Department of Neurology, Albert Einstein College of Medicine, Bronx, New York; Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.
J Pain. 2018 Dec;19(12):1435-1444. doi: 10.1016/j.jpain.2018.06.009. Epub 2018 Jul 10.
Older adults frequently report pain; cross-sectional studies have shown that pain is associated with worse cognitive function. However, longitudinal studies are lacking. We prospectively studied 441 participants without dementia, including 285 with pain, aged 65 years and older, enrolled in the Central Control of Mobility in Aging study, a prospective cohort study. We analyzed the longitudinal association between pain (measured with the Medical Outcomes Study pain severity scale) and major cognitive impairment (measured with the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test Delta) using Cox regression analysis adjusted for age, gender, ethnicity, and education. Over a mean follow-up of 2.75 years (standard deviation = 1.94), there was no difference in the risk of developing cognitive impairment between participants with pain and participants without pain. However, among those with pain, risk for developing major memory impairment was higher among those with high levels of pain than those with low levels of pain (adjusted hazard ratio = 3.47, 95% confidence interval = 1.42-8.46). The association with pain and incident impairments in attention or executive function was not significant. We did not find that pain is associated with incident cognitive impairment in general, but among older adults with pain, a high level of pain is associated with increased risk of developing incident memory impairment. PERSPECTIVE: Our study results suggest that high levels of pain may contribute to incident memory impairment. Further research is needed to determine whether a high level of chronic pain is a modifiable risk factor for cognitive impairment in older adults.
老年人经常报告疼痛；横断面研究表明，疼痛与认知功能下降有关。然而，缺乏纵向研究。我们前瞻性地研究了 441 名无痴呆的参与者，包括 285 名有疼痛的 65 岁及以上老年人，他们参加了老龄化移动能力中心研究，这是一项前瞻性队列研究。我们使用 Cox 回归分析调整了年龄、性别、种族和教育因素，分析了疼痛（使用医疗结果研究疼痛严重程度量表测量）与主要认知障碍（使用重复性认知评估量表和走迷宫测试 Delta 测量）之间的纵向关联。在平均 2.75 年（标准差=1.94）的随访期间，有疼痛和无疼痛的参与者发生认知障碍的风险没有差异。然而，在有疼痛的参与者中，高水平疼痛的人比低水平疼痛的人更容易出现主要记忆障碍（调整后的危险比=3.47，95%置信区间=1.42-8.46）。疼痛与注意力或执行功能障碍的发生之间没有显著关联。我们没有发现疼痛与一般认知障碍的发生有关，但在有疼痛的老年人中，高水平的疼痛与发生记忆障碍的风险增加有关。观点：我们的研究结果表明，高水平的疼痛可能导致记忆障碍的发生。需要进一步研究以确定慢性疼痛水平是否是老年人认知障碍的可改变风险因素。
