How Depression Affects the Cognitive Profile of Fibromyalgia Patients

Patients with fibromyalgia experience a cluster of cognitive impairment symptoms centered on the attentional and executive domains. According to new research from Olga Gelonch, PhD, a clinical neuropsychologist and researcher at the Universitat de Lleida, Spain, and colleagues, some of these symptoms may be explained by a patient’s severity of depression. Published July 5 in Plos ONE, the research, also indicates some cognitive impairment symptoms may depend directly on the effects of fibromyalgia.¹

The investigators evaluated a range of neuropsychological tasks that covered the main attentional and executive areas. Subjects (n=110 with fibromyalgia, n=33 with depression and n=50 healthy controls) enrolled themselves in the study, and investigators acknowledge that their results may reflect some selection bias.

“In this study, we provide new evidence to further our understanding of the effects of fibromyalgia on cognitive performance,” write the authors in their discussion. “We have done this [by] separating the attributable effects of potential confounding variables and, in particular, the effects explained by depressive symptoms, and by also taking into account the influence of anxiety and sleep dysfunction.” They began their research by noting that a large difference existed between patients with fibromyalgia and healthy controls in measurements related to depression, anxiety and sleep quality. Moreover, fibromyalgia was associated with a worse quality of sleep than depressive disorder.

“With regard to the specific objectives of the study in terms of cognitive performance, the first finding was that the differences initially found between the fibromyalgia and the healthy groups in the majority of the cognitive measurements subsequently disappeared when we adjusted for depression, anxiety and sleep quality, leaving only differences in the Stroop Interference task,” the authors explain.

The Stroop test uses cards to measure automatic processing speed, controlled processing speed and cognitive flexibility. The interference index is calculated from this test and used as a measure of inhibition ability. “This lack of difference in most of the cognitive tests supports our main hypothesis that the differences in cognitive performance between groups could mainly be explained by depression for most cognitive domains,” continue the authors.

Although patients with fibromyalgia and those with depression showed similar levels of performance in most of the cognitive tests, notable differences were demonstrated. Short-term and working memory and inattention measures were associated with only symptoms of depression. Selective attention was associated with both depression and fibromyalgia. In contrast, cognitive flexibility and inhibition abilities were specifically associated with fibromyalgia.

The authors conclude, “From a clinical practice perspective, we must consider emotional symptoms, such as depression and anxiety, to be an essential part of the cognitive performance of patients with fibromyalgia. It, therefore, makes no sense to analyze them separately.”

Thus, researchers propose that patients with fibromyalgia be treated for depression and that such treatment may reduce the impairment of their attentional processes. However, they caution that the impairment of cognitive flexibility and inhibition may likely remain challenges for patients with fibromyalgia.

Lara C. Pullen, PhD, is a medical writer based in the Chicago area.

Reference

1. Gelonch O, Garolera M, Valls J, et al. The effect of depressive symptoms on cognition in patients with fibromyalgia. PLoS One. 2018 Jul 5;13(7):e0200057. eCollection 2018.