In a population-based cohort study described in JAMA Internal Medicine, older adults with persistent pain showed more rapid memory decline and greater dementia probability compared with adults without persistent pain.1
The prevalence of chronic pain in older adults is 25% to 33%, and recovery is less likely in this group compared with younger individuals.2,3 Recent findings demonstrated a link between pain and outcomes that commonly affect the elderly, including functional impairment, cognitive decline, and dementia.4-6 Older adults with chronic pain have been found to have poorer memory and executive function than their younger counterparts, both of which are closely associated with functional independence.6
In the current study, data from 10,065 participants (median baseline age, 73; 60% women; 1120 [10.9%] with persistent pain) in the Health and Retirement Study was analyzed to assess the longitudinal effects of persistent pain on memory and the probability of developing dementia. In addition, the impact of pain-related memory decline on daily functional tasks (ie, medication and financial management) was examined.
Participants initially reported outcomes in 1998 and 2000 and were followed until 2012 or until death or dropout from the study. Composite memory score and dementia probability were “estimated by combining neuropsychological test results and informant and proxy interviews.” Patients with moderate to severe persistent pain were compared with age-adjusted peers without persistent pain.
Study participants with persistent pain at baseline had worse depressive symptoms and more functional limitations pertaining to daily tasks vs participants without persistent pain. After adjustment for covariates such as marital status, alcohol use, and financial assets, more rapid memory decline was observed in patients with persistent pain (mean, 9.2%; 95% CI, 2.8%-15.0%; P <.001).
These patients also had an increased relative risk of inability to manage medications (11.8%) or finances (15.9%) after 10 years, compared with patients without persistent pain. In addition, the increase in adjusted dementia probability was 7.7% (95% CI, 0.55%-14.2%) higher in the pain group.
These findings suggest that, along with the direct treatment implications of asking patients about pain, such discussions could provide clinicians the opportunity “introduce mitigation strategies—such as assistive devices or other physical or occupational therapy interventions to address pain-related functional limitations, or self-efficacy and mindfulness strategies to reduce the affective impact of chronic pain,” the researchers concluded.
Summary and Clinical Applicability
Moderate to severe persistent pain in older adults is linked with accelerated memory decline and increased dementia probability.
Because more patients with chronic pain had higher rates of death and dropout in the study, these patients had fewer evaluations than the comparison group. Also, the Health and Retirement Study provided scant information about the origin, nature, or treatment of the pain, which precluded the stratification of participants based on common criteria.
- Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders [published online June 5, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.1622
- Mäntyselkä PT, Turunen JH, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003;290(18):2435-2442. doi:10.1001/jama.290.18.2435
- Elliott AM, Smith BH, Hannaford PC, Smith WC, Chambers WA. The course of chronic pain in the community: results of a 4-year follow-up study. Pain. 2002;99(1-2):299-307. doi:10.1016/S0304-3959(02)00138-0
- Shega JW, Weiner DK, Paice JA, et al. The association between noncancer pain, cognitive impairment, and functional disability: an analysis of the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2010;65(8):880-886. doi:10.1093/gerona/glq039
- Dublin S, Walker RL, Gray SL, et al. Prescription opioids and risk of dementia or cognitive decline: a prospective cohort study. J Am Geriatr Soc. 2015;63(8):1519-1526
- van der Leeuw G, Eggermont LH, Shi L, et al. Pain and cognitive function among older adults living in the community. J Gerontol A Biol Sci Med Sci. 2016;71(3):398-405. doi:10.1093/gerona/glv166