Dyscognition refers to the complaint that a person's ability to perform thinking tasks is impaired. This complaint is colloquially known as “brain fog”. It is a major symptom of a variety of disorders and associated with considerable work and social disability for those experiencing it. However, attempts to demonstrate objective cognitive impairment in persons reporting “brain fog” have not been straightforward. In this lecture, the symptom of cognitive dysfunction will be described from the patient's point of view, using fibromyalgia as a disease model. The cognitive tests used to determine objective alterations in cognitive ability will be reviewed, the amount of objective impairment demonstrated in fibromyalgia will be placed into clinical context, and the “disconnect” between what the experience of dyscognition is and the cognitive content measured by modern testing will be discussed. The poor relationship between the magnitude of subjective dyscognition and objective cognitive performance will be examined, including evidence gleaned from neurological imaging studies. In conclusion, the experience of cognitive fog is not well captured by current testing paradigms. Subjective complaint is a poor predictor of objective cognitive performance. The neuronal mechanisms responsible for the experience of cognitive fog may be separate from those required to perform cognitive tasks.
Disclosure of Interest None declared
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