimental baroreceptor stimulation did not occur in patients with chronic pain disorders. It has furthermore been shown that pain dampening during experimental baroreceptor stimulation only occurs in individuals with normal to high BP, whereas in those with low BP this procedure may even increase pain.”
He likewise determined anxiety and depression did not correlate to the cognitive concerns. However, this study shows that blood pressure does not look like it is a factor and that level of pain might very well be an important factor.
Clearly, there is a great deal of cognitive dysfunction with fibromyalgia sufferers such that a person is cognitively functioning twenty years older than they are. However many studies have validated that intact speed of processing is not affected which suggests the brain is not in the process of accelerated aging and that is a key difference. Another important thing to note is that these two studies and more have shown that anxiety and depression are not factors in fibromyalgia cognitive issues. The last study suggests that perhaps it is the level of pain experienced that affects cognitive abilities and certainly that does seem like an area that needs to be explored further. However, we are left wanting are we not? There have been other studies showing that pain is an indicator but perhaps because the same area of the brain is activated and it is a distraction. We are left with knowing there are these cognitive impairments but not the specific cause for them or what is going on in the brain with enough clarity to do anything specific about it. Therefore while we have a few options for pain treatment there is really nothing available to assist a person with some very important cognitive concerns. In fact, side effects can make cause mental grogginess anyway. Discovering the relationship between pain and cognition in the fibromyalgia brain is a very important area to delve into. It hardly seems probable the cognitive problems are associated with a cause separate from what we know causes pain to be hyperintense. Although it is rather hard to argue with the theory that pain is distracting, perhaps inherently so, due to its function to grab our attention and focus.
Until then all we can do to help with our cognition is stick to regulated routines, keep regular sleep habits and keep regular eating habits. Routines establish habits that enable us to remember things easier so we are less stressed. We want to keep our stress levels as low as possible. Sleep habits are difficult to maintain but irregular habits and changes cause disruptions that we physically do not handle well and can cause greater stress and fatigue. Regular eating habits of eating throughout the day, and snacking every three hours, will keep our energy levels higher and keep the fibrofog at bay. Using reminders and To-do lists also helps in the organization. If during the day you feel your concentration waning get up and have a stroll about the office or a walk around the block. The break will energize you and help refocus some of that mental energy. Sometimes changing from one task to another can also get your brain going. Distraction seems to be a component of cognitive issues. Pain is one major distraction. Perhaps along with our over-sensitivity to the environment and stimulus to external distractions. Therefore our ability to pace ourselves and take breaks when needed can certainly help if we are overly strained. Another key is to avoid multi-tasking because it naturally segments your attention into different areas and it is easy for interruptions or concentration issues to make you suddenly lose your focus mid-task. Try not to overstimulate your system with loud noises and bright lights; the fewer distractions from your environment the better. There is also a little something to exercise your brain with puzzles or brain games. Finally, double-check with your doctor to ensure the medication is not having a side effect that may be making these symptoms worse if they are troubling you.
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