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Persistent pain may be linked with cognitive decline, dementia risk

By Jane Lewis 
Persistent pain is associated with accelerated memory decline and increased probability of dementia, new research published in JAMA Internal Medicine suggests. 

‘Patients reporting ongoing pain may be at higher risk for current and incident cognitive impairment and physical debility,’ the authors of the cohort study concluded. 

Commenting on the study, Dr Steven Savvas, Stream Leader (Pain), Clinical Gerontology Division, National Ageing Research Institute, Melbourne, said because dementia has such a profound impact on a person’s sense of self, independence and quality of life, determining the conditions that may contribute to dementia risk is vital. 

‘Persistent pain can also have a profound impact on quality of life and function,’ he said, ‘so evidence that persistent pain is associated with cognitive decline is especially worrying,’ he told Pain Management Today

The US study set out to estimate the prognostic effect of persistent reports of pain on the longitudinal cognitive trajectory in the elderly, using data from biennial interviews of 10,065 community-dwelling adults aged 60 years or older at baseline (60% female; median age 73 years). At baseline, 10.9% of participants reported persistent pain. Participants with persistent pain reported more depressive symptoms, a greater prevalence of limitations in activities of daily living, and more comorbid medical conditions compared with other participants. 

Over time, participants with persistent pain experienced a 9.2% more rapid decline in memory score, translating to a 15.9% higher relative risk of inability to manage medications and an 11.8% higher relative risk of inability to manage finances independently at the end of 10 years, compared with age-adjusted peers. Adjusted dementia probability increased 7.7% faster after 10 years, translating to an absolute 2.2% increase in dementia probability for those with persistent pain. 

‘Not merely a cross-sectional effect, the presence of persistent pain has long term implications for memory performance and dementia in the elderly,’ the researchers stated.

According to Dr Savvas, although the study’s results suggest that the association between persistent pain and risk of dementia 10 years later is relatively small, the potential impact of pain on memory decline is somewhat larger. 

‘The clinical implications of this are unclear, but it may suggest that clinicians need to be vigilant for memory decline in people with persistent pain,’ he said. ‘More research is needed to better understand the relationship between pain and the risk of cognitive decline, and factors that may mitigate that risk.’
JAMA Intern Med 2017; doi: 10.1001/jamainternmed.2017.1622. 

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