Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France; INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France.
Department of Aging Psychiatry, Hospital Le Vinatier, Bron, France; Department of Psychiatry, Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
J Pain. 2021 Aug;22(8):905-913. doi: 10.1016/j.jpain.2021.01.007. Epub 2021 Feb 25.
Chronic pain (CP) and cognitive impairment are common in older adults. CP was found to be associated with cognitive impairment in many cross-sectional studies. However, their cross-sectional design precluded inference on temporality. Accordingly, we aimed to prospectively assess the association between cognitive functioning and the occurrence of CP in older community dwellers. Analyses were based on data of the first (FU1) and the second follow-up (FU2) of CoLaus|PsyCoLaus, a prospective cohort study conducted in the general population of Lausanne (Switzerland) including the participants aged 65 and over. Neuropsychological functioning including memory, language, attention and executive function was measured at FU1. CP was assessed at FU1 and FU2 by self-rating questionnaire. The association between cognitive scores and subsequent CP was determined using multiple logistic regressions. Among the 337 participants without CP at FU1, 107 (31.8%) developed CP at FU2. A significant association was observed between higher Stroop color-time and interference index at FU1 and a higher risk of CP at FU2 (OR = 1.02; P = .03 and OR = 1.49; P = .03, respectively). Our results suggest that patients with inhibitory deficit may be at higher risk of developing CP in the presence of painful events. A cognitive assessment could be recommended to identify frail patients in these situations. PERSPECTIVE: This study suggests that presence of inhibitory deficits is associated with a higher risk of developing subsequent CP in older adults. In the presence of painful events, a cognitive assessment should be recommended to identify frail patients and to manage them carefully.
慢性疼痛（CP）和认知障碍在老年人中很常见。许多横断面研究发现 CP 与认知障碍有关。然而，它们的横断面设计排除了对时间性的推断。因此，我们旨在前瞻性评估认知功能与老年社区居民 CP 发生之间的关系。分析基于 CoLaus|PsyCoLaus 的第一次（FU1）和第二次随访（FU2）的数据，这是一项在瑞士洛桑的一般人群中进行的前瞻性队列研究，包括年龄在 65 岁及以上的参与者。神经心理学功能包括记忆、语言、注意力和执行功能，在 FU1 时进行测量。CP 在 FU1 和 FU2 通过自我评估问卷进行评估。使用多变量逻辑回归确定认知评分与随后 CP 之间的关联。在 FU1 时没有 CP 的 337 名参与者中，有 107 名（31.8%）在 FU2 时发生 CP。在 FU1 时较高的 Stroop 颜色-时间和干扰指数与 FU2 时 CP 风险较高之间存在显著关联（OR=1.02；P=0.03 和 OR=1.49；P=0.03，分别）。我们的结果表明，存在抑制缺陷的患者在存在疼痛事件的情况下可能有更高的发展 CP 的风险。在这些情况下，进行认知评估可以识别体弱的患者。展望：本研究表明，存在抑制缺陷与老年人随后发生 CP 的风险较高有关。在存在疼痛事件的情况下，应建议进行认知评估，以识别体弱的患者并谨慎管理他们。
