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Meta-Analysis
. 2023 Jul;35(7):1513-1520.
doi: 10.1007/s40520-023-02434-7. Epub 2023 May 25.

Pain and mild cognitive impairment among adults aged 50 years and above residing in low- and middle-income countries

Lee Smith  1 , Guillermo F López Sánchez  2 , Jae Il Shin  3 , Pinar Soysal  4 , Damiano Pizzol  5 , Yvonne Barnett  1 , Karel Kostev  6 , Louis Jacob  7   8 , Nicola Veronese  9 , Laurie Butler  1 , Helen Odell-Miller  10 , Jodie Bloska  10 , Benjamin R Underwood  11   12 , Ai Koyanagi  7   13
Affiliations
Meta-Analysis

Pain and mild cognitive impairment among adults aged 50 years and above residing in low- and middle-income countries

Lee Smith et al. Aging Clin Exp Res. 2023 Jul.

Abstract

Background: Previous studies on the association between pain and cognitive decline or impairment have yielded mixed results, while studies from low- and middle-income countries (LMICs) or specifically on mild cognitive impairment (MCI) are scarce. Thus, we investigated the association between pain and MCI in LMICs and quantified the extent to which perceived stress, sleep/energy problems, and mobility limitations explain the pain/MCI relationship.

Methods: Data analysis of cross-sectional data from six LMICs from the Study on Global Ageing and Adult Health (SAGE) were performed. MCI was based on the National Institute on Aging-Alzheimer's Association criteria. "Overall in the last 30 days, how much of bodily aches or pain did you have?" was the question utilized to assess pain. Associations were examined by multivariable logistic regression analysis and meta-analysis.

Results: Data on 32,715 individuals aged 50 years and over were analysed [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, compared to no pain, mild, moderate, and severe/extreme pain were dose-dependently associated with 1.36 (95% CI = 1.18-1.55), 2.15 (95% CI = 1.77-2.62), and 3.01 (95% CI = 2.36-3.85) times higher odds for MCI, respectively. Mediation analysis showed that perceived stress, sleep/energy problems, and mobility limitations explained 10.4%, 30.6%, and 51.5% of the association between severe/extreme pain and MCI.

Conclusions: Among middle-aged to older adults from six LMICs, pain was associated with MCI dose-dependently, and sleep problems and mobility limitations were identified as potential mediators. These findings raise the possibility of pain as a modifiable risk factor for developing MCI.

Keywords: Epidemiology; Low- and middle-income countries; Mild cognitive impairment; Pain.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Prevalence of mild cognitive impairment by severity of pain. Bars denote 95% confidence intervals
Fig. 2
Fig. 2
Country-wise association between severe/extreme pain and mild cognitive impairment (outcome) estimated by multivariable logistic regression. Abbreviation: OR odds ratio; CI confidence interval. Models are adjusted for age, sex, education, wealth, marital status, alcohol consumption, smoking, body mass index, chronic physical conditions, and depression. Overall estimate was obtained by meta-analysis with fixed effects
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