Chronic Pain in “Probable” Vascular Dementia: Preliminary Findings

Scherder, E.J.A.; Plooij, Bart; Achterberg, Wilco P.; Pieper, Marjoleine J.C.; Wiegersma, Marije; Lobbezoo, Frank; Oosterman, Joukje M.

doi:10.1111/pme.12637

Cited by 22 publications

(13 citation statements)

References 46 publications

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“…This is the first study to relate the severity of WMH to self-reported pain intensity in patients with dementia and without dementia, limiting comparisons between studies. However, our results are in line with earlier studies of older nursing home patients with “possible” or “probable” vascular dementia who found that nursing home residents with VaD have a higher self-reported pain intensity than nursing home residents without dementia 12,13. Indeed, a similar study reported that older cognitively impaired nursing home patients with a potentially painful condition had a higher chance of reporting pain when they also suffer from diabetes or hypertension, both known risk factors for WMH.…”

Section: Discussionsupporting

confidence: 92%

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<p>White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings</p>

Binnekade¹,

Pérez

Maier

et al. 2019

JPR

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Background: The association between pain and dementia is complicated and may depend on underlying brain pathology. It was hypothesized that both medial temporal atrophy (MTA) and global cortical atrophy (GCA) predicted no/mild pain, while white matter hyperintensities (WMH) predicted moderate/severe pain. Objectives: To study the association between pain intensity and measures of brain pathology, more specifically MTA, GCA, and WMH. Methods: In total, 115 consecutive patients visiting an outpatient memory clinic were included. In total, diagnoses included dementia (N=70), mild cognitive impairment (N=30), and subjective cognitive impairment (N=15). Without administering stimuli, pain intensity was assessed with the Brief Pain Inventory. MTA, GCA, and WMH were measured with a MRI visual rating scale. Logistic regression analyses to examine the relationship between WMH, MTA, GCA, and self-reported pain intensity (no/mild pain versus moderate/severe pain) were adjusted for confounders. Results: Mean age of the patients was 81 years (IQR: 78–85, 53% female). Moderate/severe pain was reported by 23.5% and associated with greater WMH (OR =3.34, 95% CI =1.01–10.97, p =0.047), but not MTA or GCA. Conclusions: In contrast to the present results, earlier studies have reported either a positive or negative relationship between pain and brain volume. It is suggested that the presence of dementia may explain the absence of a relationship between pain and brain volume. WMH is positively related with pain in an older memory outpatient population. Considering the small sample size, our findings should be interpreted with caution. Hence, our conclusions are preliminary findings, warranting future replication.

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Section: Discussionsupporting

confidence: 92%

“…Patients with AD report a lower chronic pain intensity than individuals without dementia 8–11. Patients with VaD report a higher pain intensity than individuals without dementia 12,13. A loss of awareness of pain has been reported by carers of patients with frontotemporal dementia (FTD).…”

Section: Introductionmentioning

confidence: 99%

<p>White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings</p>

Binnekade¹,

Pérez

Maier

et al. 2019

JPR

Self Cite

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“…An important issue that has barely been examined to date concerns the effect of dementia pathology on patients' responses to pain. For example, whereas patients with vascular dementia have been shown to report more pain compared to cognitively intact elderly controls [72,73], those two studies on patients with (frontal variant of) FTD suggest a decrease in pain in these patients, as was demonstrated by proxies' evaluations of patients' pain experience [74] as well as by a study showing increased pain threshold and tolerance levels in these patients [75]. Results in AD are more mixed, however, with some studies pointing to an increased pain reactivity [76] in these patients.…”

Section: The Impact Of Dementia Subtypementioning

confidence: 99%

The Use of Facial Expressions for Pain Assessment Purposes in Dementia: A Narrative Review

Oosterman

Zwakhalen

Sampson

et al. 2016

Neurodegener. Dis. Manag.

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Facial expressions convey reliable nonverbal signals about pain and thus are very useful for assessing pain in patients with limited communicative ability, such as patients with dementia. In this review, we present an overview of the available pain observation tools and how they make use of facial expressions. Utility and reliability of facial expressions to measure pain in dementia are discussed, together with the effect of dementia severity on these facial expressions. Next, we present how behavioral alterations may overlap with facial expressions of pain, and may even influence the extent to which pain is facially expressed. The main focus is on disinhibition, apathy and emotional changes. Finally, an overview of theoretical considerations and practical implications is presented for assessing pain using facial expressions in clinical settings.

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“…Specific mental health conditions (e.g., depression, anxiety) and chronic sleep impairment have also been shown to predict subsequent cognitive decline and conversion to ADRD [13][14][15][16]. In addition, there is growing evidence from observational and experimental research that chronic pain, an increasingly common and highly burdensome condition, may also contribute to elevated risk for neurocognitive impairment and development of ADRD [17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer’s Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001–2013

Khalid

Sambamoorthi

Innes

2020

IJERPH

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Accumulating evidence suggests that certain chronic pain conditions may increase risk for incident Alzheimer’s disease and related dementias (ADRD). Rigorous longitudinal research remains relatively sparse, and the relation of overall chronic pain condition burden to ADRD risk remains little studied, as has the potential mediating role of sleep and mood disorders. In this retrospective cohort study, we investigated the association of common non-cancer chronic pain conditions (NCPC) at baseline to subsequent risk for incident ADRD, and assessed the potential mediating effects of mood and sleep disorders, using baseline and 2-year follow-up data using 11 pooled cohorts (2001–2013) drawn from the U.S. Medicare Current Beneficiaries Survey (MCBS). The study sample comprised 16,934 community-dwelling adults aged ≥65 and ADRD-free at baseline. NCPC included: headache, osteoarthritis, joint pain, back or neck pain, and neuropathic pain, ascertained using claims data; incident ADRD (N = 1149) was identified using claims and survey data. NCPC at baseline remained associated with incident ADRD after adjustment for sociodemographics, lifestyle characteristics, medical history, medications, and other factors (adjusted odds ratio (AOR) for any vs. no NCPC = 1.21, 95% confidence interval (CI) = 1.04–1.40; p = 0.003); the strength and magnitude of this association rose significantly with increasing number of diagnosed NCPCs (AOR for 4+ vs. 0 conditions = 1.91, CI = 1.31–2.80, p-trend < 0.00001). Inclusion of sleep disorders and/or depression/anxiety modestly reduced these risk estimates. Sensitivity analyses yielded similar findings. NCPC was significantly and positively associated with incident ADRD; this association may be partially mediated by mood and sleep disorders. Additional prospective studies with longer-term follow-up are warranted to confirm and extend our findings.

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Chronic Pain in “Probable” Vascular Dementia: Preliminary Findings

Abstract: As VaD patients may experience greater pain than controls, it is essential for prescribers to be aware of the presence of this neuropathology if these patients are to receive adequate treatment.

Cited by 22 publications

References 46 publications

<p>White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings</p>

<p>White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings</p>

The Use of Facial Expressions for Pain Assessment Purposes in Dementia: A Narrative Review

Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer’s Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001–2013

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