ABSTRACT
OBJECTIVE: A systemized approach to subjective cognitive complaints (SCCs) in elderly people is needed owing to the high prevalence of such complaints and their impact on the psychosocial well-being of those affected. The aim of this study was to carry out a systematic review of the characteristics and effectiveness of intervention programmes that use a neuropsychological approach to target SCCs in cognitively unimpaired older people and that are tested in randomized controlled trials. METHODS: The search included a time-unlimited query of Scopus, PsycInfo and Medline, yielding 215 articles, of which only 7 met the inclusion/exclusion criteria. RESULTS: The number of intervention programmes was very limited (11 interventions), but diverse, with cognitive stimulation, physical exercise, psychoeducation and cognitive restructuring all used to address SCCs. CONCLUSIONS: Interventions including only cognitive stimulation were not effective in reducing SCCs, but interventions including cognitive stimulation and psychoeducation, physical exercise, and group sessions and discussions reinforced by the therapist were effective.
Subject(s)
Cognitive Behavioral Therapy , Exercise , Aged , Cognition/physiology , Exercise/physiology , Humans , Randomized Controlled Trials as TopicABSTRACT
Fibromyalgia (FM) is a chronic syndrome involving widespread pain of unclear pathophysiology. FM patients frequently complain about cognitive symptoms that interfere with their daily life activities. Several studies have reported attentional deficits and working memory impairment in FM patients. Nevertheless, the mechanisms involved in these alterations are still poorly understood. In this study we recorded electroencephalographic activity in 32 women with FM and 30 matched controls while they performed a 2-back working memory task. We analyzed behavioural data, posterior alpha and midfrontal theta frequency power, and theta phase synchronization between midfrontal locations and the remaining scalp-recorded areas. Task performance was similar in patients and controls; however, time-frequency analysis showed a smaller decrease in the amplitude of the posterior alpha (related to attentional processing) and a smaller increase in midfrontal theta power (related to mental effort) in FM patients than in healthy controls. The FM patients also showed lower functional connectivity between midfrontal locations and rest of the scalp-recorded areas in the theta band (related to information transfer across distant brain regions when top-down control is required). To our knowledge, this is the first study relating alterations in oscillatory activity and impaired connectivity to attentional working memory complaints in FM patients. Reduced power in the theta band during performance of the task suggests that the medial frontal cortex may play an important role in the attentional deficits reported in FM.
Subject(s)
Attention/physiology , Brain/physiopathology , Fibromyalgia/physiopathology , Memory, Short-Term/physiology , Adult , Brain/physiology , Case-Control Studies , Electroencephalography , Female , Fibromyalgia/psychology , Humans , Middle AgedABSTRACT
Working memory (WM) is a critical process for cognitive functioning in which fibromyalgia (FM) patients could show cognitive disturbances. Dyscognition in FM has been explained by interference from pain processing, which shares the neural substrates involved in cognition and may capture neural resources required to perform cognitive tasks. However, there is not yet data about how pain is related to WM performance, neither the role that other clinical variables could have. The objectives of this study were (1) to clarify the WM status of patients with FM and its relationship with nociception, and (2) to determine the clinical variables associated to FM that best predict WM performance. To this end, 132 women with FM undertook a neuropsychological assessment of WM functioning (Digit span, Spatial span, ACT tests and a 2-Back task) and a complete clinical assessment (FSQ, FIQ-R, BDI-1A, HADS, PSQI, MFE-30 questionnaires), including determination of pain thresholds and tolerance by pressure algometry. Patients with FM seem to preserve their WM span and ability to maintain and manipulate information online for both visuospatial and verbal domains. However, up to one-third of patients showed impairment in tasks requiring more short-term memory load, divided attention, and information processing ability (measured by the ACT task). Cognitive performance was spuriously related to the level of pain experienced, finding only that pain measures are related to the ACT task. The results of the linear regression analyses suggest that sleep problems and fatigue were the variables that best predicted WM performance in FM patients. Future research should take these variables into account when evaluating dyscognition in FM and should include dynamic measures of pain modulation.
ABSTRACT
BACKGROUND: Cognitive dysfunction in fibromyalgia (FM) encompasses objective cognitive difficulties, as measured in neuropsychological tests, and self-reported cognitive complaints. Although it has been suggested that FM patients display problems in working memory, the data are inconsistent, and the overall working memory status of the patients is unclear. It is also not clear whether the working memory problems are related to cognitive complaints or how the dyscognition is affected by the characteristic clinical symptoms of FM. METHODS: To clarify these aspects, we explored the neuropsychological performance for different components of working memory and the subjective self-perception of cognitive status in a sample of 38 women with FM. They were compared with a matched group of 32 healthy women. RESULTS: Our findings suggested that the FM patients do not differ from healthy controls in their overall working memory functioning. Only a poor performance was found in a single task of visuospatial working memory, mediated by the presence of depressive symptoms, fatigue and pain. The FM patients also displayed a higher level of perception of cognitive difficulties than healthy controls, and this difference was mediated by depression and fatigue. Furthermore, cognitive complaints in FM patients were only associated with a lower verbal WM capacity. DISCUSSION: FM patients have a subtle specific impairment in their working memory functioning, as well as elevated concern about their cognitive status. These findings suggest a disconnection between neuropsychological performance and subjective complaints. In FM patients, clinical variables such as pain, fatigue, and depression play an important role in dyscognition, as assessed by both objective and subjective measures, and should be taken into account in future research.
ABSTRACT
Diversos estudios han puesto de manifiesto la existencia de diferencias entre sexos en el rendimiento neuropsicológico, así como la influencia de las hormonas sexuales sobre el mismo. En este trabajo se lleva a cabo una revisión de los hallazgos en esta línea de investigación entre los años 1980 y 2007 a partir de búsquedas bibliográficas en las bases de datos Medline y PsycInfo. Los resultados indican que los hombres rinden mejor en tareas espaciales, habilidades matemáticas y razonamiento abstracto, mientras que las mujeres rinden mejor en habilidades lingüísticas, movimientos motores finos, sensibilidad perceptiva y memoria. Asimismo, existen evidencias de que las variaciones en los niveles de hormonas sexuales influyen en el rendimiento en este tipo de tareas para cada sexo. Se concluye que los patrones de rendimiento neuropsicológico típicos de cada sexo pueden, además, variar en función de los niveles de hormonas sexuales, por lo que planteamos la necesidad de que se analice la relación entre estos factores y se tenga en cuenta en futuras investigaciones (AU)
Different studies have shown the existence of sex differences in neuropsychological performance, as well as the influence of sexual hormones on it. In this paper a review of findings in this line of research from 1980 to 2007 is carried out starting from bibliographical search in Medline and PsycInfo databases. Results show that men outperform women in spatial tasks, mathematical abilities and abstract reasoning while women excel verbal abilities, precision motor skills, perception and memory. Moreover evidence suggests that natural variations in sexual hormones levels affect mens and womens performance in these tasks. We conclude that sex-related neuropsychological performance patterns may also remain sensitive to natural variations in sexual hormones levels, and consequently we highlight the need to analyze the relationship among sex and hormonal fluctuations taking it into account in future research on the field