Pain in Older Adults with Cognitive Impairment: A Review on the Relationship Between Chronic Pain and Subjective Cognitive Decline.

This review investigated current research on the relationship between chronic pain and cognitive performance, subjective cognitive decline, and dementia. In addition, we reviewed current research on pain management in older adults across the cognitive trajectory. Chronic pain remains a common problem in older adults. A new, international classification system highlights the complexity of chronic pain syndromes. Research supports relationships between chronic pain and changes in cognitive performance in generally healthy adults. Evidence also supports associations between pain and subjective cognitive decline, which is considered a possible precursor to dementia. The impact of dementia on pain expression is also reviewed. To manage pain in older adults, we present a multimodal pain management hierarchy that includes pharmacological and non-pharmacological treatments. To avoid the risks and side effects of analgesics, non-pharmacological treatment is recommended as the first line therapy for chronic pain. Medical cannabis and music therapy are two non-pharmacological treatments that have been the focus of substantial recent research; evidence supports their effectiveness in reducing pain and both strategies warrant further investigation. Chronic pain is associated with different levels of cognitive decline across the cognitive trajectory. Medical cannabis and music therapy are the two emerging non-pharmacological treatment methods. Clinical studies with rigorous research design are needed to further investigate the effects of these two strategies on pain relief in older adults.

High-impact pain predicts subjective cognitive decline and interacts with APOE4 genotype in the development of objective cognitive impairment.

In an ageing Europe, chronic pain is a major public health problem, but robust epidemiological data are scarce. This study aimed to analyse the prevalence of and factors associated with chronic musculoskeletal pain by gender in older adults of 14 European countries. A cross-sectional study was performed from wave 5 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The study included people ≥50 years residing in Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, the Netherlands, Slovenia, Spain, Sweden and Switzerland. Chronic pain was defined as being bothered by joint and/or back pain for the previous 6months. Multivariable Poisson regression models with robust variance were performed to analyse prevalence ratio by covariates, stratified by sex. A total of 61,157 participants were included. Overall prevalence of chronic musculoskeletal pain was 35.7% (28.8-31.7), ranging from 18.6% (17.1-20.1) for Switzerland to 45.6% (43.3-47.8) for France. Prevalence was higher in women than in men: 41.3% (40.2-42.4) versus 29.1% (28.0-30.3). Chronic musculoskeletal pain was lower in men aged >75 years (PR=0.82; 0.72-0.92) than the younger (50-59) group. Separated/divorced status presented opposite effects among men (PR=0.85; 0.76-0.96) and women (PR=1.12; 1.03-1.21) compared with married, and unemployment was a significant factor in men (PR=1.21; 95% CI 1.02-1.43) compared with employed. Musculoskeletal pain in older European adults is very frequent, especially in women, with large differences depending on the country of residence. Health policy makers should prioritize strategies aimed at improving the prevention and management of chronic musculoskeletal pain in Europe. This study provides epidemiological data of chronic musculoskeletal pain in older adults. Reported differences contribute to highlight the relevance of considering a gender perspective in chronic musculoskeletal pain research. Cross-national comparison also offers a map of differences that improves the knowledge of this chronic condition in Europe.

Chronic lower back pain prevalence is greatest among older adults. Older adults (65+) often have multiple comorbidities and are more likely to have high-impact chronic pain that significantly impacts daily activities and function. Owing to greater pain burden, older adults are prime candidates for low-risk, in-home pain treatment. The goal of the present study was two-fold: (1) to examine clinical effectiveness of an FDA-Authorized Skills-Based Virtual Reality delivered therapy for chronic lower back pain in adults (18–64) and older adults (65+) by conducting a secondary analysis of a randomized controlled trial (N = 505), and (2) to examine engagement rates with the Skills-Based Virtual Reality delivered therapy in adults and older adults in the randomized controlled trial sample, and a separate real-world clinical sample (N = 2460). The clinical effectiveness analysis found that adults and older adults with chronic lower back pain showed statistically equivalent and clinically meaningful reductions in pain intensity and pain interference that were durable to 12-months post-treatment along with parallel improvements in sleep, depression, and physical disability. Adult and older adult high-impact chronic pain patients showed greater pain reductions than lower impact chronic pain patients with the majority shifting to lower impact chronic pain status at end-of-treatment that was maintained at 12-months post-treatment. VR program engagement analysis showed that older adults evidenced higher engagement in VR relative to adults in both the randomized controlled trial and real-world clinical sample. Together these results challenge common misperceptions about older adults and suggest that this Skills-Based VR therapy is an accessible solution for chronic lower back pain in older adults that leads to strong clinical outcomes and high VR program engagement.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT05263037.

