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Persistent pain associated with accelerated cognitive decline

Elders reporting persistent moderate-to-severe pain have an increased risk for memory decline and dementia, according to a study published in JAMA Internal Medicine.

“Chronic pain affects 25% to 33% of older adults, and its prevalence increases with age... More recently, population-based studies have demonstrated an association between pain and geriatric syndromes such as falls, functional impairment, and cognitive decline and dementia,” Elizabeth L. Whitlock, MD, MSc, from the department of anesthesia and perioperative care at University of California, San Francisco, and colleagues wrote.

“Because of the implications for functional independence and quality of life, the association between chronic pain and cognitive impairment deserves further attention,” they added.

Whitlock and colleagues conducted a cohort study to evaluate the relationship between persistent pain, defined as often experiencing moderate or severe pain, and subsequent cognitive decline. Participants included 10,065 community-dwelling older adults aged 62 years or older in 2000 who had participated in the Health and Retirement Study. They were interviewed in 1998 and 2000 and answered questions on pain and cognition.

The researchers combined neuropsychological test results and informant and proxy interviews to estimate composite memory score and dementia probability. They used linear mixed-effects models to determine the association of persistent pain with the slope of subsequent cognitive trajectory. The analysis was adjusted for demographic characteristics and comorbidities.

Baseline data indicated that 10.9% of participants had persistent pain. These participants were more likely to have worse depressive symptoms and more limitations in activities of daily living. Compared with participants without persistent pain, those with persistent pain had 9.2% (95% CI, 2.8-15.0) more rapid memory decline. This accelerated memory decline increased the relative risk for inability to manage medications and finances independently by 15.9% and 11.8%, respectively, after 10 years. Participants with persistent pain had a 7.7% faster increase of adjusted dementia probability (95% CI, 0.55%-14.2%), resulting in an absolute increase of 2.2% after 10 years.

“We demonstrate that a persistent report of moderate-to-severe pain, which may reflect chronic pain, is associated with accelerated cognitive decline and increased dementia probability in a large population-representative data set of elders,” Whitlock and colleagues concluded. “Clinicians should be aware of this association, which persisted after extensive statistical adjustment for confounding health and demographic factors. Patients reporting ongoing pain may be at higher risk for current and incident cognitive impairment and physical debility.” – by Alaina Tedesco

Disclosure: Whitlock reports receiving support from the National Institute of General Medical Sciences. Please see full study for complete list of all other authors’ relevant financial disclosures.