title: The use of facial expressions for pain assessment purposes in dementia: a narrative review.
abstract: Facial expressions convey reliable nonverbal signals about pain and thus are very useful for assessing pain in patients with limited communicative ability, such as patients with dementia. In this review, we present an overview of the available pain observation tools and how they make use of facial expressions. Utility and reliability of facial expressions to measure pain in dementia are discussed, together with the effect of dementia severity on these facial expressions. Next, we present how behavioral alterations may overlap with facial expressions of pain, and may even influence the extent to which pain is facially expressed. The main focus is on disinhibition, apathy and emotional changes. Finally, an overview of theoretical considerations and practical implications is presented for assessing pain using facial expressions in clinical settings.
authors.affiliation: Radboud University Nijmegen, Donders Institute for Brain, Cognition & Behaviour, Nijmegen, The Netherlands.
authors.forename: Joukje M
authors.initials: JM
authors.lastname: Oosterman
authors.affiliation: Maastricht University, Department of Health Services Research, CAPHRI School for Public Health & Primary Care, Maastricht, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Zwakhalen
authors.affiliation: Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London Medical School, London, UK.|North Middlesex University Hospital, Barnet Enfield & Haringey Mental Health Trust, London, UK.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Sampson
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Section Gerontology, Groningen, The Netherlands.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kunz
mesh_terms: D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D005149:Facial Expression; D006801:Humans; D010146:Pain / Q000175:diagnosis* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods*; D010775:Photic Stimulation / Q000379:methods*
keywords: apathy; cognitive impairment; dementia; disinhibition; emotional changes; expertise; facial expression; neuropsychological functioning; pain assessment; subjective pain report