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What a dread disease dementia is. At its worst dementia can result in the total loss of one’s personality: loved ones don’t register, reasoning is gone, even simple matters such as dressing and bathing require assistance. Even in its more moderate forms dementia can be all-encompassing causing memory loss, problems doing ordinary tasks, mood swings and more.

Could fibro-fog be a prelude to dementia?

Could fibro-fog be a prelude to dementia?

Dementia is a broad term used to refer to several conditions that cause a severe enough reduction in the ability to think so as to impact one’s daily living. If you live long enough, you have a very good chance of developing dementia. While just 1-2% of people aged 65 have dementia, the risk of developing it after that doubles roughly every five years. If you make it to 85 your risk of developing dementia is somewhere between 30-50%. For those of us with aging parents, the costs that dementia imposes can become painfully clear.

Fibromyalgia, of course poses its own unique costs. Those costs were made clear in the 2017 study on FM and dementia.

“Fibromyalgia is a widespread musculoskeletal pain disorder associated with chronic fatigue, emotional distresses, and sleep disturbance.  Previous studies revealed that fibromyalgia is associated with the increased risk of irritable bowel syndrome, dry eye syndromes, depression, suicide rates, stroke, and coronary artery diseases.”

They left out migraine (55% of FM patients met the criteria in one study), and chronic fatigue syndrome, but never mind; fibromyalgia is “widespread” and is associated with a boatload of other conditions.

The pain, fatigue and sleep issues, of course, can be terrible but the problems don’t stop there.  There’s also the “fibro-fog”; the short-term concentration and  word-finding problems, the problems with multi-tasking, and the general fogginess where clarity used to reign. FM, then,  is a kind of all-inclusive disease; it causes pain,  fatigue, sleep issues, throws people off emotionally, and causes problems with cognition.

Diseases don’t ordinarily cause cognitive issues. Look up diseases that cause cognitive problems and you’ll find mostly brain disorders like autism, stroke, Parkinson’s disease, Huntington’s disease, brain injuries, multiple sclerosis (brain-fog), cancer (chemo-brain), chronic fatigue syndrome (brain-fog) and, of course, Alzheimer’s.  The cognitive issues in FM are pretty mild  compared with the issues found in some of these diseases, but they obviously raise a concern: could fibro-fog  be a prelude to something worse? Do people with FM have to be concerned with early-onset dementia as well?

Distraction or Dementia?

A 94-person 2016 study suggested not.  The study suggested that the cognitive issues in FM are different in kind from those found in Alzheimer’s. It found that the “encoding mechanisms” needed to transfer personal events into memory that are broken in Alzheimer’s were, for the most part, functioning in fibromyalgia. FM patients may have cognitive problems but they didn’t experience the “episodic memory losses” or progressive cognitive decline seen in Alzheimer’s.

The  major cognitive problem in FM, the authors said, comes from their brains’ inability to correctly   filter out irrelevant data.  Several studies suggests that fibromyalgia patients brains keep focusing on innocuous stimuli that healthy controls are able to quickly assess and then stop paying attention to. A correlation between reduced pain inhibition and cognitive issues also suggests that being in pain causes cognitive issues.  The cognitive findings suggest that even ordinary tasks such as dressing and personal hygiene take longer, are more difficult, and require more mental thought for people with fibromyalgia.

But what about dementia? The 2016  study suggested that when faced with distractions, FM patients actually do have the problems “encoding” personal memories. When placed in quiet, distraction-free environments, however, they do just fine. The authors concluded that the cognitive problems in FM relate to problems with cognitive distraction, rather than an Alzheimer’s-like process. They hoped that their findings “allay the worries of many with fibromyalgia who fear that fibro-fog is the start of a dementing process.”

Distraction and Possibly Dementia

Not so fast, though. This year, an 165,000 person Taiwanese study, the Fibromyalgia and Risk of Dementia -A Nationwide, Population-based, Cohort study, concluded differently. The study followed 41,000 FM patients and 124,000 healthy controls over 50 years old for ten years.

After adjusting for confounding factors (gender, age, monthly income, urbanization level, geographic region, comorbidities) the study concluded that FM is indeed associated with a significantly increased risk (hazard ratio- 2.7 x’s) of dementia, and not just one type of dementia, either. All types of dementia were increased in FM patients as they aged with  Alzheimer’s (3.35-fold increase) and non-vascular dementia (3.14-fold increase) showing the highest increases. FM patients suffering with depression, epilepsy, Parkinson’s disease, stroke, TBI, or liver issues had a further increased risk of dementia. Interestingly, the rate of depression in the FM patients in this study was quite low.

(Hazard ratio is associated with an increased hazard of an event occurring. The 2.77 HR of FM means that FM patients over 50 were 2.77 times more likely to be diagnosed with dementia than the healthy controls).

It should be noted that this study does not suggest that dementia is imminent or even common in people over 60 who have fibromyalgia; the rate of dementia is simply increased.  Just over 4% of the FM patients developed dementia in the study – as opposed to the 1.2% of the healthy controls.

It’s not clear why dementia is increased in FM, but citing the role that inflammation may play in other dementia-prone diseases, the authors suggested that systemic and/or brain inflammation might be the culprit.

Neuroinflammation is certainly present in dementia but whether it’s causing it is unclear.  A 2013 review study, which reported that anti-inflammatory drug trials have not been effective in Alzheimer’s, discounted the idea that inflammation is a key player in the disease.

A more recent review, however, suggested that the very idea of what constitutes inflammation in Alzheimer’s needs to be re-assessed and that targeting different parts of the immune system may be helpful.  (A similar re-assessment regarding inflammation may be occurring in FM and chronic fatigue syndrome (ME/CFS)).

Stopping Dementia?

That more recent review suggests that if you’re worried about developing dementia, finding ways to reduce inflammation could help. A  UCLA study employing a multidimensional approach called metabolic enhancement for neurodegeneration (MEND) which involved reducing inflammation was able to reverse Alzheimer’s symptoms in all of the participants.

The idea was to “target multiple pathways simultaneously in order to effect an improvement in symptoms and pathophysiology.” The protocol involved low glycemic/carbohydrate/grain diets, short fasts, stress reduction (yoga), exercise, brain stimulation, and supplements to reduce inflammation, enhance cognition, improve mitochondrial functioning, improve sleep, etc.

The study was very small (n=10) and  bigger studies will be needed to validate the results, but they were astonishing for such a treatment resistant disease.  One man’s cognitive test score increased from 3rd percentile to 84th percentile (3 standard deviations).  Other participants scores increased from the 1st to the 50th percentile, from the 13th percentile to the 79th percentile,  and from the 24th to the 74th percentile. One person went from considerably below average to considerably above average in many of his cognitive tests. An expanded study is reportedly underway.

Cognitive Resources

 

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