Computerized Cognitive Testing in Patients Suffering From Fibromyalgia

October 9, 2013 updated by: Tel-Aviv Sourasky Medical Center

Fibromyalgia Syndrome (FMS) is a highly prevalent condition, often affecting individuals at the prime of life, causing severe reduction of quality of life and productivity, as well as social isolation, anxiety and depression.

FMS is a condition characterized by chronic widespread pain, considered to be a manifestation of central nervous system sensitization, leading to increased processing and transmission of pain. At the same time however, it has become gradually more evident, that FMS is not merely a pain syndrome. Those patients who suffer from the full-blown clinical syndrome of FMS inevitably describe many additional symptoms beside pain. While some of these symptoms, such as heightened sensitivity to external stimulations (e.g. noise and light), can easily be understood as representing aspects of the basic underlying propensity towards central sensitization, other symptoms are not so easily explained in this context.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Unknown

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Detailed Description

While cognitive impairment has long been recognized as a part of the fibromyalgia syndrome, as extensively reviewed by Glass, early research on the pathophysiology and clinical manifestations of this aspect were relatively limited, particularly in the field of imaging. Nonetheless, physicians dealing with FMS patients are well aware of the fact, that in the real-life situation, cognitive impairment can often be more devastating for the functional status of a patient than pain. Not infrequently, a patient may relate that he or she has grown accustomed to pain and knows how to manage it, but finds it impossible to continue working or studying because of severe difficulties with memory and concentration. Research has shown that so called "fibro-fog", a popular term referring to FMS - related dyscognition, is ranked by patients as one the most important complaints.

Memory impairment appears to constitute an important aspect of the dysfunction typical of FMS. Characteristic disturbances have been demonstrated in FMS in various memory types, including semantic memory - the ability to recollect facts and general information and episodic memory - the ability to recall past events. Attention disturbances have been demonstrated in FMS as well, such as in working memory - the ability to temporarily hold and process information in mind, Distraction from target and Selective attention.

The pathophysiology of cognitive impairment in FMS remains incompletely understood. Various modulators have been suggested, including sleep disturbances, mood disorders, medications and the salient symptom of FMS - chronic pain. While cognitive impairment remains after controlling for anxiety and depression or sleep disturbances, the levels of pain are consistently correlated with the severity of cognitive dysfunction in FMS. Notably, despite the clinical significance of cognitive impairment in FMS, and despite the above - mentioned evidence regarding the various aspects of memory impairment in this condition, the neuroscience underpinnings of these deficits have not been clearly elucidated; Moreover, neuroimaging studies demonstrating the interaction between pain and cognitive areas are strikingly few; One such study has recently demonstrated altered activations in the fronto-parietal network in FMS patients, while performing the N-back task - a frequently used working memory task.

While the new American College of Rheumatology criteria for the diagnosis of FMS have incorporated cognitive impairment into the diagnostic scheme, as well as establishing a scale of symptom severity, the interplay between cognitive impairment and the other symptoms is not clearly understood. Thus, there is no clear data regarding the degree to which cognitive impairment is correlated with symptoms such as pain, fatigue, abdominal discomfort etc in individual patients and to what extent a longitudinal relationship is maintained between these parameters (i.e. to what extent an improvement or worsening of one symptom is correlated with others). From a practical, clinical view point, assessing the degree of cognitive impairment in FMS is extremely difficult and currently is usually left (at best) to the subjective report of the patients. This difficulty is compounded both by the fact that cognition is but one of a broad array of symptom realms in FMS and by the fact that clinicians dealing with FMS patients, e.g. rheumatologists, are not regularly involved in the implementation of cognitive assessment. Thus, there is a clear need for obtaining reliable and reproducible tools for the assessment of cognitive impairment in FMS. Such tools could be utilized as an objective biomarker for evaluation the clinical course and response to treatment as well as a tool for evaluating the interplay between cognitive impairment and other domains of the fibromyalgia syndrome.

The purpose of the proposed study is to utilize a validated fully computerized cognitive assessment battery (Mindstreams; NeuroTrax Corp.) for assessing the correlation between cognitive impairments and clinical, self-reported, severity parameters in fibromyalgia syndrome. We aim to explore the relationship, if any, between reported subjective parameters, such as levels of pain, stress, depression and extent of adopting the 'sick-role' of patients with FMS, with indices of cognitive impairments. We hypothesize that the severity of subjective stress, rather than medical/clinical parameters of the syndrome, will be correlated positively with cognitive impairments.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Anticipated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
50

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Jacob Ablin, MD
  • Phone Number: 972-36973668

Study Locations

  • Israel
      • Tel Aviv, Israel
        • Jacob Ablin

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

50 Fibromyalgia patients will be recruited at the specialized fibromyalgia clinic which is part of the rheumatology institute of the Tel Aviv Sourasky Medical center. All patients will be asked to give written informed consent and the study will be submitted for approval of the institutional Helsinki committee.

The proposed number of participants (50) was chosen in order to assure sufficient statistical power of the study, based on a multi-component regression analysis as described under statistical methods.

Description

Inclusion Criteria:

  • Diagnosis of fibromyalgia using the 2011 revised American College of Rheumatology (ACR) criteria 27.

Exclusion Criteria:

  • Other physiological or psychiatric condition which might explain cognitive impairment, stress, fatigue or depression.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Correlation between cognitive parameters and the clinical domains of FMS (e.g. pain, fatigue etc,).
Time Frame: 1 year
Computerized results of Mindstream cognitive testing.
1 year

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Time Frame
Correlation between subjective components (e.g. effort level, fatigue, total Symptom Severity Score (SSS) etc to observed cognitive ability.
Time Frame: 1 year
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Tel-Aviv Sourasky Medical Center

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Jacob Ablin, MD, Tel-Aviv Sourasky Medical Center

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
December 1, 2013

Primary Completion (Anticipated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2014

Study Completion (Anticipated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
April 1, 2015

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 10, 2013

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 9, 2013

First Posted (Estimate)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 10, 2013

Study Record Updates

Last Update Posted (Estimate)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 10, 2013

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 9, 2013

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2013

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 0101-13-TLV

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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