Can pain worsen dementia?

[Anny_Middon]

I have a BIL who has been exhibiting signs of dementia. My sister has been pretty much in denial, and it seems that for the most part his confusion has been transient and not a real problem.

Lately though his back has been causing him pain. He went to the doctor for that, but the pain has gotten worse. The doc did prescribe something – I don’t know what.

His dementia has gotten a lot worse lately, according to Sis. Whereas before it had been mostly forgetfulness, it now seems he believes things have occurred that have never happened.

I know that whatever med he’s on for pain may affect his dementia, but I was wondering if there was any evidence (i.e., research papers) that the pain itself may do so.

[Qadgop_the_Mercotan]

My survey search of the basic medical literature on risk factors for dementia does not have pain listed as a risk factor.

as for what are risk factors, well, UpToDate has this list:

Age remains the strongest risk factor for dementia, particularly for Alzheimer disease (AD), in which the incidence increases exponentially with each decade.

●The genetic risk factors for dementia are studied best in AD. Genetic risk plays an important role in both early-onset and late-onset forms of AD along with other neurodegenerative diseases, such as frontotemporal dementia.

●Vascular risk factors (hypertension, hypercholesterolemia, diabetes, tobacco smoking) have been linked to cognitive decline and all-cause dementia as well as to AD and vascular dementia individually. However, associations have not been demonstrated consistently in all studies, and treatment of these conditions has not yet been clearly linked to a reduction in dementia risk in controlled trials.

●Evidence from observational studies suggests that lifestyle, in particular social, mental, and physical activity, are inversely associated with the risk for cognitive decline and dementia. However, methodologic issues may obscure the exact relationship between these features and dementia risk. One theory holds that higher levels of education along with cognitive activity produce a cognitive reserve that decreases the impact of neurodegeneration on cognitive function.

●Other factors that might increase the risk of dementia include head trauma, comorbid medical illnesses, obesity, high alcohol consumption, exposure to certain toxins, and depression

Has he actually been diagnosed with dementia?

[Qadgop_the_Mercotan]

Sorry, misread your question.

I couldn’t find evidence that pain makes dementia progress faster, but there is literature support that inadequately treated pain does acutely (and generally temporarily) reduce the ability to function as well cognitively as one with dementia could with better pain control. And if the pain interferes with their ability to do tasks normally within their range, this does increase frustration significantly which will impair ability to communicate, etc.

[Melbourne]

As above:

delirium can be induced by … uncontrolled pain…

“When patients suddenly become confused” When patients suddenly become confused - Harvard Health

[Omar_Little]

The medication he is taking may also be contributing to lower sodium levels in his body, which can exacerbate confusion, dementia like symptoms.

Your Sodium Level: What's Normal, What's Not | Livestrong.com

[Isilder]

Isn’t there a balance of COX1 and COX2 ? and the cause of pain, or the pain itself, might upset it ? Then the upset causes TIA… brain fade … “the vapours”.

Also pain causes sleepyness or depression (perhaps linked by bear like hibernation ability) so strong you are dopey…, and depression + dementia can appear as worse dementia.
Pain causes most people to want to rest… which is hibernation ??

So yes assess dementia when the pain is gone. If someone has a fall and the doctor says its dementia… ? well lots of people recover despite such a bad diagnosis… experienced GP’s would be slow to say something like “dementia” to a patient…a young hospital intern maybe saying things he shouldn’t.

[Amateur_Barbarian]

I recall that LSD was used in at least one trial to help terminal cancer patients deal with pain - it had no analgesic qualities, but it allowed them to “otherize” the pain and distance themselves from it, which helped them function better on lower dosages of heavy painkiller. I can see how continual pain would disrupt personality and ability to function/focus, making it look like an advance of the dementia.