Chronic Pain May Accelerate Cognitive Decline

In a recent JAMA Internal Medicine article, researchers reported study results that showed older adults with moderate-to-severe pain had an increased risk for cognitive decline.

Study authors, Elizabeth L Whitlock, MD, MSc, University of California (San Francisco, CA), and colleagues wrote, “[P]opulation-based studies have demonstrated an association between pain and geriatric syndromes such as falls, functional impairment, and cognitive decline and dementia….[T]he association between chronic pain and cognitive impairment deserves further attention.”
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Participants in the study included 10,065 community-dwelling older adults (age 62 years or older) in 2000 who had been part of the Health and Retirement Study. Participants had been interviewed in 1998 and 2000 regarding pain and cognition (published online June 5, 2017; doi:10.1001/jamainternmed.2017.1622).

Researchers analyzed neuropsychological tests results, informant interviews, and proxy interviews to estimate composite memory scores and dementia probability. Linear mixed-effects models were used to determine the association of persistent pain with the slope of subsequent cognitive trajectory.

At baseline, 10.9% of participants had persistent pain, which was defined as moderate or severe pain; these older adults were more likely to have worse depressive symptoms and limitations on their daily activities. Persistent pain was associated with 9.2% more rapid memory decline compared with those without persistent pain. Adjusted dementia probability increased 7.7% faster; after 10 years, this translated to an absolute 2.2% increase in dementia probability for participants with persistent pain.

After 10 years, accelerated cognitive decline also translated to a 15.9% higher relative risk of inability to manage medications and an 11.8% higher relative risk of inability to managed finances independently.

In the article, authors 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.”

In terms of study limitations, authors said that patients with chronic pain received significantly fewer evaluations “due to death or dropout in comparison with the control group.” In addition, the study from which participants were taken did not provide much information regarding the source, nature or treatment of pain. Importantly, they also noted that the association between pain and cognitive decline is multifactorial, and not all factors were taken into account in the study.

—Amanda Del Signore