Executive Function and Decision-Making in Women with Fibromyalgia

Abstract

Patients with fibromyalgia (FM) typically report cognitive problems, and they state that these deficits are disturbing in everyday life. Despite these substantial subjective complaints by FM patients, very few studies have addressed objectively the effect of such aversive states on neuropsychological performance. In this study we aimed to examine possible impairment of executive function and decision-making in a sample of 36 women diagnosed with FM and 36 healthy women matched in age, education, and socio-economic status. We contrasted performance of both groups on two measures of executive functioning: the Wisconsin Card Sorting Test (WCST), which assesses cognitive flexibility skills, and the Iowa Gambling Tasks (IGT; original and variant versions), which assess emotion-based decision-making. We also examined the relationship between executive function performance and pain experience, and between executive function and personality traits of novelty-seeking, harm avoidance, reward dependence, and persistence (measured by the Temperament and Character Inventory-Revised). Results showed that on the WCST, FM women showed poorer performance than healthy comparison women on the number of categories and non-perseverative errors, but not on perseverative errors. FM patients also showed altered learning curve in the original IGT (where reward is immediate and punishment is delayed), suggesting compromised emotion-based decision-making; but not in the variant IGT (where punishment is immediate but reward is delayed), suggesting hypersensitivity to reward. Personality variables were very mildly associated with cognitive performance in FM women.

Are Fibromyalgia Patients Cognitively Impaired? Objective and Subjective Neuropsychological Evidence

“…Regarding EF, the patients showed impairment in the shifting subcomponent, which has already been highlighted by a previous study (38). Poor performances on complex tests that involve interference or attention switching have also been found in other chronic pain states (39).…”

The effect of pain on cognitive function: A review of clinical and preclinical research

“…Clinically, executive function is assessed using interference tasks such as the Wisconsin Card Sorting Test (Grant and Berg, 1948), the Process Dissociation Procedure (Jacoby, 1991), and flexibility tasks such as the Trail Making Test (Adjutant General's Office, 1944). Patient performances on these tests appear to show that controlled executive-type functions are affected by chronic pain (Karp et al, 2006;Ryan et al,1993;Verdejo-Garcia et al, 2009;Weiner et al, 2006), and may be more severely affected than less complex, automatic processes (for example fixed sequences of operations that do not require higher control) (Grisart and Van der Linden, 2001) (Table 1). Complex tests of attention, such as those that involve interference or attention switching, may require executive function and chronic pain patients perform poorly on such tests (Bosma and Kessels, 2002;Eccleston, 1994;Karp et al, 2006;Ryan et al, 1993).…”

“…However, this study did not include a pain-free control group and was carried out specifically in elderly pain patients (ages 84.6 ± 0.5 years). Emotional decision making and emotional self-regulation are also thought to involve higher executive functioning and appear to be compromised in some chronic pain patients (Apkarian et al, 2004a;Solberg Nes et al, 2009;Verdejo-Garcia et al, 2009). Interestingly, a study by Veldhuijzen et al (2006a) also found that chronic pain patients, while showing increased errors in an attentional task, had shorter response times than healthy controls.…”

“…In addition, studies examining pain-related cognitive effects have been carried out in specific demographic groups such as older adults (Karp et al, 2006;Weiner et al, 2006), female patients only (Alanoglu et al, 2003, Park et al, 2001Verdejo-Garcia et al, 2009) and male patients only (Lee et al, 2010). Pain chronicity or duration of chronic pain illness may also be a factor in the relationship between pain and cognition.…”

“…Pain chronicity or duration of chronic pain illness may also be a factor in the relationship between pain and cognition. Eccleston et al (1994) and Alanoglu et al (2005) found that pain chronicity was not associated with differences in cognitive function, whereas other studies have shown that duration of illness (migraine, diabetes and fibromyalgia, CRPS and chronic back pain) was inversely related to cognitive performance (Apkarian et al, 2004a;Calandre et al, 2002;Ryan et al, 2005;Verdejo-Garcia et al, 2009), though analyses may also adjust for chronicity. However, the majority of studies did not consider this variable when assessing the effects of pain on cognitive function.…”