Rischer Katharina M, Anton Fernand, González-Roldán Ana M, Montoya Pedro, van der Meulen Marian
Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences, Balearic Islands Health Research Institute, University of the Balearic Islands, Palma, Spain.
Front Aging Neurosci. 2022 Jul 7;14:828742. doi: 10.3389/fnagi.2022.828742. eCollection 2022.
Growing evidence suggests that aging is associated with less efficient endogenous pain modulation as demonstrated by reduced conditioned pain modulation, and that these changes may be mediated by differences in frontal functioning. Yet, little is known about potential age-related changes in cognitive pain modulation, such as distraction from pain. In a first session, 30 healthy young (19-35 years) and 30 healthy older (59-82 years) adults completed a battery of neuropsychological tests. In a second session, we acquired functional brain images while participants completed a working memory task with two levels of cognitive load (high vs. low) and concurrently received individually adjusted heat stimuli (warm vs. painful). In both age groups, completing the high load task was associated with a significant reduction in the perceived intensity and unpleasantness of painful stimuli and a reduction in activation of brain regions involved in pain processing. Group comparisons revealed that young adults showed a stronger de-activation of brain regions involved in pain processing during the high load vs. the low load task, such as the right insula, right mid cingulate cortex and left supramarginal gyrus, compared to older adults. Older adults, on the other hand, showed an increased activation in the anterior cingulate cortex during the high load vs. low load task, when compared to young adults. Covariate analyses indicated that executive functions significantly predicted neural pain modulation in older adults: Better executive functions were associated with a more pronounced de-activation of the insula, thalamus and primary somatosensory cortex and increased activation of prefrontal regions during the high vs. low load task. These findings suggest that cognitive pain modulation is altered in older age and that the preservation of executive functions may have beneficial effects on the efficacy of distraction from pain.
越来越多的证据表明，衰老与内源性疼痛调节效率降低有关，如条件性疼痛调节减弱，且这些变化可能由额叶功能差异介导。然而，对于认知性疼痛调节中潜在的与年龄相关的变化，如从疼痛中分散注意力，我们知之甚少。在第一阶段，30名健康的年轻人（19 - 35岁）和30名健康的老年人（59 - 82岁）完成了一系列神经心理学测试。在第二阶段，我们获取了功能性脑图像，在此期间参与者完成了一个具有两种认知负荷水平（高负荷与低负荷）的工作记忆任务，并同时接受个体调整的热刺激（温暖与疼痛）。在两个年龄组中，完成高负荷任务都与疼痛刺激的感知强度和不愉快程度显著降低以及参与疼痛处理的脑区激活减少有关。组间比较显示，与老年人相比，年轻人在高负荷任务与低负荷任务期间，参与疼痛处理的脑区，如右侧岛叶、右侧中央扣带回皮质和左侧缘上回，表现出更强的去激活。另一方面，与年轻人相比，老年人在高负荷任务与低负荷任务期间前扣带回皮质的激活增加。协变量分析表明，执行功能显著预测了老年人的神经疼痛调节：更好的执行功能与在高负荷与低负荷任务期间岛叶、丘脑和初级体感皮层更明显的去激活以及前额叶区域的激活增加有关。这些发现表明，老年人的认知性疼痛调节发生了改变，并且执行功能的保留可能对从疼痛中分散注意力的效果有有益影响。
