Pain in dementia: prevalence and associated factors: protocol of a multidisciplinary study.

Janine Van Kooten,Martin Smalbrugge,Wouter Wa Zuurmond,Johannes C Van Der Wouden,Erik Ja Scherder,Suzanne Delwel,Tarik T Binnekade,Didi Rhebergen,Frank Lobbezoo,Max L Stek,Cees Mpm Hertogh,Roberto Sgm Perez

doi:10.1186/s12877-015-0025-0

Abstract

BackgroundPain is a common problem in people with dementia, however the exact prevalence of pain in dementia subtypes, e.g. Alzheimer’s Disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia (FTD) and dementia with Lewy Bodies (DLB), is unknown, as is the relation between pain and the different subtypes of dementia. In this study, the prevalence of pain in people with dementia will be investigated per dementia subtype and the relationship between the various subtypes of dementia and the presence of specific types of pain (i.e. musculoskeletal pain, neuropathic pain and orofacial pain) will be examined. Secondly, associations between various types of pain, cognitive functioning, neuropsychiatric symptoms and quality of life in people with dementia will be examined. A third purpose is to study the value of the assessment of autonomic responses in assessing pain in people with dementia. Finally, the effect of feedback to the attending physician on the presence of pain, based on examination by investigators with backgrounds in neuropsychology, geriatric dentistry and elderly care medicine, will be evaluated.Methods/DesignA cross-sectional, partially longitudinal observational study in 400 participants with dementia, aged 60 years and older. Participants will be recruited from an outpatient memory clinic and dementia special care units. All participants will be examined by an elderly care medicine trainee, a dentist with experience in geriatric dentistry, and a neuropsychologist. The primary outcome is presence of pain. Secondary outcomes will include oral health, autonomic responses to pain stimulus, vital sensibility and gnostic sensibility, musculoskeletal examination, cognitive functioning, neuropsychiatric symptoms, and quality of life.DiscussionThis study will help to enhance our knowledge regarding the prevalence of different types of pain in different dementia subtypes i.e. AD, VaD, FTD and DLB. This study also aims to contribute to a better understanding of oral health status in people with dementia, the use of autonomic responses in the assessment of pain in people with dementia and the relationships between pain and cognitive symptoms, neuropsychiatric symptoms and quality of life in people with various dementia subtypes and in different stages of the disease.

Highlights

Pain is a common problem in people with dementia, the exact prevalence of pain in dementia subtypes, e.g. Alzheimer’s Disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia (FTD) and dementia with Lewy Bodies (DLB), is unknown, as is the relation between pain and the different subtypes of dementia
This study will help to enhance our knowledge regarding the prevalence of different types of pain in different dementia subtypes i.e. AD, VaD, FTD and DLB
This study aims to contribute to a better understanding of oral health status in people with dementia, the use of autonomic responses in the assessment of pain in people with dementia and the relationships between pain and cognitive symptoms, neuropsychiatric symptoms and quality of life in people with various dementia subtypes and in different stages of the disease

Summary

Introduction

Pain is a common problem in people with dementia, the exact prevalence of pain in dementia subtypes, e.g. Alzheimer’s Disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia (FTD) and dementia with Lewy Bodies (DLB), is unknown, as is the relation between pain and the different subtypes of dementia. The prevalence of pain in people with dementia is high [1,2,3,4]; there is good agreement in both large and small studies that about 50% of the people with dementia regularly experience pain [5] This is not surprising, Pain in dementia is associated with occurrence of neuropsychiatric symptoms [8,9], and with a decline in cognitive functioning, as well as in performance of Activities of Daily Living (ADL) [10]. Results from previous small studies showed that specific neuropathological changes may affect pain experience and pain perception differently in the four commonest dementia subtypes [12], i.e., Alzheimer’s Disease (AD), Vascular Dementia (VaD), Dementia with Lewy Bodies (DLB), and frontotemporal dementia (FTD). It is suggested that with a preponderance of white matter lesions, pain experience in VaD may increase compared to other dementia subtypes [12], while in AD and FTD it is hypothesized that neuropathological changes like gray matter atrophy lead to an increase in pain tolerance [13,14,15]

Objectives

Methods

Findings

Conclusion