Search

Background: The association between pain and dementia is complicated and may depend on underlying brain pathology. It was hypothesized that both medial temporal atrophy (MTA) and global cortical atrophy (GCA) predicted no/mild pain, while white matter hyperintensities (WMH) predicted moderate/severe pain. Objectives: To study the association between pain intensity and measures of brain pathology, more specifically MTA, GCA, and WMH. Methods: In total, 115 consecutive patients visiting an outpatient memory clinic were included. In total, diagnoses included dementia (N=70), mild cognitive impairment (N=30), and subjective cognitive impairment (N=15). Without administering stimuli, pain intensity was assessed with the Brief Pain Inventory. MTA, GCA, and WMH were measured with a MRI visual rating scale. Logistic regression analyses to examine the relationship between WMH, MTA, GCA, and self-reported pain intensity (no/mild pain versus moderate/severe pain) were adjusted for confounders. Results: Mean age of the patients was 81 years (IQR: 78-85, 53% female). Moderate/severe pain was reported by 23.5% and associated with greater WMH (OR =3.34, 95% CI =1.01-10.97, p=0.047), but not MTA or GCA. Conclusions: In contrast to the present results, earlier studies have reported either a positive or negative relationship between pain and brain volume. It is suggested that the presence of dementia may explain the absence of a relationship between pain and brain volume. WMH is positively related with pain in an older memory outpatient population. Considering the small sample size, our findings should be interpreted with caution. Hence, our conclusions are preliminary findings, warranting future replication.

BACKGROUND: The number of people with dementia and natural dentition is growing. As dementia progresses, the degree of self-care decreases and the risk of oral health problems and orofacial pain increases.OBJECTIVES: To examine and compare the presence of orofacial pain and its potential causes in older people with Mild Cognitive Impairment (MCI) or dementia.METHODS: In this cross-sectional observational study, the presence of orofacial pain and its potential causes was studied in 348 participants with MCI or dementia with all levels of cognitive impairment in two outpatient memory clinics and ten nursing homes.RESULTS: Orofacial pain was reported by 25.7% of the 179 participants who were considered to present a reliable pain self-report (Mini-Mental State Examination score ≥14 points), while it could not be determined in people with more severe cognitive impairment. The oral health examination of the 348 participants indicated that potential painful conditions, such as coronal caries, root caries, tooth root remnants or ulcers were present in 50.3%. There was a significant correlation between the level of cognitive impairment and the number of teeth, r = 0.185, P = 0.003, teeth with coronal caries, r = -0.238, P < 0.001, and the number of tooth root remnants, r = -0.229, P = 0.004, after adjusting for age.CONCLUSIONS: This study indicated that orofacial pain and its potential causes were frequently present in participants with MCI or dementia. Therefore, a regular oral examination by (oral) healthcare providers in people with MCI or dementia remains imperative, even if no pain is reported.

Contains fulltext : 191183.pdf (Publisher’s version ) (Closed access) Objective: To assess the pain prevalence, pain intensity, and pain medication use in older patients with a diagnosed subtype of dementia, mild cognitive impairment (MCI), or subjective cognitive impairment (SCI). Design: Cross-sectional. Setting: Outpatient memory clinics. Subjects: In total, 759 patients with Alzheimer's disease (AD), vascular dementia, mixed AD and vascular pathology (MD), frontotemporal dementia, dementia with Lewy Bodies, MCI, or SCI. Methods: Self-reported presence and intensity of pain, prescribed medication, and related descriptive variables were given for each group. To compare groups on prevalence of pain, logistic regression analyses were adjusted for age, gender, and mood. Differences in pain intensity were tested using a Kruskall-Wallis test, and differences in analgesic use with chi-square analyses. Results: Pain prevalence ranged from 34% in MD to 50% in SCI. AD (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.34-0.93) and MD (OR = 0.45, CI = 0.20-0.98) patients were less likely to report pain than SCI patients. The self-reported pain intensity did not differ between groups. In total, 62.5% of patients did not use any analgesic medication despite being in pain, which did not differ significantly between groups. Conclusion: Outpatient memory clinic patients with mild to moderate AD and MD are less likely to report pain than patients with SCI. No difference in self-reported pain intensity was present. The high percentage of patients with and without dementia who do not use analgesics when in pain raises the question of whether pain treatment is adequate in older patients. 8 p.

