Characteristics and Mechanisms of Cognitive Problems in Fibromyalgia

纤维肌痛认知问题的特点和机制

• 批准号: 9262055
• 负责人: Anna Louise Kratz
• 金额: $ 13.1万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9262055
• 关键词: Address; Adult; Affect; Age; Anxiety; Area; Arthritis; Assessment tool; Attention; Automobile Driving; Award; Behavioral; Brain; Brain region; Characteristics; Chronic; Chronic Disease; Clinical; Clinical Research; Clinical Trials; Cognition; Cognitive; Complement; Complex; Confusion; Control Groups; Data Analyses; Depressed mood; Development; Diagnosis; Distress; Doctor of Philosophy; Etiology; Evaluation; Fatigue; Fibromyalgia; Functional Magnetic Resonance Imaging; Future; Goals; Gold; Health; Heart; Image; Image Analysis; Imaging technology; Impaired cognition; Individual; Intervention; K-Series Research Career Programs; Knowledge; Life; Link; Measurement; Measures; Medical; Memory; Mental Depression; Mentors; Mentorship; Methods; Michigan; Multiple Sclerosis; Musculoskeletal Diseases; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Nature; Neurobiology; Neurocognitive; Neurologic; Neurologic Process; Neuropsychological Tests; Neuropsychology; Outcome; Outcome Measure; Pain; Patient Self-Report; Patients; Performance; Phenotype; Prevalence; Principal Investigator; Problem Sets; Process; Productivity; Psyche structure; Psychologist; Psychometrics; Quality of life; Recording of previous events; Reporting; Research; Research Methodology; Research Personnel; Resources; Rheumatism; Robin bird; Sampling; Scholarship; Scientific Advances and Accomplishments; Scientist; Severities; Sleep Disorders; Sleep disturbances; Structure; Symptoms; Techniques; Technology Assessment; Testing; Training; Training and Education; United States; United States National Institutes of Health; Universities; Validation; Validity and Reliability; Work; base; brain morphology; career; chronic pain; clinical application; clinical care; clinical diagnostics; clinical practice; cognitive function; cognitive task; cognitive testing; collaborative environment; common symptom; disabling symptom; experience; fibromyalgia pain; health related quality of life; improved; insight; neurobiological mechanism; neuroimaging; performance tests; programs; psychologic; public health relevance; response; sex; skills; study characteristics; theories; tool

Fibromyalgia (FM) is an idiopathic chronic musculoskeletal pain disorder affecting approximately 5 million adults in the United States.1-4 Though pain is typically considered the cardinal symptom of FM, most people experience a constellation of symptoms, including fatigue, sleep disturbances, depression, anxiety, morning stiffness, and cognitive problems.4-8 The latter, cognitive problems, are reported by approximately 70% of those with FM, and are rated as one of the most troubling FM symptoms.4,7-9 However, cognitive problems are rarely addressed by clinicians and are critically understudied. Commonly called "fibrofog," this dyscognition has been described by patients as problems with concentration, memory, confusion, and speaking.4,6,8,10 Anecdotally, fibrofog is linked to devastating effects on quality of life and functioning; contributing to difficulties maintaining relationships, working, communicating, driving, organizing, planning, and initiating activities of daily life.6,8 Distressingly little is known about the nature of fibrofog, despite its acknowledged prevalence and impact. Because the research that has examined difficulty on cognitive tests in FM is limited in scope and rigor, there are ongoing questions as to whether fibrofog is just a problem with attention and memory, or whether other areas of cognition are affected. Previous studies have also not adequately assessed or controlled for the effects of coexisting symptoms or compared FM to other clinical groups, such as depressed individuals; therefore, it is not known whether fibrofog is a manifestation of other FM symptoms (e.g. depression, fatigue) or a unique set of problems. Because there has been very limited neuroimaging research in FM, there is a lack of understanding of the neurological processes that might be contributing to fibrofog. Finally, there have been no efforts to examine the validity and utility of existing cognitive assessment tools in FM; so, researchers and clinicians have no direction as to which tools to use to assess fibrofog severity. The overarching goal of this proposal is to provide education and training to the Principal Investigator (PI), Anna Kratz, PhD, so that she has the requisite knowledge and skills to address these limitations in the scientific evidence on fibrofog. Dr. Kratz is a clinical psychologist whose research has focused on chronic pain in medical conditions such as arthritis, fibromyalgia, and multiple sclerosis. The proposed training plan will allow her to extend her knowledge from chronic pain into the areas of cognitive dysfunction, neuroimaging, and outcomes measurement. The PI has demonstrated commitment to a career in clinical health research, and a history of scholarship and research productivity. The University of Michigan provides her with a supportive, stimulating, and collaborative environment that offers an abundance of resources and support for early career scientists and clinical research. A diverse and accomplished mentoring team has been assembled to guide the PI toward expertise in cognitive dysfunction in FM, neurocognitive and self-report assessment technologies, and functional magnetic resonance imaging. Dr. Kratz's short-term career goals are to gain expertise in the nature of fibrofog, neurobiological functioning, neuroimaging, and evaluating and developing contemporary measures of fibrofog. These short-term goals will support her progression toward her long-term plan to develop an independent research program that makes significant contributions to the understanding and treatment of cognitive problems in other medical conditions where "dyscognition" is present but not the central focus of the condition. Ultimately, the skills that she acquires through the proposed training and research may be used to identify mechanisms of cognitive dysfunction that are common across medical diagnoses. The scientific objectives of this application are to methodically describe the phenotypic nature of fibrofog, examine the neurobiological processes underlying these cognitive problems, and test the utility of cognitive measures in fibrofog. First, to characterize the major areas of cognitive problems in fibrofog, a comprehensive set of contemporary (NIH Toolbox of Neurological and Behavioral Function) and "gold standard" neuropsychological tests will be administered to a sample of individuals with FM and an age- and sex-matched depressed control group. Second, functional magnetic resonance imaging will be conducted on individuals with FM and depressed controls while they are completing cognitive tasks. This will examine the dynamic connectivity of relevant brain regions that might provide insight about neurobiological mechanisms underlying fibrofog. Comparisons to depressed controls in terms of neuropsychological test performance and neurobiological functioning will provide insight about how fibrofog may be distinct from depression-related cognitive problems. Third, newly-developed and traditional measures of cognitive dysfunction will be submitted to psychometric analyses to determine their validity, reliability, and utility in detecting fibrofog. The ultimate aim of this study is to improve the clinical care of individuals with fibrofog through the advancement of our understanding and assessment of this troubling set of symptoms. This award will enable Dr. Kratz to acquire the expertise and skills necessary to become an independent researcher capable of achieving the overall goal of elucidating the scope and mechanisms of cognitive dysfunction in FM.

