Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders

Abstract

IMPORTANCE Chronic pain is common among the elderly and is associated with cognitive deficits in cross-sectional studies; the population-level association between chronic pain and longitudinal cognition is unknown. OBJECTIVE To determine the population-level association between persistent pain, which may reflect chronic pain, and subsequent cognitive decline. DESIGN, SETTING, AND PARTICIPANTSCohort study with biennial interviews of 10 065 community-dwelling older adults in the nationally representative Health and Retirement Study who were 62 years or older in 2000 and answered pain and cognition questions in both 1998 and 2000. Data analysis was conducted between June 24 and October 31, 2016.EXPOSURES "Persistent pain," defined as a participant reporting that he or she was often troubled with moderate or severe pain in both the 1998 and 2000 interviews. MAIN OUTCOMES AND MEASURESCoprimary outcomes were composite memory score and dementia probability, estimated by combining neuropsychological test results and informant and proxy interviews, which were tracked from 2000 through 2012. Linear mixed-effects models, with random slope and intercept for each participant, were used to estimate the association of persistent pain with slope of the subsequent cognitive trajectory, adjusting for demographic characteristics and comorbidities measures in 2000 and applying sampling weights to represent the 2000 US population. We hypothesized that persistent pain would predict accelerated memory decline and increased probability of dementia. To quantify the impact of persistent pain on functional independence, we combined our primary results with information on the association between memory and ability to manage medications and finances independently. RESULTSOf the 10 065 eligible HRS sample members, 60% were female, and median baseline age was 73 years (interquartile range, 67-78 years). At baseline, persistent pain affected 10.9% of participants and was associated with worse depressive symptoms and more limitations in activities of daily living. After covariate adjustment, persistent pain was associated with 9.2% (95% CI, 2.8%-15.0%) more rapid memory decline compared with those without persistent pain. After 10 years, this accelerated memory decline implied a 15.9% higher relative risk of inability to manage medications and an 11.8% higher relative risk of inability to manage finances independently. Adjusted dementia probability increased 7.7% faster (95% CI, 0.55%-14.2%); after 10 years, this translates to an absolute 2.2% increase in dementia probability for those with persistent pain.CONCLUSIONS AND RELEVANCE Persistent pain was associated with accelerated memory decline and increased probability of dementia.

The Beneficial Effect of Physical Activity on Cognitive Function in Community-Dwelling Older Persons with Locomotive Syndrome: Results of a Pilot Study

“…Moderate to severe persistent pain, which re ects chronic pain, has been reported to be associated with accelerated cognitive decline and increased dementia onset in the aged [37]. This report supports the relationship between decreased LS scores and increased cognitive function in the present study.…”

“…It has also been reported that smaller hippocampal volume in the healthy aged is associated with severe acute and chronic pain [40]. Furthermore, it has been reported that persistent pain in a longitudinal cohort of older people is associated with decreased memory and an increased likelihood of dementia [37]. The results of the present suggest that the LS population may have increased memory owing to increased physical activity and pain relief.…”

Public Interest in Cognitive Impairment: An Analysis of the Top 50 Articles on Cognitive Impairment on Altmetric

“…Leisure activity and midlife cardiovascular fitness were also associated with the risk of dementia. Some studies reported that comorbid conditions such as hearing loss (#19) [17], poor sleep (#26) [18], and chronic pain (#46) [19] deteriorated cognitive health. Environmental factors such as living near a major road (#4) [20] and lead exposure (#32) [21] affected cognitive health.…”

Cohort profile: Oxford Pain, Activity and Lifestyle (OPAL) Study, a prospective cohort study of older adults in England

“…10 Musculoskeletal pain has a large impact on many other aspects of older people's health such as loss of mobility, frailty, cognitive impairment, falls and poor sleep quality. [11][12][13][14][15] However, the role of musculoskeletal pain on adverse health outcomes in older adults is poorly understood. The majority of studies are cross-sectional in design, thus are limited; and only few longitudinal studies have examined potential mediators between pain and disability.…”