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

Víctor I Madariaga,Joukje M Oosterman,Jurgen A H R Claassen,Eduard Overdorp,Inti A Brazil

doi:10.3390/brainsci11091156

Víctor I Madariaga, Joukje M Oosterman + Show 3 more

Open Access

https://doi.org/10.3390/brainsci11091156

Copy DOI

Abstract

Cognitive impairment has been linked to reduced self-reporting of pain. However, it is unclear whether the various cognitive functions are similarly and/or independently associated with such pain report measures. In the present study, we explored how executive functioning (EF), memory, and global cognition relate to self-reported pain and investigated whether underlying neuropathology partially accounts for these results. We used Lasso categorical regression to analyze data from 179 individuals visiting a memory clinic. The data included the self-reported pain occurrence, intensity, severity and frequency, clinical diagnoses, neuropsychological scores, white matter hyperintensities, medial temporal lobe atrophy, depressive symptoms, and demographics. Our results showed that worse memory and EF performance predicted a lower pain occurrence. In those individuals who did report pain, worse memory predicted lower pain intensity, severity, and frequency levels, but for EF reversed effects were found, with worse EF predicting higher pain scores. These relationships were only partially explained by reductions in white matter and medial temporal lobe integrity. Similar effects were found for depressive symptoms. Our findings highlight the distinct associations of EF and memory with self-reported pain. A similar pattern of relationships found for both self-reported pain and depressive symptoms may reflect shared latent affective components.

Highlights

Reliable pain assessment is a major challenge in people with cognitive impairment because the cognitive decline reduces their ability to communicate about their pain
Was related to higher self-reported, clinical pain levels [16,17]. These studies, corroborate experimental pain studies, in which worse executive functioning (EF) was related to higher pain sensitivity [18,19]; these findings support the results found in patients with vascular dementia (VaD) in whom higher pain reports and deficits in EF are concurrently present [8]
In line with the current literature regarding neurocognitive correlates of self-reported pain in older adults, our results confirmed that memory and executive functioning are independently associated with self-reported pain

Summary

Introduction

Reliable pain assessment is a major challenge in people with cognitive impairment because the cognitive decline reduces their ability to communicate about their pain. Studies indicate that pain is reported less (i.e., less verbally expressed) by adults with cognitive alterations and that their pain tolerance following electrical stimulation is increased [1,2]. As recognized by the International Association for the Study of Pain (IASP), impaired communicative abilities may reduce pain self-reporting without altering pain experience itself—in other words, pain experience in persons with cognitive decline may be unaltered, or even increased, despite a reduction in self-reported pain [3]. The presence of cognitive impairment is not always associated with a reduction in self-reported pain; the underlying neuropathology may play an important role in how self-reported pain is altered [7].

Objectives

Methods

Findings

Discussion

Conclusion