Poorly treated pain in older adults with dementia is a critical public health problem. When compared to people without dementia, people with dementia receive less pain medication in the presence of similar pain-related conditions. Gender associated differences in the experience of pain are reported in the literature with women generally experiencing more pain and reporting increased sensitivity. Poorly treated pain leads to many associated symptoms, negatively impacts quality of life, and increases healthcare costs. Exploring the biological reasons for alterations in pain processing is essential to increasing our understanding about pain in older adults with Alzheimer's disease (AD) and Vascular dementia (VaD). The paucity of evidence to support best practice pain management in older adults with different types of dementia places these individuals at risk for poor pain management practices. The goals of this project are to determine AD- or VaD-associated psychophysical and psychosocial differences in the processing of pain in older females. Our pilot data in a sample of 12 male and 12 female (age-matched) cognitively normal older adults (ages 65-81) suggests that in response to thermal pain, females reported decreased sensory thresholds for pain and reduced pain associated unpleasantness. A second pilot sample of observational pain in people with AD and VaD indicated that people with VaD may have more behavioral indicators of pain. Using psychophysics (to measure sensory threshold and affective unpleasantness) we will examine dementia and gender-associated differences in thermal pain processing in a broad range of older adults with AD or VaD (age 66-95). Our overall hypothesis is that specific alterations in experimental thermal pain responses, which reflect differences in central pain processing and are of relevance to clinical pain responsiveness, are associated with dementia subtypes (AD, VaD), and amount of white matter vascular lesion burden. These changes may place women with certain dementia subtypes at increased risk for non-detection of pain following injury, under treatment of pain, development of chronic pain, and poor quality of life at end-of-life. Results from this study will contribute to development of improved targeted pain assessment techniques and pain management approaches.

Public Health Relevance

Older females with dementia are at risk of having their pain undertreated. We do not definitively know what dementia sub-type and female gender-related changes occur in the pain pathways that impact individual reporting of pain. This study will provide information so healthcare providers can better treat these people.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Aging Systems and Geriatrics Study Section (ASG)
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St Hillaire-Clarke, Coryse
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Vanderbilt University Medical Center
United States
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