Association between Self-Reported Pain, Cognition, and Neuropathology in Older Adults Admitted to an Outpatient Memory Clinic-A Cross-Sectional Study

Longitudinal associations between pain and cognitive decline in middle-aged and older Chinese adults: the mediating role of depressive symptoms

Objective

The primary aim of this scholarly investigation was to elucidate the correlation between Number of Pain Sites and cognitive decline within the older adult population. Additionally, the study sought to examine the potential mediating influence of depressive symptoms in moderating the association between pain and cognitive deterioration.

Methods

We analyzed 8,835 participants aged 45 and above, with data collected from 2011 to 2018. Participants were categorized into two groups-stable and rapidly declining cognitive function-using the KML3D clustering method. Binary logistic regression analysis was conducted to examine the association between pain status, depressive symptoms, and cognitive trajectories, and mediation analysis was used to assess the mediating role of depression.

Results

Multi-site pain was significantly associated with the risk of rapid cognitive decline (adjusted OR = 1.30, 95% CI: 1.14-1.48), and depressive symptoms were also a significant predictor of rapid cognitive decline (adjusted OR = 1.49, 95% CI: 1.32-1.68). Mediation analysis revealed that depression mediated the effect of pain on cognitive decline, accounting for 25.71% of the total effect.

Conclusion

Our study establishes a significant longitudinal link between Number of Pain Sites and cognitive decline, mediated in part by depressive symptoms. This finding underscores the need for interventions that address pain and depression to potentially decelerate cognitive decline in older adults.

Measurement properties of self-reported outcome measures for older adults with nonspecific low back pain: a systematic review

OBJECTIVE

To summarise the measurement properties of patient-reported outcome measures (PROMs) for older adults with nonspecific low back pain.

METHODS

Eight databases were searched from inception to January 2024. Two independent reviewers conducted article screening, data extraction, risk of bias assessments, evaluations of measurement properties of PROMs, syntheses of quality of evidence and forming recommendation levels using relevant checklists and assessment tools.

RESULTS

Ten PROMs were identified from 12 included studies. The Functional Rating Index, Oswestry Disability Index, Roland Morris Disability Questionnaire and Quebec Back Pain Disability Scale demonstrated the highest recommendation (category A: PROM most suitable) for evaluating pain-related functional limitation or pain intensity in older adults with acute, subacute or chronic nonspecific low back pain. The Pain Response to Activity and Positioning questionnaire obtained a category A recommendation for making a differential diagnosis of chronic nonspecific low back pain in older adults. The 36-Item World Health Organization Disability Assessment Schedule 2.0 was considered promising (category B: PROM recommended) for assessing physical functioning, while the Back Believe Questionnaire, Catastrophizing Avoidance Scale D-65+, Pain Catastrophizing Scale and Psychological Inflexibility in Pain Scale obtained category B recommendation for evaluating negative thoughts in this population, although further validation is warranted.

CONCLUSIONS

This systematic review identified suitable PROMs for assessing physical function in older adults with nonspecific low back pain, but more studies are needed to evaluate the measurement properties of questionnaires on other outcome domains in this population.

Pain in Huntington's disease and its potential mechanisms

Pain is common and frequent in many neurodegenerative diseases, although it has not received much attention. In Huntington's disease (HD), pain is often ignored and under-researched because attention is more focused on motor and cognitive decline than psychiatric symptoms. In HD progression, pain symptoms are complex and involved in multiple etiologies, particularly mental issues such as apathy, anxiety and irritability. Because of psychiatric issues, HD patients rarely complain of pain, although their bodies show severe pain symptoms, ultimately resulting in insufficient awareness and lack of research. In HD, few studies have focused on pain and pain-related features. A detailed and systemic pain history is crucial to assess and explore pain pathophysiology in HD. This review provides an overview concentrating on pain-related factors in HD, including neuropathology, frequency, features, affecting factors and mechanisms. More attention and studies are still needed in this interesting field in the future.

