Depressive Symptoms Are Associated with Analgesic Use in People with Alzheimer’s Disease: Kuopio ALSOVA Study

Abstract

Neuropsychiatric symptoms of Alzheimer’s disease (AD) such as depression may be associated with pain, which according to the literature may be inadequately recognized and managed in this population. This study aimed to identify the factors associated with analgesic use in persons with AD; in particular, how AD severity, functional status, neuropsychiatric symptoms of AD, co-morbidities and somatic symptoms are associated with analgesic use. 236 community-dwelling persons with very mild or mild AD at baseline, and their caregivers, were interviewed over five years as part of the prospective ALSOVA study. Generalized Estimating Equations (GEEs) were used to estimate unadjusted and adjusted odds ratios (ORs) for the factors associated with analgesic use over a five year follow-up. The proportion of persons with AD using any analgesic was low (13.6%) at baseline and remained relatively constant during the follow-up (15.3% at Year 5). Over time, the most prevalent analgesic changed from non-steroidal anti-inflammatories (8.1% of persons with AD at Year 1) to acetaminophen (11.1% at Year 5). Depressive symptoms (measured by the Beck Depression Inventory, BDI) were independently associated with analgesic use, after effects of age, gender, education, AD severity, comorbidities and somatic symptoms were taken into account. For every one unit increase in BDI, the odds of analgesic use increased by 4% (OR = 1.04, 95% confidence interval CI = 1.02-1.07). Caregiver depressive symptoms were not statistically significantly associated with analgesic use of the person with AD. Depressive symptoms were significantly associated with analgesic use during the five year follow-up period. Possible explanations warranting investigation are that persons with AD may express depressive symptoms as painful somatic complaints, or untreated pain may cause depressive symptoms. Greater awareness of the association between depressive symptoms and analgesic use may lead to safer and more effective prescribing for these conditions.

Differences in analgesic use in community‐dwelling persons with and without Alzheimer's disease

“…Moreover, we observed a significant time-related trend in the use of analgesics between 2005 and 2011, as the odds of analgesic and opioid use multiplied by 234% and 378%, respectively, and odds of NSAID use decreased by 27%. Use of analgesics has been previously investigated among community-dwelling persons with unspecified dementia (L€ ovheim et al, 2008;Haasum et al, 2011;Jensen-Dahm et al, 2015) or small samples of persons with AD (Gallini et al, 2013;Gilmartin et al, 2015). In previous studies on persons with AD (Gallini et al, 2013;Gilmartin et al, 2015), prevalence of analgesic use has been markedly lower among persons with AD than in our study.…”

“…Use of analgesics has been previously investigated among community‐dwelling persons with unspecified dementia (Lövheim et al., ; Haasum et al., ; Jensen‐Dahm et al., ) or small samples of persons with AD (Gallini et al., ; Gilmartin et al., ). In previous studies on persons with AD (Gallini et al., ; Gilmartin et al., ), prevalence of analgesic use has been markedly lower among persons with AD than in our study. This is likely due to differences in study design as both studies were interview‐based utilizing point prevalence definition of analgesic use.…”

“…Alongside personal suffering, pain in persons with AD is also associated with difficult behavioural and psychological symptoms of dementia (BPSD), e.g. depression and agitation (van Dalen-Kok et al, 2015;Gilmartin et al, 2015;Sampson et al, 2015), which in turn are often treated with antipsychotics with a questionable riskbenefit ratio (Balfour and O'Rourke, 2003;Wang et al, 2015).…”

Factors associated with antidepressant use in residents with and without dementia in Australian aged care facilities

“…This may be partly because of difficulties in identifying pain and differentiating it from depressive symptoms in persons with dementia [Gilmartin et al 2015]. Antidepressant use may have alleviated these depressive symptoms.…”

“…Investigating antidepressant use in residents with dementia is particularly important because depressive symptoms are common neuropsychiatric symptoms of dementia [Gao et al 2013]. Pain and depressive symptoms are closely connected to each other [Gilmartin et al 2015]. Studying the association between pain and antidepressant use is important given the high prevalence of pain in residents with and without dementia [Tan et al 2015a].…”