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

Abstract

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; M age = 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 followup), 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. Public Significance StatementPain in later life is related to cognitive decline in older adults and may serve as a key target to curtail poorer cognition in later life.

Exploring the chain mediating roles of frailty and depressive symptoms in the relationship between pain and cognitive function among nursing home older adults

“…The current study has uncovered that pain was associated with cognitive function, which was in agreement with previous studies showing older adults with chronic pain had an increased risk of cognitive decline 9,10 . Eccleston and Crombez developed the Cognitive‐Affective model of the Interruptive Function of Pain, which illustrated that pain distracted attention and had competing effects on the brain, resulting in chronic declining of cognitive function over time 28 .…”

“…The incidence of pain among nursing home older adults is as high as 83%, which seriously harms their quality of life 8 . It has been reported that pain is a vital factor in cognitive function as a result of individual demands for attention and competition for limited attentional resources 9,10 . A recent review showed that older adults with pain might experience memory deficits, decreased executive function, and lower emotional decision‐making, thus affecting cognitive function 2 .…”

Pain Characteristics and Progression to Sarcopenia in Chinese Middle-Aged and Older Adults: A 4-Year Longitudinal Study

“…We divided the pain distribution into no pain, single-site pain, and more than one site of pain (multisite pain). Similar to other observational pain studies ( 25 , 26 ), by combining the pain characteristics assessment reports at the baseline survey and the follow-up survey 4 years later, we further categorized pain status into the following categories: (1) reporting no pain at both baseline survey and follow-up survey (no pain); (2) reporting pain at the same site at both baseline survey and follow-up survey (pain persistence); and (3) reporting pain at baseline survey but no pain at follow-up survey, or reporting no pain at baseline survey but pain at follow-up survey, etc., that did not meet the criteria for the definition of pain persistence (incident pain). We further categorized the distribution of pain as follows: (1) no pain or single-site pain at baseline survey and follow-up survey; (2) a shift from no pain or single-site pain at baseline survey to multisite pain at follow-up survey; (3) multisite pain at both baseline survey and follow-up survey (multisite pain persistence); and (4) and a shift from multisite pain at baseline survey to no pain or single-site pain at follow-up survey.…”

“…To account for potential confounding factors, 4 models were constructed, yielding odds ratios (ORs) and 95% confidence intervals (95% CIs) with varying covariate adjustments: Model 1 was unadjusted; Model 2 adjusted for gender and age; Model 3 further included residential area, education, and marital status; and Model 4 also incorporated smoking, drinking, comorbidities (hyperglycemia, hypertension, stroke, heart disease, chronic lung disease, asthma, liver disease, emotional and mental disorders, and malignancies), and falls. To investigate the association between pain characteristics over time and sarcopenia status, we used analytic methods similar to those used in other pain studies ( 25 , 26 ). We classified pain status into 3 categories: no pain, incident pain, and pain persistence, and used univariate and multivariate logistic regression models to analyze their association with sarcopenia.…”

The Relationship Between Chronic Pain and Cognitive Impairment in the Elderly: A Review of Current Evidence

“…12,[18][19][20][21] In recent years, an increasing number of longitudinal cohort studies with large samples are also available to support this view. [13][14][15]22,23 For example, a cohort study that followed 10,065 older Americans for 12 years reported that persistent pain was associated with accelerated cognitive decline and an increased probability of dementia. 13 Similarly, a prospective longitudinal study recruiting 693 elderly patients in France also reported that the presence of chronic pain was associated with higher cognitive decline in older adults.…”