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. 2024 Dec 18:10:23337214241307537.
doi: 10.1177/23337214241307537. eCollection 2024 Jan-Dec.

Neuropsychological Symptoms and Functional Capacity in Older Adults with Chronic Pain

Anna S Ord  1 , Kim Coddington  1 , Genevieve P Maksad  1 , Sophia R Swiatek  1 , Joyelle Saunders  1 , David Netz  1 , Donna Washburn  1 , Susan Braud  1 , Jamie Holland  1 , Adrienne H Eldridge  1 , Shannon G Kuschel  1 , Anna T Magnante  1   2   3   4 , Alicia Cooper  1 , Scott W Sautter  1   5
Affiliations

Neuropsychological Symptoms and Functional Capacity in Older Adults with Chronic Pain

Anna S Ord et al. Gerontol Geriatr Med. .

Abstract

The impact of chronic pain on neuropsychological functioning of older adults is under-studied. The present study examined the relationship between chronic pain, depression, anxiety, cognition, and functional capacity in community-dwelling older adults (ages 60-89) who completed an outpatient neuropsychological evaluation (N = 452). Psychometrically sound and validated measures were used to assess depression (Geriatric Depression Scale [GDS]), anxiety (Beck Anxiety Inventory [BAI]), cognitive functioning (the Mini Mental Status Exam [MMSE] and the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]), and functional capacity (Texas Functional Living Scale [TFLS] and Instrumental Activities of Daily Living Questionnaire [IADL]). Multivariate analyses of covariance (MANCOVA) were conducted to examine differences between individuals with and without chronic pain, adjusting for age, education, gender, marital status, and other medical conditions. Results indicated that participants endorsing chronic pain displayed significantly higher levels of depression and anxiety, as well as lower levels of cognitive functioning and functional capacity, than those without chronic pain. Additionally, results of hierarchical multiple regressions indicated that chronic pain explained unique variance in all outcome variables, beyond demographic characteristics and health status. Chronic pain management may be an important intervention target for clinicians to help address cognitive and psychological functioning in older adults.

Keywords: anxiety; chronic pain; cognitive functioning; depression; older adults.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Differences in psychiatric symptoms between individuals with chronic pain and without chronic pain. Note. GDS-SF = geriatric depression scale, short form; BAI = Beck anxiety inventory. Higher scores indicate higher levels of psychiatric symptoms. Participants who endorsed chronic pain displayed significantly higher scores on measures of depression (GDS-SF) and anxiety (BAI). Differences were statistically significant (p < .001) after false discovery rate (FDR) correction for multiple comparisons.
Figure 2.
Figure 2.
Differences in functional capacity between individuals with chronic pain and those without chronic pain. Note. IADL = instrumental activities of daily living questionnaire (higher score indicates a higher number of problems in completing instrumental activities of daily living and therefore lower functional capacity); TFLS = Texas functional living scale (higher scores indicate better functional capacity and higher independence in instrumental activities of daily living). Participants who endorsed chronic pain displayed significantly higher scores on IADL questionnaire and lower scores on TFLS, indicating lower functional capacity. The differences in IADL and TFLS total scores were statistically significant (p < .001) after false discovery rate (FDR) correction for multiple comparisons.
Figure 3.
Figure 3.
Differences in cognitive functioning between individuals with chronic pain and those without chronic pain. Note. MMSE = mini-mental state examination; RBANS = repeatable battery for the assessment of neuropsychological status. Higher scores indicate better cognitive functioning. Participants who did not report chronic pain concerns displayed significantly better total scores on both measures of cognitive functioning: MMSE and RBANS. Differences were statistically significant (p < .001) after false discovery rate (FDR) correction for multiple comparisons.
Figure 4.
Figure 4.
Unique variance (ΔR2) explained by chronic pain beyond demographic characteristics and number of medical conditions. Note. BAI = Beck anxiety inventory; GDS = geriatric depression scale, short form; TFLS = Texas functional living scale; IADL = instrumental activities of daily living questionnaire; MMSE = mini-mental state examination; RBANS = repeatable battery for the assessment of neuropsychological status. The figure displays the percentage of unique variance explained by chronic pain above and beyond demographic variables and the number of medical conditions. ΔR2 change numbers were statistically significant after false discovery rate (FDR) correction for multiple comparisons.
Figure 5.
Figure 5.
Differences in RBANS subtests scores between chronic pain group and control group. Note. RBANS = repeatable battery for the assessment of neuropsychological status. Higher scores indicate better performance. Participants who reported chronic pain performed significantly lower on most RBANS subtests (with the exception of list recognition) compared to those who did not report chronic pain.
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