Decoding the cognitive profile of fibromyalgia: interactions among psychiatric symptoms, personality traits, and quality of life

Abstract Background In addition to persistent widespread pain, fibromyalgia (FM) is accompanied by fatigue and by affective and cognitive disturbances that reduce health-related quality of life (QoL). This study assessed the psychiatric and cognitive burden of FM, compared patients with and without MoCA-defined cognitive impairment, and examined the demographic, clinical and personality variables associated with these outcomes. Methods Ninety adults were enrolled at Assiut University Hospital in a cross-sectional case–control design: 45 patients satisfying the 2016 revised American College of Rheumatology criteria and 45 controls matched individually for age and sex. Every participant underwent a structured psychiatric interview supplemented by the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Symptom Checklist-90-Revised (SCL-90-R) and the Suicide Probability Scale (SPS). Cognition was indexed by the Montreal Cognitive Assessment (MoCA) and the Wechsler Adult Intelligence Scale, third edition (WAIS-III), personality by the Five-Factor Model, and QoL by the Short Form-36 Health Survey (SF-36). Patients were then classified into two subgroups using a prospectively defined threshold on the education-adjusted MoCA total score (< 26 = MoCA-defined cognitive impairment). Results Compared with controls, patients scored higher on depression, anxiety, somatisation and suicidal probability, lower on both cognitive measures, and worse on every SF-36 domain. Within the patient group, those with MoCA-defined cognitive impairment had longer illness duration and higher symptom severity and psychopathology scores. Neuroticism was positively associated with psychiatric distress, whereas extraversion and conscientiousness were inversely associated with it. In exploratory multivariable models, more severe bodily pain and lower conscientiousness were independently associated with depressive severity; poorer physical functioning and higher neuroticism with anxiety; greater depressive severity and higher interpersonal sensitivity with suicidal probability; and greater depressive severity and lower openness to experience with poorer MoCA performance. Conclusions These cross-sectional data are consistent with FM as an integrated neuropsychiatric condition in which affective distress, cognitive performance and personality structure are jointly associated with functional outcome.