Increasing Pain Interference Is Associated With Cognitive Decline Over Four Years Among Older Puerto Rican Adults

BACKGROUND

Pain is associated with cognitive decline among older adults, but few studies have investigated bidirectional associations between pain and cognitive decline, especially in older Hispanic populations. Our objective was to assess the bidirectional association between pain interference and cognitive performance in a sample of older Puerto Rican adults.

METHODS

Data came from baseline and 4-year follow-up of the Puerto Rican Elderly: Health Conditions Study, a longitudinal representative study of Puerto Rican older adults aged 60 and older. Pain and cognitive performance were assessed at each wave. A pain interference variable was created using the sum of pain status (yes/no) and pain interference (yes/no; range 0-2). Global cognitive performance was assessed with the Mini-Mental Cabán. We tested bidirectional associations using a path model with concurrent and cross-lagged paths between pain and cognitive performance, adjusting for sociodemographic and health factors (n = 2 349).

RESULTS

Baseline pain interference was not associated with baseline cognitive performance (p = .636) or with cognitive performance at follow-up (p = .594). However, increased pain interference at follow-up was associated with greater cognitive decline at follow-up (β = -0.07, standard error [SE] = 0.02, p = .003). Greater baseline cognitive performance was associated with lower pain interference at follow-up (β = -0.07, SE = 0.02, p = .007).

CONCLUSIONS

These findings highlight the importance of worsening pain interference as a potentially modifiable risk factor for cognitive decline, as pain treatment options exist. Additionally, better baseline cognitive performance may be a protective factor for pain, providing further evidence of the dynamic relationship between pain and cognitive performance.

Longitudinal associations of pain and cognitive decline in community-dwelling older adults

Pain is inversely associated with cognitive function in older adults, but the effects of pain on cognitive decline are not fully clear. This study examined the associations of baseline pain, pain persistence, and incident pain with changes in cognition across 10 years in a sample of healthy community-dwelling older adults (n = 688; Mage = 74, SD = 6.05) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. While ACTIVE was a four-arm single-blind cognitive training randomized controlled trial, the present study includes only participants from the no-contact control group. Pain was examined using the Medical Outcomes Survey SF-36-Item (MOS SF-36) and cognitive tests examined simple processing speed, complex processing speed, divided and selective attention, memory, reasoning, and cognitive status. Multilevel models tested the associations of baseline pain, incident pain, and pain persistence on cognitive function and cognitive decline, adjusted for baseline age, time (years after follow-up), race, gender, education, marital status, and depressive symptoms at baseline and over time. Thirty-one percent reported pain at baseline which was related to worse baseline memory and accelerated decline in processing speed. Forty-two percent of older adults reported incident pain had accelerated decline in complex processing speed, divided attention, memory, reasoning, and cognitive status. On average, older adults reported a mean of two waves of pain persistence related to accelerated decline in memory. In sum, pain is common in community-dwelling older adults and is related to accelerated cognitive decline, especially when the incident. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pain Processing in Cognitive Impairment and Its Association with Executive Function and Memory: Which Neurocognitive Factor Takes the Lead?

It is well established that individuals with cognitive impairment present with disturbed forms of pain processing of still unknown origin. As a neurocognitive factor, executive functions have become favored candidates for explanation. For further insights, we aimed at comparing executive functions and memory in their association with parameters indicating onset and escalation of pain perception. Subjective ratings of experimentally induced pressure pain applied in ascending series were assessed in older individuals with (N = 32) and without mild cognitive impairments (MCI) (N = 32). We investigated whether executive functioning (Trail Making Test-B (TMT-B), semantic fluency) or memory (word list and figure recall) were more closely linked to the onset and the escalation of pain. For the MCI group, a strong linkage between pain responses and the TMT-B could be found, i.e., poor test performance was associated with weak pain onset but strong pain escalation. The contribution of memory functions was less substantial and systematic. The prominent role of executive function for pain processing in individuals with MCI could be replicated by a test of cognitive flexibility. This lack of adaptability let individuals with MCI be less vigilant to pain at the beginning but allows for escalating pain in the further course. Thus, being first not sufficiently prepared and later overwhelmed as regards pain may be an early problem in MCI individuals with reduced executive functioning.