Pain in patients with different dementia subtypes, mild cognitive impairment, and subjective cognitive impairment

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.