Longitudinal associations of pain and cognitive decline in community-dwelling older adults

Abstract

Pain is inversely associated with cognitive function in older adults, but the effects of pain on cognitive decline are not fully clear. This study examined the associations of baseline pain, pain persistence, and incident pain with changes in cognition across 10 years in a sample of healthy community-dwelling older adults (n = 688; M_age = 74, SD = 6.05) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. While ACTIVE was a four-arm single-blind cognitive training randomized controlled trial, the present study includes only participants from the no-contact control group. Pain was examined using the Medical Outcomes Survey SF-36-Item (MOS SF-36) and cognitive tests examined simple processing speed, complex processing speed, divided and selective attention, memory, reasoning, and cognitive status. Multilevel models tested the associations of baseline pain, incident pain, and pain persistence on cognitive function and cognitive decline, adjusted for baseline age, time (years after follow-up), race, gender, education, marital status, and depressive symptoms at baseline and over time. Thirty-one percent reported pain at baseline which was related to worse baseline memory and accelerated decline in processing speed. Forty-two percent of older adults reported incident pain had accelerated decline in complex processing speed, divided attention, memory, reasoning, and cognitive status. On average, older adults reported a mean of two waves of pain persistence related to accelerated decline in memory. In sum, pain is common in community-dwelling older adults and is related to accelerated cognitive decline, especially when the incident. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT00298558.

Figure 1.

Illustration of the statistical model. Notes. Baseline pain is a fixed variable coded 0 for not reporting baseline pain and 1 for reporting baseline pain; incident pain is a time-varying variable coded 0 for not reporting incident pain and 1 for reporting incident pain (and 1 consistently thereafter to estimate change in slope). Pain persistence is the running sum of total waves reporting pain. γ07 estimates initial cognitive differences between older adults with and without baseline pain, while β10 estimates differences in the rate of cognitive change. β3 estimates initial cognitive differences between older adults with and without incident pain, while β12 estimates differences in the rate of cognitive change. β4 estimates initial cognitive differences between people experiencing an added wave of pain persistence compared to those who do not, while β13 estimates differences in the rate of cognitive change.

Figure 2.

Summary of study findings. Notes. Main results:(1) baseline pain and incident pain were related to faster declines in cognitive status (MMSE); (2) baseline pain was related to slower processing speed (3); incident pain was related to worse memory (PRT), divided attention (UFOV2), and reasoning (Word Series and Letter Series); (4) pain persistence was related to accelerated memory decline (AVLT); and (5) except for mental status and memory measures, people with baseline pain and incident pain showed initial cognitive function in domains they eventually declined faster in compared to people with no pain, possibly due to activation of cognitive compensation or longstanding differences in cognitive reserve. Gray diagonal lines: Baseline pain may have involved pain from earlier life, which may have influenced our findings. AVLT = Auditory Verbal Learning Task; PRT = Rivermead Paragraph Recall Task; MMSE = Mini Mental Status Examination.

Figure 3.

Differences in simple processing speed in people with baseline pain, incident pain, and no pain. Note. DSST = Digit Symbol Substitution Task.

Figure 4.

Differences in cognitive status in people with baseline pain, incident pain, and no pain. Note. MMSE = Mini-Mental Status Examination.

Figure 5.

Differences in complex processing speed in people with baseline pain, incident pain, and no pain. Note. CRT = Complex Reaction Time.

Figure 6.

Differences in divided attention in people with baseline pain, incident pain, and no pain. Note. UFOV2 = Useful Field of View Subtest 2.

Figure 7.

Differences in reasoning on the Word Series task in people with baseline pain, incident pain, and no pain.

Figure 8.

Differences in reasoning on the Letter Series task in people with baseline pain, incident pain, and no pain.

Figure 9.

Differences in memory in people with baseline pain, incident pain, and no pain. Note. PRT = Rivermead Paragraph Recall Task.