Pain processing in older adults with dementia-related cognitive impairment is associated with frontal neurodegeneration

Neurobiol Aging. 2021 Oct:106:139-152. doi: 10.1016/j.neurobiolaging.2021.06.009. Epub 2021 Jun 18.

Abstract

Experimental pain research has shown that pain processing seems to be heightened in dementia. It is unclear which neuropathological changes underlie these alterations. This study examined whether differences in pressure pain sensitivity and endogenous pain inhibition (conditioned pain modulation (CPM)) between individuals with a dementia-related cognitive impairment (N=23) and healthy controls (N=35) are linked to dementia-related neurodegeneration. Pain was assessed via self-report ratings and by analyzing the facial expression of pain using the Facial Action Coding System. We found that cognitively impaired individuals show decreased CPM inhibition as assessed by facial responses compared to healthy controls, which was mediated by decreased gray matter volume in the medial orbitofrontal and anterior cingulate cortex in the patient group. This study confirms previous findings of intensified pain processing in dementia when pain is assessed using non-verbal responses. Our findings suggest that a loss of pain inhibitory functioning caused by structural changes in prefrontal areas might be one of the underlying mechanisms responsible for amplified pain responses in individuals with a dementia-related cognitive impairment.

Keywords: Conditioned pain modulation; Dementia; Diffusion tensor imaging; Facial expression of pain; Pain; Voxel-based morphometry.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / pathology*
  • Aging / psychology*
  • Cognitive Dysfunction / diagnostic imaging
  • Cognitive Dysfunction / pathology*
  • Cognitive Dysfunction / psychology*
  • Dementia / diagnostic imaging
  • Dementia / pathology*
  • Dementia / psychology*
  • Diffusion Tensor Imaging
  • Female
  • Gray Matter / diagnostic imaging
  • Gray Matter / pathology
  • Gray Matter / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Nerve Degeneration / diagnostic imaging
  • Nerve Degeneration / pathology*
  • Nerve Degeneration / psychology*
  • Organ Size
  • Pain / pathology*
  • Pain / physiopathology*
  • Pain Perception*
  • Prefrontal Cortex / diagnostic imaging
  • Prefrontal Cortex / pathology*
  • Prefrontal Cortex / physiopathology