老年人慢性疼痛与长期痴呆风险：一项长达 24 年的纵向研究结果。

Chronic pain and long-term dementia risk in older adults: Results from a 24-year longitudinal study.

机构信息

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.

出版信息

Int J Geriatr Psychiatry. 2022 May;37(5). doi: 10.1002/gps.5713.

DOI:10.1002/gps.5713

PMID:35434855

Abstract

INTRODUCTION

Chronic pain (CP) was associated with cognitive impairment in previous studies. However, the longitudinal association between CP and dementia remains under debate. We aimed to assess the prospective link between CP and long-term dementia risk in a population-based cohort of older participants, considering covariables linked to CP and cognitive functioning.

METHODS

The study sample was selected from the PAQUID study, an ongoing cohort of older community-dwellers aged 65 years and over at baseline; Information regarding CP and analgesics consumption was collected using questionnaires. Dementia was clinically assessed every 2 years. The population was divided into 4 groups according to CP and analgesic drugs intake (CP+/A+, CP+/A-, CP-/A+, CP-/A-). An illness-death model was used to estimate the link between CP and incident dementia risk controlled for sex, educational level, comorbidities, depression, antidepressant drugs and analgesics.

RESULTS

Five hundred ninety three participants (364 women) who completed a CP questionnaire, were included. They were followed-up over 24 years (mean follow-up: 11.3 years, SD 7.3). A total of 223 participants (32.5%) had CP, among them 88 (38.6%) took analgesic drugs. Compared to CP-/A- group, CP+/A+ participants had a higher risk of developing dementia in the univariate model (hazard ratio (HR) = 1.73, 95%CI:1.18-2.56; p = 0.0051). However, these results did not persist in the multivariate models (aHR = 1.23, 95%CI:0.88-1.73; p = 0.23). No significant risk for dementia were observed in CP-/A+ and CP+/A- (HR = 1.30, 95%CI:0.84-2.01; p = 0.23 and HR = 1.36, 95%CI:0.95-1.96; p = 0.09, respectively).

CONCLUSION

Our results failed to show a significant relationship between the presence of CP and long-term dementia risk, suggesting that the cognitive decline associated with CP observed in the literature does not appear to be related to Alzheimer's disease or related disorders.

摘要

简介

在先前的研究中，慢性疼痛（CP）与认知障碍有关。然而，CP 与痴呆症之间的纵向关联仍存在争议。我们旨在评估 CP 与老年参与者人群中长期痴呆风险之间的前瞻性联系，同时考虑与 CP 和认知功能相关的协变量。

方法

研究样本选自 PAQUID 研究，这是一项针对 65 岁及以上社区居民的正在进行的队列研究；使用问卷收集 CP 和止痛药使用情况的信息。每两年对痴呆症进行一次临床评估。根据 CP 和止痛药的摄入情况，人群分为 4 组（CP+/A+、CP+/A-、CP-/A+、CP-/A-）。使用疾病死亡模型来估计 CP 与经过性别、教育水平、合并症、抑郁、抗抑郁药和止痛药调整后的新发痴呆症风险之间的联系。

结果

593 名（364 名女性）完成 CP 问卷的参与者被纳入研究。他们的随访时间为 24 年（平均随访时间为 11.3 年，标准差为 7.3 年）。共有 223 名参与者（32.5%）患有 CP，其中 88 名（38.6%）服用了止痛药。与 CP-/A-组相比，CP+/A+组在单变量模型中发生痴呆的风险更高（危险比（HR）=1.73，95%CI：1.18-2.56；p=0.0051）。然而，这些结果在多变量模型中并未持续（调整后 HR=1.23，95%CI：0.88-1.73；p=0.23）。CP-/A+和 CP+/A-组发生痴呆的风险无显著增加（HR=1.30，95%CI：0.84-2.01；p=0.23 和 HR=1.36，95%CI：0.95-1.96；p=0.09）。