Department of Psychiatry, University of California San Diego, San Diego, California, USA.
J Am Geriatr Soc. 2022 Feb;70(2):449-458. doi: 10.1111/jgs.17542. Epub 2021 Nov 5.
No studies have examined the longitudinal association between the persistence of pain and its relationship to cognitive problems in older adults. The objective of this study was to examine how the persistent of pain associates with cognitive performance, cognitive impairment, and subjective memory decline.
Across 10 biennial waves, 8515 adults ages 65 and over were assessed from the Health and Retirement Study (M = 74.17, SD = 6.87, 59.2% female). At each wave, individuals were asked to report on pain presence, and if present, rate its intensity and interference with daily activities such as housework or chores. Using running frequencies or averages, we calculated the persistence of pain using these three pain measures. Cognition was assessed using cognitive performance and different cognitive impairment cutoffs. Incident subjective memory decline was additionally measured as new self-reported memory change in the last 2 years. General estimating equations examined concurrent associations between persistence of pain and cognitive variables, adjusting for demographics, depressive symptoms, and medical comorbidities.
Persistence of pain presence was associated with an increased risk of cognitive impairment. Only persistence of pain interference, not pain intensity, was significantly associated with poorer cognitive performance or being classified as cognitively impaired. For every 2 years, persistence of pain interference was associated with 21% increased odds of cognitive impairment. Only one of three pain variables was related to incident subjective memory decline.
Persistence of pain is associated with poorer cognitive performance in community-dwelling older adults, especially when involving ongoing interference in chores and work. Facilitating pain management might be important for helping to maintain later-life cognition and reduce dementia risk.
目前尚无研究探讨老年人疼痛持续存在与认知问题之间的纵向关联。本研究旨在探讨疼痛持续存在与认知表现、认知障碍和主观记忆减退之间的关系。
在健康与退休研究的 10 个两年期波次中，评估了 8515 名年龄在 65 岁及以上的成年人（M=74.17，SD=6.87，59.2%为女性）。在每个波次中，个体均需报告疼痛的存在情况，如果存在，则需评估其强度以及对日常活动（如家务或杂务）的干扰程度。我们使用运行频率或平均值，基于这三个疼痛指标计算疼痛的持续存在情况。使用认知表现和不同的认知障碍标准来评估认知。此外，还将最近 2 年内新出现的自我报告记忆变化作为新发主观记忆减退进行测量。使用一般估计方程，调整人口统计学、抑郁症状和合并症后，同时检验疼痛持续存在与认知变量之间的关联。
疼痛持续存在与认知障碍的风险增加相关。只有疼痛干扰的持续存在与认知表现较差或被归类为认知障碍显著相关，而疼痛强度的持续存在则不然。疼痛干扰的持续存在每增加 2 年，认知障碍的风险就会增加 21%。三个疼痛变量中只有一个与新发主观记忆减退相关。
在社区居住的老年人中，疼痛持续存在与认知表现较差有关，尤其是当疼痛持续存在并对家务和工作造成持续干扰时。促进疼痛管理可能对维持老年人的认知能力和降低痴呆风险非常重要。
