Poorly treated pain in older adults with Alzheimer's disease (AD) is a critical public health problem, and understanding AD-related differences in pain function is an National Institute of Aging (NIA) priority area. When compared to healthy adults, and in the presence of similar known painful conditions, older adults with AD receive less pain medication. Reasons for this discrepancy are poorly understood. Inadequately treated pain negatively impacts quality of life and increases health care costs. Exploring the biological reasons for alterations in pain processing is essential for increasing our understanding of pain in older adults with AD. Evidence suggests that brain structure and brain function are altered in AD. However, it is unclear how these structural and functional nervous system alterations impact psychophysical and neurophysiological responses to pain in AD. The goals of this career development project are to provide the PI with the training and skills necessary to transition from a mentored role to an independent scientist focused on pain, aging, and dementia. The career development plan strikes a balance of training and coursework in years one and two, with increased research and independence in years three and four. Training will include courses selected to increase knowledge in specific areas (neuroscience, neurobiology, ethics, grant writing, and leadership). In addition, workshops are included that will increase the skills necessary to both design studies and carry out neuroimaging analysis. The proposed research will examine how psychophysical responses to acute experimental thermal pain differs between older adults with and without AD, and how these differences map onto regional and network brain functional changes. Experimental acute thermal pain delivery predicts well the response to painful medical conditions. We propose to examine the psychophysical and neurophysiological response to experimental thermal stimuli in healthy adults (aged 65 or older) and aged match adults with AD (aged 65 or older).
The aims of this study are to determine whether sensory (stimulus intensity) and affective (stimulus unpleasantness) responses differ in adults with and without AD during cutaneous thermal stimulation. We hypothesize that AD will be associated with a blunted response in sensory pain and affective pain systems. These changes may arise from AD-associated changes in brain structure and function as well as from specific alterations in pain-related brain networks. Examining baseline differences in experimental thermal pain between adults with and without AD will provide a foundation for understanding factors that may contribute to untreated pain risk, as well as for developing novel assessment, prevention, and treatment strategies in the older population.

Public Health Relevance

Older adults with Alzheimer's disease (AD) are at risk of having their pain undertreated. We do not definitively know what AD-related changes occur in the pain pathways that impact individual reporting of pain. This study will provide training and research focused on better management of pain in people with AD.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Neuroscience of Aging Review Committee (NIA)
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St Hillaire-Clarke, Coryse
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Vanderbilt University Medical Center
Schools of Nursing
United States
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Monroe, Todd B; Beach, Paul A; Bruehl, Stephen P et al. (2017) The Impact of Alzheimer's Disease on the Resting State Functional Connectivity of Brain Regions Modulating Pain: A Cross Sectional Study. J Alzheimers Dis 57:71-83
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