Brain Advance Access originally published online on September 26, 2008
Brain 2008 131(12):3222-3231; doi:10.1093/brain/awn229
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Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulate cortex in fibromyalgia patients: structural correlates of pain–cognition interaction
1Department of Neurology, University of Regensburg, Regensburg and 2Clinic for Rheumatology, Asklepios Kilinikum Bad Abbach, Bad Abbach, Germany
Correspondence to: Tobias Schmidt-Wilcke, MD, Department of Neurology, Universitätsklinik Regensburg, Universitätsstraße 84, D-93053 Regensburg, Germany E-mail: tobias.schmidt-wilcke{at}medbo.de
Fibromyalgia (FM) is a disorder of unknown aetiology, characterized by chronic widespread pain, stiffness and sleep disturbances. In addition, patients frequently complain of memory and attention deficits. Accumulating evidence suggests that FM is associated with CNS dysfunction and with an altered brain morphology. However, few studies have specifically investigated neuropsychological issues in patients suffering from FM. We therefore sought to determine whether neuropsychological deficits found in FM patients may be correlated with changes in local brain morphology specifically in the frontal, temporal or cingulate cortices. Twenty FM patients underwent extensive testing for potential neuropsychological deficits, which demonstrated significantly reduced working memory and impaired non-verbal long-term memory (limited to free recall condition) in comparison with normative data from age- and education-matched control groups. Voxel-based morphometry (VBM) was used to evaluate for potential correlations between test results and local brain morphology. Performance on non-verbal working memory was positively correlated with grey matter values in the left dorsolateral prefrontal cortex, whereas performance on verbal working memory (digit backward) was positively correlated with grey matter values in the supplementary motor cortex. On the other hand, pain scores were negatively correlated with grey matter values in the medial frontal gyrus. White matter analyses revealed comparable correlations for verbal working memory and pain scores in the medial frontal and prefrontal cortex and in the anterior cingulate cortex. Our data suggest that, in addition to chronic pain, FM patients suffer from neurocognitive deficits that correlate with local brain morphology in the frontal lobe and anterior cingulate gyrus, which may be interpreted to indicate structural correlates of pain–cognition interaction.
Key Words: fibromyalgia; chronic pain; neuropsychology; voxel-based morphometry
Abbreviations: ACC, anterior cingulate cortex; CLBP, chronic low back pain; CTTH, chronic tension type headache; DLPFC, dorsolateral prefrontal cortex; FM, fibromyalgia; FWE, family-wise error; Medial FG, medial frontal gyrus; MFG, middle frontal gyrus; PFC, prefrontal cortex; ROI, region of interest; SES, Schmerzempfindungsskala (pain experience scale); SMA, supplementary motor cortex; SSRI, selective serotonin reuptake inhibitor; VBM, voxel-based morphometry.
Received February 29, 2008. Revised July 28, 2008. Accepted August 29, 2008.
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