Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis

doi:10.1186/s12877-015-0048-6

Review

. 2015 Apr 19:15:49.

doi: 10.1186/s12877-015-0048-6.

Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis

Annelore H van Dalen-Kok¹, Marjoleine J C Pieper^{2

3}, Margot W M de Waal⁴, Albert Lukas⁵, Bettina S Husebo^{6

7}, Wilco P Achterberg⁸

Affiliations

¹ Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. a.h.van_dalen@lumc.nl.
² Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. m.j.c.pieper@lumc.nl.
³ Department of General Practice & Elderly Care Medicine, VU University Medical Centre Amsterdam, van der Boechorststraat 7, Amsterdam, BT, 1081, The Netherlands. m.j.c.pieper@lumc.nl.
⁴ Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. m.w.m.de_waal@lumc.nl.
⁵ Malteser Hospital Bonn/Rhein-Sieg, Centre of Geriatric Medicine, Academic Hospital University of Bonn, Von-Hompesch-Straße 1, Bonn, 53123, Germany. albert.lukas@malteser.org.
⁶ Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway. bettina.husebo@igs.uib.no.
⁷ Stavanger University Hospital, Bergen, Norway. bettina.husebo@igs.uib.no.
⁸ Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. w.p.achterberg@lumc.nl.

PMID: 25928621
PMCID: PMC4409739
DOI: 10.1186/s12877-015-0048-6

Review

Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis

Annelore H van Dalen-Kok et al. BMC Geriatr. 2015.

. 2015 Apr 19:15:49.

doi: 10.1186/s12877-015-0048-6.

Authors

Annelore H van Dalen-Kok¹, Marjoleine J C Pieper^{2

3}, Margot W M de Waal⁴, Albert Lukas⁵, Bettina S Husebo^{6

7}, Wilco P Achterberg⁸

Affiliations

¹ Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. a.h.van_dalen@lumc.nl.
² Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. m.j.c.pieper@lumc.nl.
³ Department of General Practice & Elderly Care Medicine, VU University Medical Centre Amsterdam, van der Boechorststraat 7, Amsterdam, BT, 1081, The Netherlands. m.j.c.pieper@lumc.nl.
⁴ Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. m.w.m.de_waal@lumc.nl.
⁵ Malteser Hospital Bonn/Rhein-Sieg, Centre of Geriatric Medicine, Academic Hospital University of Bonn, Von-Hompesch-Straße 1, Bonn, 53123, Germany. albert.lukas@malteser.org.
⁶ Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway. bettina.husebo@igs.uib.no.
⁷ Stavanger University Hospital, Bergen, Norway. bettina.husebo@igs.uib.no.
⁸ Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. w.p.achterberg@lumc.nl.

PMID: 25928621
PMCID: PMC4409739
DOI: 10.1186/s12877-015-0048-6

Erratum in

Erratum to: Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis.
van Dalen-Kok AH, Pieper M, de Waal M, Lukas A, Husebo BS, Achterberg WP. van Dalen-Kok AH, et al. BMC Geriatr. 2015 Sep 9;15:109. doi: 10.1186/s12877-015-0085-1. BMC Geriatr. 2015. PMID: 26354753 Free PMC article. No abstract available.

Abstract

Background: Pain, neuropsychiatric symptoms (NPS) and functional impairment are prevalent in patients with dementia and pain is hypothesized to be causal in both neuropsychiatric symptoms (NPS) and functional impairment. As the exact nature of the associations is unknown, this review examines the strength of associations between pain and NPS, and pain and physical function in patients with dementia. Special attention is paid to the description of measurement instruments and the methods used to detect pain, NPS and physical function.

Methods: A systematic search was made in the databases of PubMed (Medline), Embase, Cochrane, Cinahl, PsychINFO, and Web of Science. Studies were included that described associations between pain and NPS and/or physical function in patients with moderate to severe dementia.

Results: The search yielded 22 articles describing 18 studies, including two longitudinal studies. Most evidence was found for the association between pain and depression, followed by the association between pain and agitation/aggression. The longitudinal studies reported no direct effects between pain and NPS but some indirect effects, e.g. pain through depression. Although some association was established between pain and NPS, and pain and physical function, the strength of associations was relatively weak. Interestingly, only three studies used an observer rating scale for pain-related behaviour.

Conclusions: Available evidence does not support strong associations between pain, NPS and physical function. This might be due to inadequate use or lack of rating scales to detect pain-related behaviour. These results show that the relationship between pain and NPS, as well as with physical function, is complicated and warrants additional longitudinal evaluation.

