Fibro Fog

Many people with fibromyalgia report cognitive dysfunction — often referred to as fibro fog — including problems such as muddy thinking, poor concentration, short-term memory loss, and difficulty finding the right words.

These symptoms can occur at any age and can affect all areas of a person’s life, including job performance and personal relationships. But they do not appear to worsen over time. Researchers do not yet know what causes cognitive problems to develop in people with fibromyalgia.

Know the signs of fibro fog

Fibro fog, an umbrella term, encompasses a number of cognitive problems. It is the simultaneous presence of memory problems and a high level of mental fog in people diagnosed with fibromyalgia. Once fibro fog is suspected — often after symptoms are observed — a neurocognitive evaluation can be a valuable tool for evaluating a person’s brain function.

Mental fog

This is a sense of confusion marked by a loss of mental clarity. However, it may be overlooked in people with fibromyalgia because it seems unrelated to their chief complaint of widespread pain. The Mental Clutter Scale numerically quantifies the intensity of a person’s mental fog on a scale of 1 to 10 using eight features linked to mental clarity:

· spaciness;
· looking at life through a haze;
· confusion;
· cluttered thinking;
· fogginess;
· rushing thoughts;
· fuzzy-headedness; and
· information overload.

Individuals are asked to rate how frequently they have experienced these problems in the past week on a 10-point scale, with 1 being not at all and 10 being all the time. Anyone with an average score of 5 or more likely has high levels of mental fog.

Memory loss

People with fibro fog often experience an accelerated rate of memory loss when distracted. Distractions that need to be attended to, such as a knock on the door or the timer on a stove, can cause forgetfulness. New information fades much more rapidly when one is distracted. This tendency can be measured by the Auditory Consonant Trigram, which gives a person three letters to remember, then distracts the subject with another test for nine, 18 or 36 seconds before asking him or her to recall the three letters. With a distraction lasting nine seconds, people with fibromyalgia forget 38 percent more information than people without it. With a distraction lasting 18 seconds, that difference rises to 44 percent.

Word-finding difficulties

In people with fibromyalgia, the part of the brain known as the lexical, or word, memory does not work as quickly as other parts of the brain, resulting in a slower-than-normal ability to retrieve words from the brain’s memory bank. The Stroop Color & Word Test contains a Naming Speed subtest that measures a person’s lexical speed. It asks people to read words as quickly as they can for 45 seconds. The speed at which someone names words is a good indicator of his or her lexical speed. When people with fibromyalgia are asked to name words from a list, they tend to name them more slowly. For example, if an individual names one word every 420 milliseconds over 45 seconds, his lexical network works pretty well. People with fibromyalgia, however, generally name one word every 620 milliseconds over a 45-second period. This indicates that it takes 200 milliseconds longer for critical information released by the mental lexicon to arrive at the brain connections that build neural signals into coherent information. This slowness may contribute to word-retrieval problems and can make it harder to follow a conversation because of a lag in understanding what the other person is talking about.

Treating fibro fog

What can a person do, if anything, about slow word retrieval and difficulty remembering when distracted? One thing that can help is to recognize that the experience is real. People with fibromyalgia can feel frustrated — and possibly doubt their own experience — when others, including some medical professionals, do not take their complaints seriously. So if possible, work with a health-care provider who understands that though you may appear perfectly fine, your fibro fog symptoms are real, and the effect they have on your life is real.

Something that may help those with fibro fog to remember better is a technique called verbalization. When a person says something out loud, it helps cement the words or thoughts in the short-term memory. When meeting someone new or learning a new word, for example, it helps to say the name or word aloud once or twice. You might also consider finding ways to avoid distraction. For example, you could turn the ringer on your phone off when concentrating on a task or conduct non-urgent business via e-mail instead of on the phone.

Using the drug methylphenidate (brand name Ritalin), which is approved for treating attention deficit disorder (ADD), may also help. Ritalin appears to have short-term benefits for naming speed and cognitive functioning in people with fibromyalgia. In some short clinical trials, Ritalin was able to reduce the time delay in the lexical/word-retrieval clock by approximately 50 percent, so that word information was back in partial sync with other streams of neural information. This change occurred in tandem with broadly improved cognitive functioning.

Ritalin is a controlled substance and requires a monthly written prescription, which can make using it inconvenient. However, if a person’s fibro fog is bad enough to significantly impair functioning, it may be worth the trouble. Other medicines sometimes used for ADD, such as Adderall (a combination of amphetamine and dextroamphetamine) and atomoxetine (Strattera), may also be helpful for the cognitive symptoms of fibromyalgia.

Want to learn more about fibromyalgia? Read “What Is Fibromyalgia?” and “Fibromyalgia Symptoms and Overview.”

Dr. Katz is a Professor of Medicine at Rush Medical College, in Chicago, and Dr. Leavitt is a Professor Emeritus of Psychology at Rush Medical College.

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