Introduction Growing evidence indicates that subjective cognitive decline (SCD), characterized by self-reported cognitive deterioration without measurable cognitive impairment, may be an early indicator of Alzheimer’s disease. The impact of sleep disturbance on cognitive decline in individuals with SCD, and the extent to which this differs across age groups, remains unknown. This study investigated the association between baseline sleep disturbance and a 10-year trajectory of cognitive performance in individuals with SCD and examined if this association differed between age groups (50–64 years and ≥65 years). Methods Using six waves (2010–2020) of the Health and Retirement Study, we included individuals aged ≥50 years who were cognitively unimpaired with SCD at baseline and had ≥3 waves of cognitive function data (n = 1,372). Sleep disturbance was assessed using the modified Jenkins Sleep Scale, while global cognitive function was measured with the 27-point Modified Telephone Interview for Cognitive Status (TICS-M). Latent growth curve modeling was employed to examine the associations between sleep disturbance and cognitive trajectories, controlling for sociodemographic and health factors. To explore potential age-related differences, an interaction term between sleep disturbance and age group was included in the model. Subgroup analyses were conducted when the interaction term was statistically significant. Results Results showed that sleep disturbance was not significantly associated with cognitive change rate in SCD individuals overall. However, a significant sleep disturbance by age group interaction was observed, when added to the model (estimate = -0.05, 95%CI: -0.08, -0.01). Further subgroup analyses revealed that in those aged 50–64 years (n = 814), baseline sleep disturbance was not significantly associated with cognitive change (estimate = 0.02, 95%CI: -0.01, 0.04). In contrast, among those aged ≥65 years (n = 558), poorer sleep at baseline was associated with accelerated cognitive decline (estimate = -0.04, 95%CI: -0.07, -0.01). Conclusion These findings suggest that sleep disturbance may impact cognitive decline more with advancing age in individuals with SCD, underscoring the importance of sleep health for older adults. Future research could investigate the potential of sleep interventions to mitigate further cognitive decline in older adults with SCD. Support (if any) This study is supported by the National Institutes of Health (NIH) through fellowship F99AG088437.

The increasing prevalence of chronic pain and obesity has significant health and cost implications for economies in the developed and developing world. Evidence suggests that there is a positive correlation between obesity and chronic pain and the link between them is thought to be systemic inflammation. The aim of this narrative review was to explore the physiological links between chronic musculoskeletal pain and obesity and to consider the potential role of regular physical activity in providing a means of managing obesity-related chronic pain. Systemic inflammation, mechanical overload, and autonomic dysfunction are associated with increased prevalence and severity of chronic pain in individuals with obesity. It has been proposed, therefore, that interventions that target systemic inflammation could help to reduce chronic pain in obese individuals. Reduction in abdominal fat has been shown to alleviate pain and reduce the systemic markers of inflammation that contribute to chronic pain. Interventions that include exercise prescription have been shown to reduce both abdominal fat and systemic inflammation. Furthermore, exercise is also known to reduce pain perception and improve mental health and quality of life that also improves pain outcomes. However, adherence to formal exercise prescription is poor and therefore exercise programmes should be tailored to the interests, needs, and abilities of individuals to reduce attrition.

