Karp Jordan F, Reynolds Charles F, Butters Meryl A, Dew Mary Amanda, Mazumdar Sati, Begley Amy E, Lenze Eric, Weiner Debra K
Intervention Research Center and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Pain Med. 2006 Sep-Oct;7(5):444-52. doi: 10.1111/j.1526-4637.2006.00212.x.
Persistent pain and cognitive impairment are each common in older adults. Mental flexibility, memory, and information-processing speed may be particularly vulnerable in the aging brain. We investigated the effects of persistent pain on these cognitive domains among community-dwelling, nondemented older adults.
Older Adult Pain Management Program.
A total of 56 new patients (mean age 76.1 years) were recruited to describe 1) rates of persistent pain conditions and pain intensity; 2) cognition (mental flexibility, short-term memory, and psychomotor speed); 3) severity of depression; and 4) sleep quality. All patients had nonmalignant pain for at least 3 months. Pain intensity was measured with the McGill Pain Questionnaire and depression severity with the 17-item Hamilton Rating Scale for Depression. Cognition was assessed with 1) Mini-Mental State Exam; 2) Number-Letter-Switching and Motor Speed subtests of the Delis-Kaplan Executive Function System Trail Making Test; 3) Digit Symbol Subtest (DSST) of the Wechsler Adult Intelligence Scales-III; and 4) free and paired recall of the DSST digit-symbol pairs. Multiple linear regression modeled whether these variables predicted poorer cognitive outcomes, after adjusting for the effects of opioids, sleep impairment, depression, medical comorbidity, and years of education.
In univariate analysis, pain severity was associated with a greater impairment on number-letter switching (r = -0.42, P = 0.002). This association remained after adjusting for the effects of depression, sleep, medical comorbidity, opioid use, and years of education (t = -1.97, P = 0.056).
In community dwelling older adults, neither pain nor mood was associated with measures of short-term memory or information-processing speed. However, pain severity was associated with decreased performance on a test of number-letter switching, indicating a relationship between pain and mental flexibility.
持续性疼痛和认知障碍在老年人中都很常见。心理灵活性、记忆力和信息处理速度在衰老的大脑中可能特别容易受到影响。我们调查了持续性疼痛对社区居住的非痴呆老年人这些认知领域的影响。
老年人疼痛管理项目。
共招募了56名新患者（平均年龄76.1岁），以描述1）持续性疼痛状况的发生率和疼痛强度；2）认知（心理灵活性、短期记忆力和精神运动速度）；3）抑郁严重程度；4）睡眠质量。所有患者均患有非恶性疼痛至少3个月。使用麦吉尔疼痛问卷测量疼痛强度，使用17项汉密尔顿抑郁评定量表测量抑郁严重程度。认知功能通过以下方式进行评估：1）简易精神状态检查表；2）德利斯科-卡普兰执行功能系统连线测验中的数字-字母转换和运动速度子测验；3）韦氏成人智力量表第三版的数字符号替换测验；4）数字符号替换测验数字-符号对的自由回忆和配对回忆。在调整了阿片类药物、睡眠障碍、抑郁、医疗合并症和受教育年限的影响后，多元线性回归模型分析了这些变量是否能预测较差的认知结果。
在单变量分析中，疼痛严重程度与数字-字母转换能力的更大损伤相关（r = -0.42，P = 0.002）。在调整了抑郁、睡眠、医疗合并症、阿片类药物使用和受教育年限的影响后，这种关联仍然存在（t = -1.97，P = 0.056）。
在社区居住的老年人中，疼痛和情绪均与短期记忆力或信息处理速度的测量指标无关。然而，疼痛严重程度与数字-字母转换测试中的表现下降相关，表明疼痛与心理灵活性之间存在关联。
