The Temporal Relationship between Pain Intensity and Pain Interference and Incident Dementia

Abstract

Background: Chronic pain is common among older adults and is associated with cognitive dysfunction based on cross-sectional studies. However, the longitudinal association between chronic pain and incident dementia in community-based samples is unknown. Objective: We aimed to evaluate the association of pain intensity and pain interference with incident dementia in a community-based sample of older adults. Methods: Participants were 1,114 individuals 70 years of age or older from Einstein Aging Study (EAS), a longitudinal cohort study of community-dwelling older adults in the Bronx County, NY. The primary outcome measure was incident dementia, diagnosed using DSM-IV criteria. Pain intensity and interference in the month prior to first annual visit were measured using items from the SF-36 questionnaire. Pain intensity and pain interference were assessed as predictors of time to incident dementia using Cox proportionate hazards models while controlling for potential confounders. Results: Among participants, 114 individuals developed dementia over an average 4.4 years (SD=3.1) of follow-up. Models showed that pain intensity had no significant effect on time to developing dementia, whereas higher levels of pain interference were associated with a higher risk of dementia. In the model that included both pain intensity and interference as predictors of incident dementia, pain interference had a significant effect on incident dementia, and pain intensity remained non-significant. Conclusion: As a potential remediable risk factor, the mechanisms linking pain interference to cognitive decline merit further exploration.

Resting-State Magnetoencephalography Reveals Neurobiological Bridges Between Pain and Cognitive Impairment

“…T, t value; P, P value; X, X-coordinate; Y, Y-coordinate; Z, Z-coordinate. Pain-VAS, subjective level of pain measured by VAS These two conditions (pain and cognitive dysfunction) are demonstrably interrelated [11][12][13][14]43], and pain has been identified as a risk factor for dementia [17]. However, the neural mechanisms underlying their interaction remain unclear.…”

“…The filtered data were used directly for source-level analyses. To identify the specific locations of the brain regions responsible for producing the resting-state-induced components, source inversion procedures were applied separately to the oscillation components of delta (0-3 Hz), theta (4-7 Hz), alpha (8-12 Hz), beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and gamma (low gamma, 26-40 Hz; high gamma, 41-80 Hz). We used a maximal smoothness algorithm with a spatially coherent source model (i.e., COH algorithms implemented in SPM-12) [35], which is comparable to standardised low-resolution brain electromagnetic tomography (sLORETA) [36].…”

“…As a multi-systemic phenomenon, pain relies on a widely distributed cortical/subcortical network known as the 'pain matrix' [1,10]: a network that affects cognitive functions such as attention, memory, and executive function [11][12][13][14][15][16][17][18]. This link is evidenced by psychomotor slowing in patients with diabetic peripheral neuropathy [19], the association between the subjective level of pain and poor performance on executive functioning tasks in patients with rheumatoid arthritis [20], and the identification of pain as a risk factor for dementia [17]. On the other hand, cognitive status mediates the subjective level of pain.…”

Emerging Promise of Cannabinoids for the Management of Pain and Associated Neuropathological Alterations in Alzheimer’s Disease

“…Based on the Einstein Aging Study, Ezzati et al (2019) assessed the connection of pain intensity, as well as pain interference with incident dementia in 1,114 participants who were 70 years of age or older and 10% of the participants, developed dementia over 4.4 years. In this study, it has been observed that higher levels of pain interference are directly connected with a higher possibility of developing dementia (Ezzati et al, 2019). In a study by Ikram et al (2019) also advocated that pain interference was considerably linked with AD and related dementia (ADRD).…”

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

“…BPSD include depressive symptoms that can be linked to unrelieved pain. Incidentally, persistent and chronic pain per se represents risk factors for cognitive decline and dementia (see [20][21][22]). Previous work from our group has demonstrated accuracy of treatment of inflammatory pain, but limited access to the treatment of chronic and neuropathic pain in demented patients in Calabria in the period 2014-2016 [23,24].…”