SUBJECTIVE COGNITIVE DECLINE VERSUS SUBTLE DEFICITS AS INDICATORS OF PRECLINICAL AD: RESULTS FROM THE MULTICENTER OBSERVATIONAL STUDY ON PREDEMENTIA ALZHEIMER’S DISEASE (DELCODE) STUDY

Background: Subjective cognitive decline (SCD) is a self-perceived cognitive worsening without objective cognitive impairment. Due to its heterogeneity and potential risk of Alzheimer’s disease (AD), baseline biomarkers to predict progression are clinically important. In the present study, cognitive trajectories during a 24-month period were compared between amyloid-positive SCD (A+SCD) and amyloid-negative SCD (A−SCD) subjects, and biomarkers associated with memory decline were investigated. Methods: Data from a prospective cohort study in Korea between 2016 and 2019 were analyzed. SCD subjects ≥50 years of age were eligible. All participants underwent neuropsychological tests, brain magnetic resonance imaging, and florbetaben positron emission tomography scans. Amyloid burden and regional volumes were measured. Cognitive changes corrected for age were compared between A+SCD and A−SCD groups. Biomarkers associated with memory decline were assessed. Results: Forty-seven SCD subjects (69.9 ± 6.7 years, mini-mental state examination (MMSE) score 27.5) were enrolled, and 31 completed at least 1 annual follow-up (mean follow-up: 24.7 months). Baseline characteristics except age, hippocampal atrophy, and white matter hyperintensities were similar between A+SCDs (n = 12, 25.6%) and A−SCDs (n = 35). A+SCD subjects showed greater decline in the verbal memory function compared with the A−SCD subjects after adjustment for age. MMSE scores decreased more in the A+SCD (1.1 in the A+SCD; 0.55 in the A−SCD), although it was not statistically significant. Amyloid burden and baseline memory score were associated with memory decline. Conclusions: Within SCD, A+SCD subjects showed faster memory decline compared with the A−SCD subjects and amyloid burden might be associated with future memory decline in SCD.

Subjective cognitive decline (SCD) is a known risk factor for Alzheimer's disease. However, little research has examined whether healthy older adults with SCD (SCD+) exhibit lower cognition and increased rates of cognitive decline compared to those without SCD (SCD-). The goal of this study was to examine if cognitive change over a 15-year period differs between SCD+ and SCD-. 3,019 cognitively normal older adults (831 SCD+) from 3 Rush Alzheimer's Disease Center cohort studies were followed annually for up to a maximum of 15years. Due to attrition, the average follow-up time was 5.7years. Cognition was measured using z-scores of global cognition, episodic memory, semantic memory, perceptual speed, visuospatial ability, and working memory. Linear mixed-effects models investigated whether SCD was associated with cognitive change. Both baseline cognition and cognitive change over time differed between SCD+ and SCD-. People with SCD+ exhibited lower baseline scores and a steeper decline in global cognition, episodic memory, semantic memory, and perceptual speed. People with SCD+ did not differ from SCD- in baseline visuospatial ability or working memory but exhibited increased change over time in those two domains compared to SCD-. The observed results reveal that older adults with SCD+ have lower baseline cognition and steeper declines in cognition over time compared to SCD-. Older adults with SCD may be aware of subtle cognitive declines that occur over time in global cognition, episodic memory, semantic memory, perceptual speed, visuospatial ability, and working memory compared to those without SCD.

