The relationship between pain and mental flexibility in older adult pain clinic patients.
OBJECTIVE
Persistent pain and cognitive impairment are each common in older adults. Mental flexibility, memory, and information-processing speed may be particularly vulnerable in the aging brain. We investigated the effects of persistent pain on these cognitive domains among community-dwelling, nondemented older adults.


METHODS
Older Adult Pain Management Program.


METHODS
A total of 56 new patients (mean age 76.1 years) were recruited to describe 1) rates of persistent pain conditions and pain intensity; 2) cognition (mental flexibility, short-term memory, and psychomotor speed); 3) severity of depression; and 4) sleep quality. All patients had nonmalignant pain for at least 3 months. Pain intensity was measured with the McGill Pain Questionnaire and depression severity with the 17-item Hamilton Rating Scale for Depression. Cognition was assessed with 1) Mini-Mental State Exam; 2) Number-Letter-Switching and Motor Speed subtests of the Delis-Kaplan Executive Function System Trail Making Test; 3) Digit Symbol Subtest (DSST) of the Wechsler Adult Intelligence Scales-III; and 4) free and paired recall of the DSST digit-symbol pairs. Multiple linear regression modeled whether these variables predicted poorer cognitive outcomes, after adjusting for the effects of opioids, sleep impairment, depression, medical comorbidity, and years of education.


RESULTS
In univariate analysis, pain severity was associated with a greater impairment on number-letter switching (r = -0.42, P = 0.002). This association remained after adjusting for the effects of depression, sleep, medical comorbidity, opioid use, and years of education (t = -1.97, P = 0.056).


CONCLUSIONS
In community dwelling older adults, neither pain nor mood was associated with measures of short-term memory or information-processing speed. However, pain severity was associated with decreased performance on a test of number-letter switching, indicating a relationship between pain and mental flexibility.
Karp
Jordan F
JF
Intervention Research Center and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania, USA. karpjf@upmc.edu
Reynolds
Charles F
CF
Butters
Meryl A
MA
Dew
Mary Amanda
MA
Mazumdar
Sati
S
Begley
Amy E
AE
Lenze
Eric
E
Weiner
Debra K
DK
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology* / Q000523:psychology; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000453:epidemiology; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests; D010146:Pain / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D018710:Pain Clinics / Q000706:statistics & numerical data*; D010147:Pain Measurement; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology; D013223:Statistics as Topic
D000701:Analgesics, Opioid