Sex Differences in Pain Reports and Brain Activation in Older Adults with Alzheimers Disease

项目摘要 阿尔茨海默病（AD）老年人的疼痛治疗不当是一个严重的公共卫生问题， 了解疼痛功能的性别和AD相关差异是NIA的优先领域。与健康相比， 在存在类似已知疼痛状况的情况下，患有AD的老年人疼痛较少 药造成这种差异的原因尚不清楚。治疗不当的疼痛会对 提高生活质量，增加医疗费用。有充分的证据表明，认知健康的男性和女性 急性和慢性疼痛的经历和报告不同，但尚不清楚这些差异是否延伸到 老年AD患者的数量。确定性别差异的生物学原因， 疼痛处理的改变对于增加我们对老年AD患者疼痛的理解至关重要。在 对于疼痛的反应，有证据表明，大脑结构和大脑功能因性别而异，并且可能会在 AD.然而，目前尚不清楚这些结构和功能性神经系统的变化如何因性别而异， AD如何影响对疼痛的心理生理和神经生理反应。 在R 01申请中提出的研究将研究如何口头疼痛报告模式， 急性实验性热痛在患有和不患有AD的老年男性和女性之间存在差异，以及这些差异是如何产生的。 性别差异映射到区域和网络脑功能变化。实验性急性热痛 分娩很好地预测了对痛苦的医疗状况的反应。我们建议检查心理物理学 和神经生理反应的实验性热刺激之间的健康男性和女性（年龄65 或更老）和年龄匹配患有AD的男性和女性（65岁或更老）。 本研究的目的是确定是否感觉（刺激强度）和情感（刺激 在皮肤热刺激期间，患有和不患有AD的人的（不愉快）反应因性别而异。 我们假设，AD将与女性敏感性增加有关，而AD男性将与女性敏感性增加有关。 经历更大的痛苦。这些变化可能是由于AD相关的大脑变化引起的。 结构和功能以及与疼痛相关的大脑网络的性别特异性改变。检查基线 患有和不患有AD的男性和女性之间的实验性热痛的差异将提供 了解可能导致未经治疗的疼痛风险的因素以及发展性行为的基础- 在老年AD患者中进行特定的新评估、预防和治疗策略。

PROJECT SUMMARY Poorly treated pain in older adults with Alzheimer's disease (AD) is a critical public health problem and understanding sex and AD-related differences in pain function is an NIA priority area. When compared to healthy adults, and in the presence of similarly 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. It is well documented that cognitively healthy males and females experience and report acute and chronic pain differently, however it is unknown if these differences extend into the population of older adults with AD. Determining the biological reasons for sex-differences leading to alterations in pain processing is essential for increasing our understanding of pain in older adults with AD. In response to pain, evidence suggests that brain structure and brain function differ by sex and may be altered in AD. However, it is unknown how these structural and functional nervous system alterations differ by sex and how AD impacts psychophysical and neurophysiological responses to pain. The proposed research in this R01 application will examine how verbal pain reporting patterns in responses to acute experimental thermal pain differs between older males and females with and without AD and how these sex-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 between healthy males and females (aged 65 or older) and aged match males and females with AD (aged 65 or older). The aims of this study are to determine whether sensory (stimulus intensity) and affective (stimulus unpleasantness) responses differ by sex in people with and without AD during cutaneous thermal stimulation. We hypothesize that AD will be associated with an increased sensitivity in females yet males with AD will experience greater unpleasantness with pain. These changes may arise from AD-associated changes in brain structure and function as well as from sex-specific alterations in pain-related brain networks. Examining baseline differences in experimental thermal pain between males and females with and without AD will provide a foundation for understanding factors that may contribute to untreated pain risk, as well as for developing sex- specific novel assessment, prevention, and treatment strategies in the older population with AD.