Fibromyalgia syndrome and cognitive dysfunction in elderly: a case series.
OBJECTIVE
Fibromyalgia syndrome (FMS) is an extremely rare complication of neurocognitive disorders (NCDs). We experienced seven such cases, and we discuss their clinical manifestation and pathomechanisms.


METHODS
Seven patients with FMS as a complication of NCD were enrolled. We used the patients' medical records to identify clinical manifestations and obtain experimental data, such as pain questionnaire scores, cognitive tests, genetics and radiological imaging of the brain.


RESULTS
The seven patients were clinically diagnosed with frontotemporal NCD (n = 3) or Alzheimer's disease (n = 4). No patient presented with any organic disorder that would explain their chronic pain. Through their courses, they experienced refractory widespread pain continuously despite analgesics. Brain magnetic resonance imaging revealed moderate or severe atrophic changes in the temporal lobes and hippocampus. Three-dimensional stereotactic surface projection (3D-SSP) analysis of brain single photon emission computed tomography (SPECT), indicated severe hypoperfusion on the right side of the medial temporal lobe, both sides of the anterior corpus callosum, anterior cingulate gyrus, and primary sensory area. Genetic analysis uncovered no pathogenic mutations.


CONCLUSIONS
Neurodegenerative disorders are rarely complicated by FMS, which is associated with relatively severe pain. Central sensitization may be a possible risk factor of widespread pain in elderly patients with NCD.
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Kenya
K
Nishioka
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Tetsuo
T
Hayashi
Department of Radiology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Michimasa
M
Suzuki
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Yuanzhe
Y
Li
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Sachiko
S
Nakayama
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Takashi
T
Matsushima
Department of Psychiatry, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Chie
C
Usui
Department of Psychiatry, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Nobuto
N
Shibata
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Yumiko
Y
Motoi
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Ryota
R
Tanaka
Department of Rheumatology, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan.
Kusuki
K
Nishioka
Department of Neurology, Juntendo University School of Medicine, Tokyo Medical University, Tokyo, Japan.
Nobutaka
N
Hattori
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D000544:Alzheimer Disease / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D018888:Aphasia, Primary Progressive / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D059333:Central Nervous System Sensitization; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D057180:Frontotemporal Dementia / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D013577:Syndrome; D015899:Tomography, Emission-Computed, Single-Photon
Alzheimer's disease; fibromyalgia; frontotemporal neurocognitive disorders; single photon emission computed tomography