Characterizing Neurocognitive Impairment in Juvenile Fibromyalgia Syndrome: Subjective and Objective Measures of Dyscognition

Sabrina Gmuca; Maitry Sonagra; Rui Xiao; Elizabeth Mendoza; Kimberly S Miller; Nina H Thomas; Jami F Young; Pamela F Weiss; David D Sherry; Jeffrey S Gerber

doi:10.3389/fped.2022.848009

Characterizing Neurocognitive Impairment in Juvenile Fibromyalgia Syndrome: Subjective and Objective Measures of Dyscognition

Front Pediatr. 2022 Feb 24:10:848009. doi: 10.3389/fped.2022.848009. eCollection 2022.

Authors

Sabrina Gmuca^{1

2

3

4}, Maitry Sonagra^{1

2

3

5}, Rui Xiao^{2

6}, Elizabeth Mendoza^{1

7}, Kimberly S Miller^{1

4}, Nina H Thomas^{4

8

9}, Jami F Young^{3

4

9}, Pamela F Weiss^{1

2

4}, David D Sherry^{1

4}, Jeffrey S Gerber^{2

4

10}

Affiliations

¹ Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
² Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
³ PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
⁴ Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
⁵ Seattle Children's Hospital, University of Washington, Seattle, WA, United States.
⁶ Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States.
⁷ Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
⁸ Center for Human Phenomic Science Behavioral Neuroscience Core, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
⁹ Department of Child and Adolescent Psychiatry and Behavioral Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
¹⁰ Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States.

Abstract

Objectives: Our understanding of brain fog, or dyscognition, among youth with juvenile fibromyalgia syndrome is limited. We aimed to determine the prevalence of subjective (self-reported) and objective dyscognition, as well as factors associated with subjective dyscognition in juvenile fibromyalgia syndrome.

Methods: A cross-sectional cohort study of patients (n = 31) 12-17 years old diagnosed with primary juvenile fibromyalgia syndrome and one of their parents from 2017 to 2019. Subjects completed a series of survey measures and patients completed a brief neurocognitive battery. Subjective dyscognition was determined based on scores on the Pediatric Quality of Life Inventory (PedsQL) Cognitive Functioning Scale and Behavior Rating Inventory of Executive Function (BRIEF-2) global executive composite (GEC). Objective dyscognition was defined as impairment of more than two standard deviations in any of the neurocognitive domains. We used Fisher's exact test or Wilcoxon rank-sum test, as appropriate, to compare clinical patients based on the presence of dyscognition. Multivariable logistic regression modeling was performed to determine factors associated with subjective dyscognition.

Results: Of the 31 subjects, 65% reported subjective dyscognition and 39% had objective dyscognition, primarily in the domains of psychomotor speed (23%), executive function (23%), and attention (3%). Subjective dyscognition was not indicative of objective dyscognition. Subjective dyscognition was independently associated with functional disability (OR: 1.19 [95% CI: 1.02-1.40]) and anxiety (OR: 1.12 [95% CI: 1.02-1.24]).

Discussion: Adolescents with fibromyalgia predominantly experience subjective dyscognition but more than 1/3 also experience objective dyscognition. Future research should explore the impact of interdisciplinary rehabilitation programs on the treatment of dyscognition in youth with JFMS.

Keywords: dyscognition; juvenile fibromyalgia syndrome; musculoskeletal pain and adolescents; pediatric chronic pain; pediatrics.