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Figures

**Figure 1**
PRISMA flowdiagram of the inclusion of studies.

**Figure 2**
Forest plot: Pain and Depression.

**Figure 3**
Forest plot: Pain and Agitation/Aggression.

**Figure 4**
Forest plot: Pain and Physical Function (with reports of 5 out of 10 included studies).

See this image and copyright information in PMC

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References

1. Feldt KS, Warne MA, Ryden MB. Examining pain in aggressive cognitively impaired older adults. J Gerontol Nurs. 1998;24(11):14–22. doi: 10.3928/0098-9134-19981101-07. - DOI - PubMed
1. Zwakhalen SM, Koopmans RT, Geels PJ, Berger MP, Hamers JP. The prevalence of pain in nursing home residents with dementia measured using an observational pain scale. Eur J Pain. 2009;13(1):89–93. doi: 10.1016/j.ejpain.2008.02.009. - DOI - PubMed
1. Tosato M, Lukas A, van der Roest HG, Danese P, Antocicco M, Finne-Soveri H, et al. Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain. 2012;153(2):305–10. doi: 10.1016/j.pain.2011.10.007. - DOI - PubMed
1. Cipher DJ, Clifford PA. Dementia, pain, depression, behavioral disturbances, and ADLs: toward a comprehensive conceptualization of quality of life in long-term care. Int J Geriatr Psychiatry. 2004;19(8):741–8. doi: 10.1002/gps.1155. - DOI - PubMed
1. Buffum MD, Miaskowski C, Sands L, Brod M. A pilot study of the relationship between discomfort and agitation in patients with dementia. Geriatr Nurs. 2001;22(2):80–5. doi: 10.1067/mgn.2001.115196. - DOI - PubMed

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[1] Feldt KS, Warne MA, Ryden MB. Examining pain in aggressive cognitively impaired older adults. J Gerontol Nurs. 1998;24(11):14–22. doi: 10.3928/0098-9134-19981101-07. - DOI - PubMed

[2] Feldt KS, Warne MA, Ryden MB. Examining pain in aggressive cognitively impaired older adults. J Gerontol Nurs. 1998;24(11):14–22. doi: 10.3928/0098-9134-19981101-07. - DOI - PubMed

[3] Zwakhalen SM, Koopmans RT, Geels PJ, Berger MP, Hamers JP. The prevalence of pain in nursing home residents with dementia measured using an observational pain scale. Eur J Pain. 2009;13(1):89–93. doi: 10.1016/j.ejpain.2008.02.009. - DOI - PubMed

[4] Zwakhalen SM, Koopmans RT, Geels PJ, Berger MP, Hamers JP. The prevalence of pain in nursing home residents with dementia measured using an observational pain scale. Eur J Pain. 2009;13(1):89–93. doi: 10.1016/j.ejpain.2008.02.009. - DOI - PubMed

[5] Tosato M, Lukas A, van der Roest HG, Danese P, Antocicco M, Finne-Soveri H, et al. Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain. 2012;153(2):305–10. doi: 10.1016/j.pain.2011.10.007. - DOI - PubMed

[6] Tosato M, Lukas A, van der Roest HG, Danese P, Antocicco M, Finne-Soveri H, et al. Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain. 2012;153(2):305–10. doi: 10.1016/j.pain.2011.10.007. - DOI - PubMed

[7] Cipher DJ, Clifford PA. Dementia, pain, depression, behavioral disturbances, and ADLs: toward a comprehensive conceptualization of quality of life in long-term care. Int J Geriatr Psychiatry. 2004;19(8):741–8. doi: 10.1002/gps.1155. - DOI - PubMed

[8] Cipher DJ, Clifford PA. Dementia, pain, depression, behavioral disturbances, and ADLs: toward a comprehensive conceptualization of quality of life in long-term care. Int J Geriatr Psychiatry. 2004;19(8):741–8. doi: 10.1002/gps.1155. - DOI - PubMed

[9] Buffum MD, Miaskowski C, Sands L, Brod M. A pilot study of the relationship between discomfort and agitation in patients with dementia. Geriatr Nurs. 2001;22(2):80–5. doi: 10.1067/mgn.2001.115196. - DOI - PubMed

[10] Buffum MD, Miaskowski C, Sands L, Brod M. A pilot study of the relationship between discomfort and agitation in patients with dementia. Geriatr Nurs. 2001;22(2):80–5. doi: 10.1067/mgn.2001.115196. - DOI - PubMed

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Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis

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Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis

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