Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Fibrofog: Harbinger of Early Alzheimer's Disease?

Fibromyalgia as agent of chronic pain and cognitive decline? Maybe. Maybe not.

It is not infrequent that a fibromyalgia patient will ask me whether her (or his) “fibrofog”—that cognitive dysfunction experienced by up to 80 percent of fibromyalgia patients—is a disturbing harbinger of something worse.

Something more final and more devastating to self and family.

Something like dementia. What patients usually just call “Alzheimer’s.”

And I guess it is not unreasonable for younger individuals to wonder what sort of elderly misery might be in store for them who have such a difficult time in youth.

These difficulties with memory, concentration, language, and thinking, known as fibrofog, are experienced by fibromyalgia patients who are generally under 60 years of age. Interestingly, fibrofog is not as insidious as most cases of dementia; and actually can be quite dramatic, creating a significant amount of distress in those who are affected by it. It is as if one’s mind has been hijacked by the chronic pain, the victims seeing a curving road speeding ahead that is simultaneously spiraling into an early case of Alzheimer’s.

Thankfully, recent data presented at the last American College of Rheumatology annual meeting indicates that the fibromyalgia patient may not have to add the fear of an early diagnosis of dementia to the burden that the diagnosis of fibromyalgia alone brings to the life of a chronic pain patient.

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A cross-sectional study examined a group of fibromyalgia patients with symptoms of cognitive dysfunction of no more than 12 months’ duration, comparing these individuals with another group of fibromyalgia patients who had been suffering fibrofog symptoms for anywhere from seven to 26 years. The groups were similar in terms of depression measures, education level, and vocabulary scale scores.

The two groups were also similar in that no significant differences were found on 13 of 14 measures of neurocognitive function measured in this study, some of which included logical memory, paired association tasks, digit symbol recognition, letter fluency, processing speed, and word speed and color speed tests. It was the measure of spatial scanning and cognitive sequencing where the long-duration fibrofog patients did worse compared to the other cohort.

Reassuringly, the level of cognitive impairment in fibromyalgia patients was extremely low compared to Alzheimer’s patients when measured against standardized normative means for the 14 neurocognitive tests utilized in the study. Actually, measures of processing speed and episodic memory—which are significantly impacted in early or so-called “pre-clinical” Alzheimer’s disease—were normal in both groups studied.

Fibrofog, it appears, is not a condition of progressive cognitive decline. No one is losing one’s mind—at least due to fibromyalgia.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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