Sex Differences in Associations of Cognitive Function with Perceptions of Pain in Older Adults

Abstract

Background: Sex differences in pain have been shown to exist in older adults with normal cognition and people with Alzheimer’s disease. It is unknown if sex differences in pain in older adults exist in a range of communicative older adults with varying cognitive ability from no impairment to moderately severe cognitive impairment. Objective: This study proposes to compare the association between psychophysical responses to experimental thermal pain between males and females to determine if sex differences in pain exist across the cognitive spectrum. Methods: We conducted a secondary analysis of data from an age- and sex-matched between-groups cross-sectional study examining the psychophysical response to contact heat in people with and without dementia. Results: Median age of males ( n = 38) and females ( n = 38) was 73 (range: 68–87) with similar distributions of Mini-Mental State Examination (MMSE) scores (range: 11–30). Findings revealed inverse statistically significant associations with the threshold temperature of warmth (females: r = –0.41, p = 0.010; males: r = –0.33, p = 0.044). There was an apparent divergent pattern of MMSE associations with unpleasantness ratings between the groups. At the moderate pain threshold, that difference became statistically significant ( p = 0.033). Females demonstrated a positive association of MMSE with unpleasantness ( r = 0.30, p = 0.072), while males demonstrated an inverse association at that respective threshold ( r = –0.20, p = 0.221). Conclusions: Between-group findings suggest that patterns of responses to thermal stimulus intensity may differ between males and females with worsening cognition with females reporting significantly less unpleasantness with the percept of moderate pain and males reporting significantly higher unpleasantness with moderate pain perception.

Cognitive Functioning, Life Satisfaction, and Their Relationship with the Financial Attitudes of Older Individuals Who Participate in an Active Aging Program

“…Our data revealed gender differences in the MMSE, with higher means for men. These data are consistent with previous studies on older people without severe cognitive impairment [ 55 , 56 ]. However, women tend to perform less well than men in cognitive functioning at the onset of aging but then stabilize [ 55 ].…”

Chronic Pain in the Elderly: Mechanisms and Perspectives

“…Strikingly, the same study demonstrated that older males had an increased pain tolerance when compared with older females ( Gallant and Hadjistavropoulos, 2017 ). The sex differences relating to pain perception in older persons have also demonstrated by Romano et al (2019) . The authors reported that females have significantly less unpleasantness with moderate pain perception (contact to heat), when compared with males.…”

Treating the most vulnerable: A discursive review of experimental pain in Alzheimer’s disease

“…In the third study, the authors aimed to examine sex differences in response to psychophysical assessment across the cognitive spectrum, including both cognitively intact controls and participants with MCI and AD in each group (Romano et al., 2019 ). The authors excluded participants with MMSE scores below 10 to account for the potential confound of adults with more severe AD since the parent study included communicative adults with AD who scored less than 10 on the MMSE.…”

“…Three studies offer significant insight into different aspects of pain perception in AD (Cowan et al., 2017 ; Monroe et al., 2016 ; Romano et al., 2019 ). The first study, Monroe et al., 2016 , is the parent study from which two additional sub‐analyses were conducted.…”