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

Author(s): Ali Ezzati*, Cuiling Wang, Mindy J. Katz, Carol A. Derby, Andrea R. Zammit, Molly E. Zimmerman, Jelena M. Pavlovic, Martin J. Sliwinski, Richard B. Lipton.

Journal Name: Current Alzheimer Research

Volume 16 , Issue 2 , 2019

  Journal Home
Translate in Chinese
Submit Manuscript
Submit Proposal

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.

Keywords: Pain intensity, pain interference, dementia, Alzheimer's disease, remediable risk factor.

[1]
Alzheimer’s A. 2015 Alzheimer’s disease facts and figures. Alzheimer’s Dementia: J Alzheimer’s Association 11: 332. (2015).
[2]
Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. N Engl J Med 368: 1326-34. (2013).
[3]
Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 10: 819-28. (2011).
[4]
Jakobsson U, Klevsgard R, Westergren A, Hallberg IR. Old people in pain: a comparative study. J Pain Symptom Manage 26: 625-36. (2003).
[5]
Mantyselka PT, Turunen JH, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA 290: 2435-42. (2003).
[6]
Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders. JAMA Intern Med 177(8): 1146-53. (2017).
[7]
Moriarty O, McGuire BE, Finn DP. The effect of pain on cognitive function: a review of clinical and preclinical research. Prog Neurobiol 93: 385-404. (2011).
[8]
Berryman C, Stanton TR, Bowering KJ, Tabor A, McFarlane A, Moseley GL. Evidence for working memory deficits in chronic pain: a systematic review and meta-analysis. Pain 154: 1181-96. (2013).
[9]
Poblador-Plou B, Calderón-Larrañaga A, Marta-Moreno J, Hancco-Saavedra J, Sicras-Mainar A, et al. Comorbidity of dementia: a cross-sectional study of primary care older patients. BMC Psychiatry 14: 84. (2014).
[10]
Cleeland C, Ryan K. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23(2): 129-38. (1994).
[11]
Scherder EJ, Eggermont L, Plooij B, Oudshoorn J, Vuijk PJ, Pickering G, et al. Relationship between chronic pain and cognition in cogni-tively intact older persons and in patients with Alzheimer’s disease. Gerontology 54: 50-8. (2008).
[12]
Suhr JA. Neuropsychological impairment in fibromyalgia: relation to depression, fatigue, and pain. J Psychosom Res 55: 321-9. (2003).
[13]
Morley S, Pallin V. Scaling the affective domain of pain: a study of the dimensionality of verbal descriptors. Pain 62: 39-49. (1995).
[14]
Povedano M, Gascón J, Gálvez R, Ruiz M, Rejas J. Cognitive function impairment in patients with neuropathic pain under standard condi-tions of care. J Pain Symptom Manage 33: 78-89. (2007).
[15]
Rodríguez-Andreu J, Ibáñez-Bosch R, Portero-Vázquez A, Masramon X, Rejas J, Gálvez R. Cognitive impairment in patients with fibrom-yalgia syndrome as assessed by the mini-mental state examination. BMC Musculoskelet Disord 10: 1. (2009).
[16]
van der Leeuw G, Eggermont LH, Shi L, Milberg WP, Gross AL, Hausdorff JM, et al. Pain and cognitive function among older adults living in the community. J Gerontol A Biol Sci Med Sci 71(3): 398-405. (2016).
[17]
Iezzi T, Duckworth MP, Vuong LN, Archibald YM, Klinck A. Predictors of neurocognitive performance in chronic pain patients. Int J Behav Med 11: 56-61. (2004).
[18]
Von Korff M, Dworkin SF, Le Resche L. Graded chronic pain status: an epidemiologic evaluation. Pain 40: 279-91. (1990).
[19]
Katz MJ, Lipton RB, Hall CB, Zimmerman ME, Sanders AE, Verghese J, et al. Age and sex specific prevalence and incidence of mild cog-nitive impairment, dementia and Alzheimer’s dementia in blacks and whites: a report from the Einstein Aging Study. Alzheimer Dis Assoc Disord 26: 335. (2012).
[20]
