title: Pain Assessment in Elderly with Behavioral and Psychological Symptoms of Dementia.
abstract: BACKGROUND
  Pain is under-detected and undertreated in people with dementia. The present study investigates the prevalence of pain in people with dementia hospitalized in nursing homes that are members of National Association of Third Age Residences (ANASTE) Calabria, and evaluates the association among pain, mood, and behavioral and psychological symptoms of dementia (BPSD).
  
  
  OBJECTIVE
  The aim of this study is to define the prevalence of pain in people with dementia in long term care facilities using scales of self-reporting and observational tools and, particularly, to study the relationship between pain and BPSD.
  
  
  METHODS
  A prospective observational study was carried out on 233 patients. Pain assessment was performed using self-reporting tools such as the Numeric Rating Scale (NRS) for patients with slight cognitive impairment or no cognitive impairment and observational tools such as Pain Assessment In Advanced Dementia Scale (PAINAD) for patients with moderate or severe cognitive impairment. Mood was evaluated through the Cornell Scale for Depression in Dementia (CSDD) while behavioral problems were assessed through the Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory (NPI).
  
  
  RESULTS
  Only 42.5% of patients evaluated by NRS provided a reliable answer; of these, 20.4% reported no pain. The percentage of pain evaluated by PAINAD was 51.8% . Analysis of data showed a statistically significant correlation between diagnosis of pain and depressive symptoms, assessed with CSDD (p = 0.0113), as well as by single items of NPI, such as anxiety (p = 0.0362) and irritability (p = 0.0034), and F1 profile (Aggression) of CMAI (p = 0.01).
  
  
  CONCLUSIONS
  This study confirms that self-report alone is not sufficient to assess pain in elderly people with dementia; the observational tool is a necessary and suitable way of assessing pain in patients with cognitive impairment. If not adequately treated, chronic pain can cause depression, agitation, and aggression in patients with dementia.
authors.forename: Alba
authors.initials: A
authors.lastname: Malara
authors.forename: Giuseppe Andrea
authors.initials: GA
authors.lastname: De Biase
authors.forename: Francesco
authors.initials: F
authors.lastname: Bettarini
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceravolo
authors.forename: Serena
authors.initials: S
authors.lastname: Di Cello
authors.forename: Michele
authors.initials: M
authors.lastname: Garo
authors.forename: Francesco
authors.initials: F
authors.lastname: Praino
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Settembrini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sgrò
authors.forename: Fausto
authors.initials: F
authors.lastname: Spadea
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rispoli
mesh_terms: D000339:Affect; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D001007:Anxiety / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003704:Dementia / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D010146:Pain / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index
chemical_list: D000700:Analgesics
keywords: Behavior; dementia; nursing home; pain