Background The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published. Objective To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues. Methods A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list. Results The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia. Conclusions The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow. Scientific rationale for study With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia. Principal findings Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow. Practical implications The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia. Electronic supplementary material The online version of this article (10.1007/s00784-017-2264-2) contains supplementary material, which is available to authorized users.

Introduction: Reference values to define cognitive impairment in individuals aged 90 years and older are lacking. We systematically reviewed the literature to determine the level of cognitive functioning of individuals aged 90 years and older without dementia. Methods: The search identified 3972 articles of which 20 articles were included in the review. We calculated mean cognitive test scores and cut-off scores for cognitive tests published in two or more articles. Results: The mean cognitive test scores (SD)/cut-off scores for individuals aged 90 years and older without dementia of the five most commonly used cognitive tests were: MMSE: 26.6 (2.6)/23.3 points, Digit Span forward: 5.9 (1.8)/3.6 digits, Digit Span backward: 4.4 (1.6)/2.4 digits, TMT-A: 85.8 (42.5)/140.2 s and TMT-B: 220.3 (99.2)/347.3 s. Discussion: We provided mean cognitive test scores and cut-off scores that will improve the diagnostic process of cognitive impairment in individuals aged 90 years and older. (C) 2017 Elsevier B.V. All rights reserved.

Recently, the number of studies focusing on pain in dementia has increased considerably. Still, little attention has been paid to the influence of the neuropathology of different dementia subtypes on pain experience. In 2003, a review identified several studies that indicated a relation between dementia subtype and pain experience. Now, ten years later, an update is warranted. We conducted a systematic review to identify studies that assessed pain experience and dementia subtypes by searching PubMed, Embase, PsycINFO, CINAHL, and Cochrane Library. Inclusion criteria were: (1) major dementia subtype diagnosis i.e. Alzheimer’s dementia (AD), Vascular dementia (VaD), frontotemporal dementia (FTD), Dementia with Lewy Bodies (DLB); (2) age ≥60 years; and (3) pain experience. We identified twelve studies that addressed AD, three studies VaD, one study FTD, and no studies DLB. In AD, studies on clinical pain indicate a reduced pain experience compared to controls, whereas experimental studies show inconsistent findings. In VaD, clinical studies found that primary caregivers rated pain equal to cognitively intact controls, although more painful locations were reported. During self-report, elderly with VaD reported higher pain levels than cognitively intact controls. In FTD, a significantly lower pain sensitivity to experimental pain was found. Considering the limited number of studies, these findings should be considered with caution. Existing literature provides some evidence that dementia subtype affects pain experience. Further research is needed to clarify the relation between dementia subtype and pain experience as it could serve as basis for improving the assessment and management of pain in people with dementia.

Objective: The aim of this review was to provide a systematic overview including a quality assessment of studies about oral health and orofacial pain in older people with dementia, compared to older people without dementia. Methods: A systematic literature search was performed in PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. The quality assessment of the included articles was performed using the Newcastle-Ottawa Scale (NOS). Results: The search yielded 527 articles, of which 37 were included for the quality assessment and quantitative overview. The median NOS score of the included studies was 5, and the mean was 4.9 (SD 2.2). The heterogeneity between the studies was considered too large to perform a meta-analysis. An equivalent prevalence of orofacial pain, number of teeth present, decayed missing filled teeth index, edentulousness percentage, and denture use was found for both groups. However, the presence of caries and retained roots was higher in older people with dementia than in those without. Conclusions: Older people with dementia have worse oral health, with more retained roots and coronal and root caries, when compared to older people without dementia. Little research focused on orofacial pain in older people with dementia. Clinical relevance: The current state of oral health in older people with dementia could be improved with oral care education of caretakers and regular professional dental care.

