Pain in Aging and Impaired Cognition, Especially Dementia: Clinical and Experimental Studies

Dear Colleagues,

Pain cognition research has traditionally focused on the effects of pain on cognitive function. Inadequate pain management also causes physiological changes, a tendency toward depression, sleep disorders, functional impairment, isolation, and increased healthcare costs. However, the reverse effects—that is, of cognitive impairment on pain processing—have been less studied and can vary greatly. The main difficulties and limitations of pain studies in cognitive impairment, whether they be basic, preclinical, or research on humans, lie in the intrinsic complexity of the different types of cognitive impairments with diverse etiologies and underlying pathologies, alongside the complexity and breadth of the network of brain areas involved in pain processing and the diversity of the resulting brain dysfunctions. Therefore, in the study of pain in people with cognitive impairment, especially people with dementia, in addition to recording various classical traits (onset, location, irradiation, characteristics, intensity, relief), special attention is paid to differentiating the different types of pain (nociceptive, neuropathic, mixed), temporality (acute, subacute, chronic, persistent), and etiology of dementia in order to understand how it interferes with pain processing. Assessment of the different dimensions and components of pain—cognitive affective, autonomic, and behavioral—is also important to understand the level of dysfunction that it entails. Finally, clinical studies are also limited by the impossibility of controlling and measuring the nociceptive stimuli that cause pain.

Since age is the main risk factor for cognitive decline—especially dementia, but also for pain—the number of patients experiencing this “double jeopardy of dementia and pain” will also increase in the coming decades. Although pain is a frequent complaint of people living in nursing homes, 25% do not regularly receive analgesic drugs, and the administration and prescription of pain treatments is below expert recommendations. Thus, despite these figures and the impact these factors have on the quality of life (QoL) of these people, it has been known for some time, and continues to occur, that patients with dementia and chronic pain are undertreated. In these scenarios, the QoL of people with cognitive impairment, especially dementia, worsens with their progressive deterioration and loss of the ability to express pain verbally. Sometimes, pain is expressed as agitation or can result in resistance to care or aggressive behaviors, behavioral symptoms that are treated inappropriately with antipsychotics and which underly a certain mortality risk. Therefore, the identification of pain in cognitive impairment and its management is a relevant issue for good clinical practice and quality of life of patients. Although there are a number of factors that contribute to this identification, inadequate assessment and treatment of pain in this group of patients can lead to unconscious and involuntary double-ageism based on the age and mental health condition of the patient.

Dr. Lydia Giménez-Llort
Dr. Marina de Tommaso
Prof. Dr. Miriam Kunz
Dr. Jemima Collins
Dr. Björn Johansson
Dr. Sara Invitto
Guest Editors

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• pain
• aging
• impaired cognition
• dementia