Some directions for future research

Okay, some directions for future research here. We are interested in looking at how fibromyalgia patients perform when they are distracted. We call this “dividing attention” where they have to do two things at once. And we think given their more apparent limited working memory capacity that they may have particular problems with tasks that require them to switch back and forth, or that require them to perform multiple tasks at the same time. We also think that they may not, like older adults, they may remember the gist or the target information that they’ve learned but they are going to have a lot of trouble remembering the context in which they learned the information.

In other words, they will remember that something is true but they won’t remember where they read it or who they heard it from. We call that “source memory”. Finally, we are very very interested in doing some functional neuro-imaging of these patients. In functional neuro-imaging you have patients in an MRI scanner and you collect data from the patients performing cognitive tasks while they are in the scanner and you get images of their brain and what parts of the brain are activated by measuring cerebral blood flow and compare that to baseline tests that are less cognitively demanding. And here’s an interesting pattern of results that I’d like to propose might be typical of FM patients. If you look at the superior cortex – this is a superior view – you can see that there is a lot of cortical activation on both the left and the right sides of the older adults on a verbal working memory test. But for the younger adults, the activation is primarily left frontal. There is much more left activation in the young adults and it’s bilateral in the older adults. Here you can see a lot of left activation in the young adults and a lot of left activation in the old adults. Here there is almost no activation in the right cortex in the young adults but there is a great deal of right frontal activation in the older adults.

But here’s the point. Older adults are recruiting more cortex bilaterally to perform tasks than young adults are. And the young adults are using primarily left cortex. And it’s occurred to us that we may find that the FM patients who are reporting these cognitive impairments, when they are placed in a MRI scanner, may actually recruit different areas of the brain or more brain tissue to perform the same tasks as their age-matched controls and look like old adults neuro-biologically. Or alternatively, they perform very much like young adults neuro-biologically and their poor performance may be attributed to other reasons. So these are interesting and exciting questions and I think we are on the verge of being able to get a window into not only the nature of the memory problems but also possibly some of the underpinnings of what causes the cognitive problems that fibromyalgia patients report.

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