Abstract
Accumulating evidence suggests that certain chronic pain conditions may increase risk for incident Alzheimer’s disease and related dementias (ADRD). Rigorous longitudinal research remains relatively sparse, and the relation of overall chronic pain condition burden to ADRD risk remains little studied, as has the potential mediating role of sleep and mood disorders. In this retrospective cohort study, we investigated the association of common non-cancer chronic pain conditions (NCPC) at baseline to subsequent risk for incident ADRD, and assessed the potential mediating effects of mood and sleep disorders, using baseline and 2-year follow-up data using 11 pooled cohorts (2001–2013) drawn from the U.S. Medicare Current Beneficiaries Survey (MCBS). The study sample comprised 16,934 community-dwelling adults aged ≥65 and ADRD-free at baseline. NCPC included: headache, osteoarthritis, joint pain, back or neck pain, and neuropathic pain, ascertained using claims data; incident ADRD (N = 1149) was identified using claims and survey data. NCPC at baseline remained associated with incident ADRD after adjustment for sociodemographics, lifestyle characteristics, medical history, medications, and other factors (adjusted odds ratio (AOR) for any vs. no NCPC = 1.21, 95% confidence interval (CI) = 1.04–1.40; p = 0.003); the strength and magnitude of this association rose significantly with increasing number of diagnosed NCPCs (AOR for 4+ vs. 0 conditions = 1.91, CI = 1.31–2.80, p-trend < 0.00001). Inclusion of sleep disorders and/or depression/anxiety modestly reduced these risk estimates. Sensitivity analyses yielded similar findings. NCPC was significantly and positively associated with incident ADRD; this association may be partially mediated by mood and sleep disorders. Additional prospective studies with longer-term follow-up are warranted to confirm and extend our findings.
Highlights
Alzheimer’s disease and related dementia (ADRD) is a group of serious neurodegenerative disorders characterized by progressive decline in cognitive and psychomotor function [1,2]
Mediators: To examine the potential mediating influence of mood and sleep disorders on the relation of non-cancer chronic pain conditions (NCPC) to incident ADRD, we evaluated the effects of diagnosed depression, anxiety and insomnia-related sleep disorders both separately and in combination
A significantly higher percentage of participants with baseline NCPC reported a history of chronic physical health conditions associated with ADRD, including hypertension (82% vs. 68.7%), heart disease (31.5% vs. 19.9%), stroke (14% vs. 10%), diabetes (23.5% vs. 19%) (p’s < 0.0001)
Summary
Alzheimer’s disease and related dementia (ADRD) is a group of serious neurodegenerative disorders characterized by progressive decline in cognitive and psychomotor function [1,2]. Prevalence of ADRD continues to increase worldwide, exacting enormous social, economic and healthcare costs. In the United States, at least 5.8 million adults are living with Alzheimer’s disease (AD), the most common form of dementia, with attributable Medicare costs alone exceeding $146 billion. Res. Public Health 2020, 17, 5454; doi:10.3390/ijerph17155454 www.mdpi.com/journal/ijerph
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