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Fibromyalgia

Fibromyalgia is a rheumatic disorder characterized by musculoskeletal pain and tender points. Patients report substantial fatigue. They may be depressed fibromyalgia, fibromialgia, depression, fatigue, retardation, mental impairment. Some of them have sleep disturbances and poor cognitive function. It’s differentiated from chronic fatigue syndrome in that these patients universally report pain and have tender points fibromyalgia, fibromialgia, depression, fatigue, retardation, mental impairment. The etiology of fibromyalgia is unknown. There’s almost universal reports of cognitive decline in fibromyalgia patients. Long term memory is your ability to remember lists of words over time. And word fluency refers to how rapidly you can produce words from a category like animals or all the letters that begin with f. And they did find deficits in fibromyalgia patients but they concluded that only severely depressed fibromyalgia patients showed these deficits. However, when I looked at their data it seemed that the non-depressed fibromyalgia performed really quite a lot worse than the controls, although not significantly worse because they had

In terms of what we think is the cause of fibromyalgia, or the etiology. We are not taking a strong position on that. We really believe that it’s a chronic disorder that hasn’t neuro-chemical mediators but is stress induced. The facilitating stressor could be a physical illness or an injury, or it could be an emotional stressor such as a loss or difficulty that results in a high load situation for the affected individual. And we believe for the vulnerable individual this has neuro-biological consequences and because

The relationship among aging cognition and fibromyalgia: as I said, these patients have a lot of memory complaints and I started thinking about fibromyalgia in terms of my work with older adults. Older adults do have reliable memory dysfunction. It appears that in terms of the neurobiology that areas that are particularly sensitive in older adults are the hippocampus and the frontal lobes. Frontal lobes control decision-making executive processing and other control mechanisms for cognitive system. And the hippocampus is more of a storage system for memories. Interesting, the HPA access, which is a neuro-chemical pathway, is

So the notion that both fibromyalgia patients and elderly adults have these disturbed HPA access have added some credibility to the notion that perhaps this could be … that cognitive aging might be a feasible model for understanding fibromyalgia. So we hypothesized in our initial approach to this problem, that fibromyalgia patients would have the cognitive function of 

First we want to document whether or not cognitive function, dysfunction, actually exists in fibromyalgia patients. And we decided to give fibromyalgia patients a battery of tests in areas that are maximally sensitive to aging. I’ll be showing some examples of that. And we decided primarily rather than using sort of cooked-up laboratory tests, to use a lot of neuro-psychological tests that map onto specific brain regions, primarily the frontal lobe and the hippocampus because we thought those were likely sites where the fibromyalgia patients might have problems. I’ll mainly be focusing on these issues today. We are also interested in what factors mediate this dysfunction. Several possibilities include disruption of the HPA access, on sleep disorders, on depression. And we posed the notion that the actual management of pain could drain cognitive resource in

The study I’m going to talk about today … I’m going to try to give you a quick overview of the research protocol, because I’d really like to focus on the data. We had 20 FM patients, and you need to think of these patients as existing in triplets. For instance the triplets being and age-match. For each FM patient we had an age-matched control. In other words, another

Our primary hypothesis was that FM patients would perform more like older adults than their age-matched controls on many cognitive tasks. And the reason we gave them three blocks of tasks is that patients frequently complain about fatigue and we had the idea that maybe in the first block the patients would look very much like their age-matched controls but by the third block

Let me tell you a little bit about the tasks that we gave these patients, and I do have samples of these as we go along. First we measured speed of processing. This is a very simple task. I’ll show it to you in a moment. But it basically measures how rapidly people can process information and I believe that is a fundamental building block of all cognition that predicts on complex memory function, complex decision-making. Speed of processing is important. It is very easily measured and it is very age-sensitive. And I’ll show you how age-sensitive it is in a moment. Vocabulary is an estimate of world knowledge. You know, we gave people three tasks - synonyms, simple vocabulary and antonyms - that is not age-sensitive. People tend to continue their knowledge across the life-span and it measures their vocabulary and other measures of knowledge did not show age-related

Okay, what do our participants look like? The median age of the fibromyalgia patients was 47. You can see the older controls are exactly 20 years older and the age-matched controls are within a year of the age of the fibromyalgia patients. These are well-educated participants. The fibromyalgia patients score higher on the geriatric depression scale as well as the

Now I’d like to turn to the data on cognitive function. The first data that I am going to show you is this speed of processing task. As I mentioned to you, we see speed of processing as fundamental to all of cognition. We take it as almost an overall measure of neuronal integrity, or sort of general neurologic intact-ness. It’s a very simple task. In this particular task subjects are given columns and columns of these items and they are just told to say if these items same or different. On the number of items that they can … it’s a simple perceptual scanning task. The number of items that they can complete in tow minutes is the measure of their

So the next task we gave subjects was a working memory task and we see working memory as sort of the horsepower, the mental horsepower, mental energy you bring to a cognitive situation. It’s sort of your online processing power. This is an example of the working memory test. The subjects will say, the experimentalist will say, "The fans at the football game wore hats and scarves" and then a question will flash up on the screen - the subjects are working at a computer - "Where are the fans?" Well, you know, the answer is "They are at the football game" so they’ll pick A. At the same time they have to remember the last word in the sentence. Then another sentence will be read and a question about it will flash up and they’ll answer it and they’ll have to

Here we have long-term memory. In this case subjects were given lists of words. They were given 16 words and they were asked to recall as many words as they can. The number of words recalled far exceeds 16 because this was summed across three lists. Here you can again see that very much like the working memory measures, the FM patients look like older adult controls and are performing along with the older controls significantly worse than the age-matched controls.

Verbal fluency, also another highly frontal task in terms of cortex. This is, to remind you, where subjects are given a letter like F and told to produce as many words as they can think of that begin with the letter F. They had three tasks like this and you can see again that very much like older adults FM patients performed more poorly than age-matched controls.

Finally, recognition is a more passive test that doesn’t engage the central executive dorsal lateral frontal cortex and it’s more hippocampal and passive in nature. Here you can see - just to remind you, subjects are given lists of words to study and then

What about memory complaints? We use the Pincus Cognitive Symptoms Inventory, which is simply ask patients what they complain about with respect to their memory. What are their problems? We also have a longer more elaborate cognitive inventory called the Meta-Memory Scale that I’m not going to go into here, that will give us an even better handle on the memory complaints of fibromyalgia patients. But here’s what’s interesting, I think, of the memory complaints of fibromyalgia patients. The

So what can we conclude? I think we can conclude first that fibromyalgia patients show normal speed of processing, similar to age-matched controls and that’s a very important finding. I think the finding that they are like the age-matched controls in some ways has a lot of credibility and potential for interpreting the differences where they are not like the age-matched controls. The FM patients perform significantly worse than age-matched controls and very much like older adults on measures of working

Okay, some directions for future research here. We are interested in looking at how fibromyalgia patients perform when they are distracted. We call this "dividing attention" where they have to do two things at once. And we think given their more apparent limited working memory capacity that they may have particular problems with tasks that require them to switch back and forth, or that require them to perform multiple tasks at the same time. We also think that they may not, like older adults, they may