Background. Pain and recurrent falls are highly problematic in community-dwelling older adults, yet the association remains elusive. Objective. The objective of this study was to investigate the association between pain and recurrent falls in community-dwelling older adults. Design. Two independent reviewers conducted searches of major electronic databases, completed methodological assessment, and extracted the data of all included articles. Articles that were included are those that 1) involved community-dwelling older adults; 2) recorded recurrent falls; and 3) assessed pain. Articles that were excluded are those that included participants with dementia, any neurological conditions, or those with orthopedic trauma/surgery in the past 6 months. Results. Out of a potential of 71 articles, 11 met the inclusion criteria and 7 (N = 9,581) were eligible for the meta-analysis. The annual prevalence of recurrent falls in those reporting pain (12.9%) was higher than the pain-free control group (7.2%, P < 0.001). A global meta-analysis established that pain was associated with recurrent falls (odds ratio [OR]: 2.04, confidence interval [CI]: 1.75–2.39; N = 3,950 with pain and N = 5,631 controls), and this was decreased in a subgroup meta-analysis utilizing prospective studies only (OR: 1.79, CI: 1.44–2.21, P < 0.001, I2 = 0%; N = 3, N = 2,646). A subgroup analysis comparing recurrent fallers vs non-fallers only (OR: 2.18, CI: 1.82–2.60, N = 6,320, I 2 = 0%) established the odds were particularly higher than single fallers vs non-fallers (OR:1.44, CI: 1.26–1.64, N = 6,903, I 2 = 0%). Conclusion. Older adults with pain are at particularly increased risk of recurrent falls. Clinicians working with recurrent fallers should routinely assess pain while pain specialists should inquire about older adults’ falls history.

BackgroundPain is a common problem in people with dementia, however the exact prevalence of pain in dementia subtypes, e.g. Alzheimer’s Disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia (FTD) and dementia with Lewy Bodies (DLB), is unknown, as is the relation between pain and the different subtypes of dementia. In this study, the prevalence of pain in people with dementia will be investigated per dementia subtype and the relationship between the various subtypes of dementia and the presence of specific types of pain (i.e. musculoskeletal pain, neuropathic pain and orofacial pain) will be examined. Secondly, associations between various types of pain, cognitive functioning, neuropsychiatric symptoms and quality of life in people with dementia will be examined. A third purpose is to study the value of the assessment of autonomic responses in assessing pain in people with dementia. Finally, the effect of feedback to the attending physician on the presence of pain, based on examination by investigators with backgrounds in neuropsychology, geriatric dentistry and elderly care medicine, will be evaluated.Methods/DesignA cross-sectional, partially longitudinal observational study in 400 participants with dementia, aged 60 years and older. Participants will be recruited from an outpatient memory clinic and dementia special care units. All participants will be examined by an elderly care medicine trainee, a dentist with experience in geriatric dentistry, and a neuropsychologist. The primary outcome is presence of pain. Secondary outcomes will include oral health, autonomic responses to pain stimulus, vital sensibility and gnostic sensibility, musculoskeletal examination, cognitive functioning, neuropsychiatric symptoms, and quality of life.DiscussionThis study will help to enhance our knowledge regarding the prevalence of different types of pain in different dementia subtypes i.e. AD, VaD, FTD and DLB. This study also aims to contribute to a better understanding of oral health status in people with dementia, the use of autonomic responses in the assessment of pain in people with dementia and the relationships between pain and cognitive symptoms, neuropsychiatric symptoms and quality of life in people with various dementia subtypes and in different stages of the disease.

Objective: To conduct a systematic review and meta-analysis to establish the association between pain and falls in community dwelling older adults.\ud \ud Data Sources: Electronic databases from inception until 1st March 2013 including Cochrane Library, CINAHL, EBSCO, EMBASE, PubMed and PsycINFO.\ud \ud Study Selection: Two reviewers independently conducted the searches and completed methodological assessment of all included studies. Studies were included that (a) focussed on older adults over 60 years old, (b) recorded falls over 6 or more months, (c) identified a group with and without pain. Studies were excluded that (d) included participants with dementia, a neurological condition (e.g. stroke), (e) participants whose pain was caused by a previous fall, (f) individuals with surgery/ fractures in the past 6 months.\ud \ud Data extraction: One author extracted all data and this was independently validated by another author.\ud \ud Data synthesis: 1,334 articles were screened and 21 studies met the eligibility criteria. 50.5% of older adults with pain reported one or more fall over 12 months compared to 25.7% of controls (p