Sanders AE, Wang C, Katz M, Derby CA, Barzilai N, Ozelius L, et al. Association of a functional polymorphism in the cholesteryl ester transfer protein (CETP) gene with memory decline and incidence of dementia. JAMA 303: 150-8. (2010).
[21]
Ware JE, Kosinski M, Dewey JE, Gandek B. SF-36 health survey: manual and interpretation guide. Quality Metric Inc (2000).
[22]
Brazier J, Walters S, Nicholl J, Kohler B. Using the SF-36 and Euroqol on an elderly population. Qual Life Res 5: 195-204. (1996).
[23]
Yesavage JA, Sheikh JI. 9/Geriatric Depression Scale (GDS) recent evidence and development of a shorter violence. Clin Gerontol 5: 165-73. (1986).
[24]
Marc LG, Raue PJ, Bruce ML. Screening performance of the 15-item geriatric depression scale in a diverse elderly home care population. Am J Geriatr Psychiatry 16: 914-21. (2008).
[25]
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease Report of the NINCDS‐ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34: 939-39. (1984).
[26]
Grambsch PM, Therneau TM. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81: 515-26. (1994).
[27]
Scemes E, Zammit AR, Katz MJ, Lipton RB, Derby CA. Associations of cognitive function and pain in older adults. Intern J Geriatric Psy-chiat 32: 118. (2017).
[28]
Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain 12: 964-73. (2011).
[29]
Lin EH, Katon W, Von Korff M, Tang L, Williams Jr J.W., Kroenke K, et al. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA 290: 2428-9. (2003).
[30]
Kroenke K, Shen J, Oxman TE, Williams JW, Dietrich AJ. Impact of pain on the outcomes of depression treatment: results from the RE-SPECT trial. Pain 134: 209-15. (2008).
[31]
Jorm AF. History of depression as a risk factor for dementia: an updated review. Aust N Z J Psychiatry 35: 776-81. (2001).
[32]
Szekely CA, Breitner JC, Fitzpatrick AL, Rea TD, Psaty BM, Kuller LH, et al. NSAID use and dementia risk in the Cardiovascular Health Study* Role of APOE and NSAID type. Neurology 70: 17. (2008).
[33]
Dublin S, Walker RL, Gray SL, Hubbard RA, Anderson ML, Yu O, et al. Prescription opioids and risk of dementia or cognitive decline: a prospective cohort study. J Am Geriatr Soc 63: 1519-26. (2015).
[34]
Gilbertson MW, Shenton ME, Ciszewski A, Kasai K, Lasko NB, Orr SP, et al. Smaller hippocampal volume predicts pathologic vulnerabil-ity to psychological trauma. Nat Neurosci 5: 1242-7. (2002).
[35]
Dai J, Buijs R, Swaab D. Glucocorticoid hormone (cortisol) affects axonal transport in human cortex neurons but shows resistance in Alzheimer’s disease. Br J Pharmacol 143: 606-10. (2004).
[36]
McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 87: 873-904. (2007).
[37]
May A. Chronic pain may change the structure of the brain. Pain 137: 7-15. (2008).
[38]
Schroeter ML, Stein T, Maslowski N, Neumann J. Neural correlates of Alzheimer’s disease and mild cognitive impairment: a systematic and quantitative meta-analysis involving 1351 patients. Neuroimage 47: 1196-206. (2009).
[39]
Dickerson BC, Bakkour A, Salat DH, Feczko E, Pacheco J, Greve DN, et al. The cortical signature of Alzheimer’s disease: regionally spe-cific cortical thinning relates to symptom severity in very mild to mild AD dementia and is detectable in asymptomatic amyloid-positive individuals. Cereb Cortex 19: 497-510. (2009).
[40]
Dickerson BC, Wolk DA. MRI cortical thickness biomarker predicts AD-like CSF and cognitive decline in normal adults. Neurology 78: 84-90. (2012).


Rights & PermissionsPrintExport Cite as


Article Details

VOLUME: 16
ISSUE: 2
Year: 2019
Page: [109 - 115]
Pages: 7
DOI: 10.2174/1567205016666181212162424
Price: $58

Article Metrics

PDF: 28
HTML: 2
PRC: 1