Growing evidence indicates that subjective cognitive decline (SCD), characterized by self-reported cognitive deterioration without measurable cognitive impairment, may be an early indicator of Alzheimer's Disease. This study investigated the association between baseline sleep disturbance and a 10-year trajectory of global cognitive performance in adults with SCD and examined if this association was moderated by age (50-64 years and ≥65 years) and sleep treatment. Using six waves (2010-2020) of the Health and Retirement Study, we included individuals aged ≥50 years who reported SCD but had no objective cognitive impairment at baseline (2010) and had final wave of cognitive data (n=1,372). Latent growth curve modeling was employed to examine the associations between self-reported sleep disturbance and cognitive trajectories from 2010 to 2020, controlling for sociodemographic and health-related factors. In the full sample, baseline sleep disturbance was not significantly associated with cognitive change. However, a significant interaction between sleep disturbance and age group was found (β=-0.04, 95% CI [-0.08, -0.003]). Stratified analyses showed that poorer sleep was associated with faster cognitive decline in those aged ≥65 years (β=-0.04, 95% CI [-0.07, -0.005]; n=558), and receiving sleep treatment was associated with a reduced impact of sleep disturbance on cognitive decline (β=0.31, 95% CI [0.02, 0.60]). These associations were not significant in those aged 50-64 years (n=814). Sleep disturbance was an independent risk factor of future cognitive decline in older adults ≥65 years with SCD. Sleep treatment may mitigate this decline, offering a potential intervention strategy.

Subjective cognitive decline (SCD) in older adults has been identified as a risk factor for dementia. However, the literature is inconsistent, and the underlying mechanisms are not well understood. We aimed to determine whether older adults with SCD had more modifiable protective factors against the risk of dementia and a lower risk of developing objective cognitive decline (OCD). We included 4363 older adults (71.7 ± 5.3 [mean ± standard deviation] years of age; 2239 women) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. SCD, OCD, and protective factors against dementia, such as lifestyle and activity, were assessed using interviews and objective cognitive-assessment tools. Based on initial cognitive status, participants were categorized into normal cognition, SCD-only, OCD-only, and both SCD and OCD groups. After 4 years, participants were classified as having either no impairment or mild or global cognitive impairment (i.e., OCD). Binomial logistic regression analyses were performed with the cognitive statuses of the groups at follow-up and baseline as the dependent and independent variables, respectively. After adjusting for potential confounding factors, we found that the SCD-only group had more modifiable protective factors against the risk of dementia than the OCD-only group. Community-dwelling older adults with normal cognition or those part of the SCD-only group had a lower risk of developing OCD during the 4-year follow-up, which may have been due to having more modifiable protective factors against the risk of dementia. Additionally, these factors may contribute to the inconsistencies in the literature on SCD outcomes.

Chronic pain is the most common health challenge for older adults and a significant risk factor for cognitive impairments and dementia. This study examined the relationship between high-impact pain (pain that limits daily activities) and subjective cognitive decline (SCD) in 13,763 adults aged 50 and older from the Health and Retirement Study (2004–2020). High-impact pain was associated with a higher prevalence and incidence of SCD as compared to no pain and low-impact pain, adjusted for sociodemographic and clinical factors. Additionally, high-impact pain predicted an increased risk of objective cognitive impairment, particularly in individuals without the APOE4 allele. Our findings suggest that high-impact pain is a stronger predictor of future cognitive impairments than SCD alone in most of the population who do not carry the APOE4 allele. Interventions targeting high-impact pain, starting in middle age, may help mitigate the risk of cognitive decline and dementia. Future research is needed to understand potential mechanisms and develop effective cognitive aging strategies considering the impact of pain itself on cognition.

Chronic pain may be an important factor influencing cognitive impairment; however, there is limited research on that link in older adults with disabilities. We aimed to determine the association between chronic pain and cognitive impairment in older adults with disabilities. This 24-month prospective cohort study involved 143 Japanese older adults (≥65 years of age) with long-term care insurance. Chronic pain was defined as pain persisting for ≥3 months, and cognitive impairment was defined as a Mini-Mental State Examination score ≤ 23. We employed logistic regression analysis with chronic pain as the independent variable and cognitive impairment as the dependent variable after propensity score matching (PSM). Sixty-six participants were selected using PSM, and logistic regression analysis showed that chronic pain was significantly associated with cognitive impairment (odds ratio: 4.103, 95% confidence interval: 1.455-11.567, P = 0.008). To prevent cognitive impairment in older adults with disabilities, the management of chronic pain should be considered, as they are related.

Associations between Physical Activity and Cognitive Functioning among Middle-Aged and Older Adults.

Cognitive performance before and after the onset of subjective cognitive decline in old age