Pain processing in older adults with dementia-related cognitive impairment is associated with frontal neurodegeneration

Bunk, Steffie; Zuidema, Sytse U.; Koch, Kathrin; Lautenbacher, Stefan; Deyn, Peter Paul De; Kunz, Miriam

doi:10.1016/j.neurobiolaging.2021.06.009

Cited by 15 publications

(25 citation statements)

References 68 publications

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“…Although the neurocognitive influences on pain processing differed between HC and MCI, interestingly, the pain responses themselves (including intercept and slope values across pressure intensities) did not differ between groups. Thus, we could not replicate an increased pain responsiveness as observed in patients with dementia [2][3][4]7]. However, we already found in an earlier study that individuals with MCI show comparable pain responses (pain ratings, RIII reflex, facial responses, sympathetic skin response, and evoked heart rate response) to age-matched individuals without cognitive impairments [32].…”

Section: Discussioncontrasting

confidence: 62%

“…In more advanced stages of cognitive impairment (moderate stages of dementia), the persons can no longer remember these failures and have to reexperience this cycle of ineffective pain coping and inhibition again and again without any ability to improve executive functions in this respect. At this point, noxious events at all intensities repeatedly lead to strong pain responses [2][3][4]7]. Future studies should test this developmental model at best in longitudinal studies.…”

Section: Discussionmentioning

confidence: 95%

“…The algometer has a built-in pressure transducer, an electronic recorder, and a display unit to monitor the applied pressure as well as the rate of rise. Following a previous protocol [3,7] pressure was applied to the shoulder (upper mid part of the right and left trapezius muscle halfway between the neck line and the shoulder line) and to the forearm (midportion of the right and left inner forearm, halfway between wrist and crook of the arm, arm positioned stable on a table). In total 16 pressure stimuli were applied (4 intensities × 2 body side × 2 body sites).…”

Section: Materials and Proceduresmentioning

confidence: 99%

“…The majority of findings suggest an enhancement of pain of still unknown origins [1]. From a neurobiological perspective, alterations in prefrontal functioning are of upmost relevance for changes in central nociception and for deteriorating descending inhibitory control [7][8][9]. From a neurocognitive perspective, there is some tentative evidence that worsening of executive functions is the critical mechanism [10][11][12][13], although the impairment of memory is the leading deficit in most forms of dementia [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…Another issue to be considered is that the evidence of an association between dysexecutive symptoms and enhanced pain processing in individuals with cognitive impairments (especially dementia) mainly stems from the use of facial responses as pain indicators [7,10,22]. Although facial responses to pain have been shown to be valid pain indicators [23,24], they are expressive behaviors which are regulated by inhibitory mechanisms [25,26] and may be as such sensitive to executive functions.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 95%

Section: Materials and Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Schmerz und Demenz

Kunz,

Reicherts,

Hasan

et al. 2023

InFo Neurologie

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A scoping review of neurodegenerative manifestations in explainable digital phenotyping

Alfalahi

Dias

Khandoker

et al. 2023

npj Parkinsons Dis.

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Neurologists nowadays no longer view neurodegenerative diseases, like Parkinson’s and Alzheimer’s disease, as single entities, but rather as a spectrum of multifaceted symptoms with heterogeneous progression courses and treatment responses. The definition of the naturalistic behavioral repertoire of early neurodegenerative manifestations is still elusive, impeding early diagnosis and intervention. Central to this view is the role of artificial intelligence (AI) in reinforcing the depth of phenotypic information, thereby supporting the paradigm shift to precision medicine and personalized healthcare. This suggestion advocates the definition of disease subtypes in a new biomarker-supported nosology framework, yet without empirical consensus on standardization, reliability and interpretability. Although the well-defined neurodegenerative processes, linked to a triad of motor and non-motor preclinical symptoms, are detected by clinical intuition, we undertake an unbiased data-driven approach to identify different patterns of neuropathology distribution based on the naturalistic behavior data inherent to populations in-the-wild. We appraise the role of remote technologies in the definition of digital phenotyping specific to brain-, body- and social-level neurodegenerative subtle symptoms, emphasizing inter- and intra-patient variability powered by deep learning. As such, the present review endeavors to exploit digital technologies and AI to create disease-specific phenotypic explanations, facilitating the understanding of neurodegenerative diseases as “bio-psycho-social” conditions. Not only does this translational effort within explainable digital phenotyping foster the understanding of disease-induced traits, but it also enhances diagnostic and, eventually, treatment personalization.

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Pain processing in older adults with dementia-related cognitive impairment is associated with frontal neurodegeneration

Cited by 15 publications

References 68 publications

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

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

Schmerz und Demenz

A scoping review of neurodegenerative manifestations in explainable digital phenotyping

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