Binnekade Tarik T, Perez Roberto Sgm, Maier Andrea B, Rhodius-Meester Hanneke Fm, Legdeur Nienke, Trappenburg Marijke C, Rhebergen Didi, Lobbezoo Frank, Scherder Erik Ja
Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands.
Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
J Pain Res. 2019 May 22;12:1621-1629. doi: 10.2147/JPR.S158488. eCollection 2019.
The association between pain and dementia is complicated and may depend on underlying brain pathology. It was hypothesized that both medial temporal atrophy (MTA) and global cortical atrophy (GCA) predicted no/mild pain, while white matter hyperintensities (WMH) predicted moderate/severe pain. To study the association between pain intensity and measures of brain pathology, more specifically MTA, GCA, and WMH. In total, 115 consecutive patients visiting an outpatient memory clinic were included. In total, diagnoses included dementia (N=70), mild cognitive impairment (N=30), and subjective cognitive impairment (N=15). Without administering stimuli, pain intensity was assessed with the Brief Pain Inventory. MTA, GCA, and WMH were measured with a MRI visual rating scale. Logistic regression analyses to examine the relationship between WMH, MTA, GCA, and self-reported pain intensity (no/mild pain versus moderate/severe pain) were adjusted for confounders. Mean age of the patients was 81 years (IQR: 78-85, 53% female). Moderate/severe pain was reported by 23.5% and associated with greater WMH (OR =3.34, 95% CI =1.01-10.97, =0.047), but not MTA or GCA. In contrast to the present results, earlier studies have reported either a positive or negative relationship between pain and brain volume. It is suggested that the presence of dementia may explain the absence of a relationship between pain and brain volume. WMH is positively related with pain in an older memory outpatient population. Considering the small sample size, our findings should be interpreted with caution. Hence, our conclusions are preliminary findings, warranting future replication.
疼痛与痴呆之间的关联很复杂，可能取决于潜在的脑病理学情况。据推测，内侧颞叶萎缩（MTA）和全脑皮质萎缩（GCA）预示无/轻度疼痛，而白质高信号（WMH）预示中度/重度疼痛。为研究疼痛强度与脑病理学指标之间的关联，更具体地说是MTA、GCA和WMH之间的关联。总共纳入了115名连续就诊于门诊记忆诊所的患者。诊断包括痴呆（N = 70）、轻度认知障碍（N = 30）和主观认知障碍（N = 15）。在不施加刺激的情况下，使用简明疼痛问卷评估疼痛强度。使用MRI视觉评分量表测量MTA、GCA和WMH。采用逻辑回归分析来检验WMH、MTA、GCA与自我报告的疼痛强度（无/轻度疼痛与中度/重度疼痛）之间的关系，并对混杂因素进行了校正。患者的平均年龄为81岁（四分位间距：78 - 85岁，53%为女性）。23.5%的患者报告有中度/重度疼痛，且与更大程度的WMH相关（比值比 = 3.34，95%置信区间 = 1.01 - 10.97，P = 0.047），但与MTA或GCA无关。与目前的结果相反，早期研究报道疼痛与脑容量之间存在正相关或负相关关系。有人认为痴呆的存在可能解释了疼痛与脑容量之间不存在关联的原因。在老年记忆门诊人群中，WMH与疼痛呈正相关。考虑到样本量较小，我们的研究结果应谨慎解读。因此，我们的结论是初步发现，有待未来重复验证。
