Pain interference, cognition, and depressive symptoms in Alzheimer’s disease

Abstract

AbstractBackgroundUnderrecognized and untreated pain in people with Alzheimer’s disease (AD) is a public health concern1 and is associated with sleep disturbances, loss of appetite, and depressive symptoms2. As cognition worsens, people with AD may be unable to reliably report their pain3; 4. While previous studies have examined self‐reported pain intensity in persons with AD5; 6, there has been limited investigation into how this pain interferes with daily living (i.e. pain interference). Wang et al (2017) reported that cognition has a positive association with pain interference and depression7 in AD. However, the relationship of the specific aspects of pain interference with cognitive function and depression has not been explored. Here we investigate the association of specific pain interference subscores with cognitive function and depressive symptoms in verbally communicative older adults with mild to moderate AD. We hypothesized that (1) AD individuals with better cognitive function will report more pain interference in all categories; and (2) all elements of pain interference will be positively associated with depressive symptoms.MethodFor this secondary analysis, we investigated the relationship between pain interference (Brief Pain Inventory‐ Short Form), cognitive function (Mini‐Mental Status Exam), and depressive symptoms (15‐item Geriatric Depression Scale) in 52 older communicative adults (ages ≥ 65) with AD. Data analyses were conducted in R using Spearman correlation coefficients to assess the univariate associations between study measures.ResultWe found significant positive correlations between cognitive function (median MMSE = 17.00) and pain interference subscores of general activity, mood, walking ability, normal work, sleep, and enjoyment of life (r = .30‐.37, p < 0.05), but not “relations with other people.” Further, the relationship between depressive symptomatology (median GDS‐15 = 2.00) with pain interference was significant in all measures except “general activity” (r = .26 ‐.38, p < 0.05).ConclusionAmong adults with AD, nearly all aspects of pain interference were positively associated with cognitive function and depressive symptoms. Regular assessment of specific pain interference measures and screening for depressive symptomology can be used as another tool to help identify unreported and underrecognized pain. Moreover, distinguishing individual elements of pain interference may allow for more individualized management of pain and depressive symptoms in this vulnerable population.