Cognitive problems of men with fibromyalgia — involving their memory, verbal fluency and problem-solving abilities — significantly affect their work, social relations and self-perceptions, a study finds.
The study titled “Memory gaps, lost words and crucial mistakes — Men’s experiences of cognitive difficulties in fibromyalgia” was published in the journal Chronic Illness.
Besides pain and fatigue, cognitive dysfunction is a common complaint among patients with fibromyalgia. These cognitive difficulties are often described as “fibro-fog,” which may include a perceived deterioration in mental clarity, as well as increased forgetfulness and difficulties in solving problems.
Memory dysfunction in fibromyalgia may impact working memory (short-term storage of information while performing other mental tasks), episodic long-term memory (used to remember particular episodes and experiences), and semantic memory, which involves aspects such as the meaning and relation of words.
People with fibromyalgia have also shown worse scores in performance-based memory tests, greater susceptibility to distraction, and higher levels of anxiety and worry about their memory than patients with other rheumatic conditions or healthy controls. Unlike women with fibromyalgia, men with this condition have regarded cognitive challenges as a significant interference in their ability to work.
“It seems that men and women experience dyscognition and its impact on daily life differently,” the authors wrote.
In their study of men with fibromyalgia, the scientists addressed what type of cognitive impairments these men experienced, and how they expressed and interpreted the impact of cognitive challenges on daily life, work and social relationships.
Eight men (average age of 47 years, age range between 24 to 61) were selected for their different experiences of living with fibromyalgia. On average, the participants had been diagnosed with fibromyalgia 9 years prior to the study (range of one month to 20 years), but all had had symptoms for several years before diagnosis.
Four men had a bachelor’s degree level of education, three had vocational education, and one had basic education. Three worked full-time, while three were on permanent or temporary disability pension, and the other two were on reduced working hours.
They were interviewed in three phases: In the first phase, the patient told his life story without being interrupted. In the second phase, the interviewer asked questions to enrich or fill gaps in the man’s story. The final stage involved discussing the interview as a whole. Each interview took between one to three hours.
A narrative analysis identified common themes among the stories, and created three model narratives: “Story of focusing on one thing at a time,” “Story of having memory gaps,” and “Story of losing cognitive work ability.” The scientists were particularly interested in what words, metaphors, and examples the patients used to tell about their experiences.
Cognitive problems were identified as the most important symptom in addition to pain by some patients, while others said it was only a “minor inconvenience.” The intensity and impact of cognitive dysfunction varied from patient to patient, and also from one day to the next.
In the “Story of focusing on one thing at a time,” told by two men, cognitive challenges were mild and experienced only during intensive pain periods. The patients focused on the task-at-hand as a strategy, which became more difficult as their pain intensified. These two men regarded their cognitive problems as occasional absent-mindedness that everyone experiences.
“I have always had quite good concentration skills. . . but on the other hand, I had to ask you [earlier during the interview] ‘what was the question again? [laughs]. . . but anyway, I don’t think I have any problems there,” one interviewee said.
The disturbances did not impact daily life negatively, although the men more frequently required increased effort to concentrate. The men also did not anticipate cognitive problems in the future if their pain was tolerable. They anticipated being able to work and have normal social lives and hobbies.
The “Story of having memory gaps” reflected mild to moderate but frequent cognitive difficulties experienced by three men. These patients had persistent difficulties in finding words, and experienced occasional memory problems and difficulties in concentration in activities such as reading books or newspapers. Such problems were often associated with poor sleep, daytime fatigue, and intense pain, but they could also come unexpectedly.
The men described their cognitive problems as annoying and embarrassing, both at work and at home.
“You are explaining something and suddenly you don’t have a clue what you were talking about,” one patient said. “Even if the others try to help you out, you cannot reach the thought you had. . . . it is annoying.”
They also feared having more serious memory problems in the future.
Three other men focused on experienced or anticipated loss of work ability due to severe cognitive difficulties. In their “Story of losing cognitive work ability,” they mentioned embarrassing severe concentration and memory problems, as well as difficulties in problem solving and making key mistakes at work that could lead to losing their job and work ability.
“This is the job I have done all my life and I don’t know about anything else,” a patient said. “I don’t know what is to come.”
Tasks previously performed easily were increasingly difficult and also brought difficulties in planning the workday. One of the three men was on disability pension due to severe cognitive difficulties. He had failed to continue tasks under pressure during a work tryout. In contrast, another patient was able to return to the same level of work as he had before the onset of his symptoms, due to suitable medication and increased physical activity.
“Based on our results, we suggest that instead of settling for the somewhat mystifying expressions of ‘fog,’ the health care professionals should address difficulties in problem solving, speech fluency, memory and concentration in more detail to be able to find specific interventions that would be beneficial and relevant for the patient,” the scientists wrote.