The pain, emotion and cognition nexus in older persons and in dementia

Abstract

With the rapid ageing of the worlds’ population, it becomes increasingly important to recognise and understand the complex nexus between pain, mood and cognition in this specific age group. A particular focus should be on any age-related differences in pain prevalence and the impacts of pain on mood and cognitive functions as this will influence assessment and treatment options. Pain prevalence increases with advancing age predominantly due to the rise in degenerative musculoskeletal disorders, such as osteoarthritis. However, the atypical presentation of pain in many medical conditions (i.e. cardiac, gastrointestinal, malignancy, post- surgical pain) has also shown to increase with age. Conversely, the prevalence of psychopathology (depression, anxiety) decreases in older cohorts except when comorbid with persistent pain, where similar rates are seen across the entire adult lifespan. The lack of age differences in psychopathology in those with persistent pain might suggest that older persons are more vulnerable to the negative impact of pain on mood. The cognitive mediators of pain (beliefs, attitudes) also show some clear age differences, and older age may moderate the impacts of pain on cognitive functioning and performance. The special nexus of pain and emotion in persons with dementia has also attracted increased interest in recent years. It remains unclear whether the pain experience itself is altered by dementia, but findings do emphasise some differences in the types of behavioural and psychological impacts of pain in persons with dementia.