纤维肌痛（FM）是一种特发性慢性肌肉骨骼疼痛障碍，影响约5 1-4虽然疼痛通常被认为是FM的基本症状，但大多数是 人们经历了一系列症状，包括疲劳，睡眠障碍，抑郁，焦虑， 早晨的僵硬和认知问题。4-8后者，认知问题，大约报告了 有70％的FM患者被评为最令人不安的FM症状之一。但是，认知能力为4,7-9 临床医生很少解决问题，并且严重研究了问题。通常称为“ Fibrofog”，这个 患者将失调症描述为浓度，记忆，混乱和 说话。4,6,8,10诱惑，Fibrofog与对生活质量和功能的毁灭性影响有关； 有助于维持关系，工作，沟通，驾驶，组织，计划和 开始日常生活的活动。6,8令人沮丧的是，纤维杆的性质知之甚少，尽管 公认的流行和影响。因为研究了认知测试难度的研究 在FM中，范围和严格的范围有限，关于纤维旋转是否只是一个问题的问题 注意力和记忆，或其他认知领域是否受到影响。以前的研究也没有 对共存症状的影响或对其他临床进行了充分评估或控制 群体，例如沮丧的人；因此，尚不知道纤维杆是否是其他的表现 FM症状（例如抑郁症，疲劳）或一组独特的问题。因为有非常有限的 在FM中的神经影像学研究，缺乏对可能是神经系统过程的了解 有助于纤维杆。最后，没有努力研究现有的有效性和效用 FM中的认知评估工具；因此，研究人员和临床医生没有方向用于使用哪种工具 评估纤维杆严重程度。 该提案的总体目标是向校长提供教育和培训 调查员（PI），Anna Kratz，PhD，因此她有必要的知识和技能来解决这些知识和技能 纤维杆科学证据的局限性。 Kratz博士是一名临床心理学家，其研究重点是 在关节炎，纤维肌痛和多发性硬化症等医疗状况下的慢性疼痛上。提议 培训计划将使她能够将自己的知识从慢性疼痛扩展到认知功能障碍的领域， 神经影像学和结果测量。 PI表现出对临床职业的承诺 健康研究以及奖学金和研究生产力的历史。密歇根大学提供 她的支持，刺激和协作的环境提供了丰富的资源和 支持早期职业科学家和临床研究。一个多元化且成就卓著的团队已经 组装以指导PI在FM，神经认知和自我报告的认知功能障碍方面的专业知识 评估技术和功能磁共振成像。克拉茨博士的短期职业目标是 在纤维杆菌的性质，神经生物学功能，神经影像学和评估和评估和评估方面获得专业知识 制定纤维杆的当代措施。这些短期目标将支持她向她发展 长期计划制定独立研究计划，为 在存在“失调”的其他医疗状况下了解和治疗认知问题 但不是病情的主要重点。最终，她通过拟议的培训获得的技能 研究可用于识别医学中常见的认知功能障碍的机制 诊断。 该应用的科学目标是有条不紊地描述的表型性质 纤维杆菌，检查这些认知问题的基础神经生物学过程，并测试 纤维杆菌中的认知度量。首先，要表征纤维杆菌中认知问题的主要领域，一个 全面的当代（NIH神经和行为功能的NIH工具箱）和“黄金 标准的“神经心理学测试将对有FM和年龄和年龄和年龄和年龄的个体样本进行管理 性匹配的抑郁对照组。其次，将在功能性磁共振成像上进行 具有FM和沮丧控制的人完成认知任务。这将检查 相关大脑区域的动态连通性，可能提供有关神经生物学机制的见解 基础纤维杆。根据神经心理学测试表现与沮丧控制的比较 神经生物学功能将提供有关纤维杆如何与抑郁有关的洞察力的见解 认知问题。第三，将提交新发达和传统的认知功能障碍措施 进行心理测量分析，以确定其在检测纤维杆菌中的有效性，可靠性和效用。最终目标 这项研究是通过提高我们 理解和评估这套令人不安的症状。该奖项将使Kratz博士获得 成为能够实现总体目标的独立研究人员所必需的专业知识和技能 阐明FM中认知功能障碍的范围和机制。