Differences in Pain Between Alzheimer's Disease and Vascular Dementia in Older Females

老年女性阿尔茨海默氏病和血管性痴呆的疼痛差异

• 批准号: 9353271
• 负责人: RONALD L COWAN
• 金额: $ 6.43万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9353271
• 关键词: Acute Pain; Address; Affect; Affective; Age; Alzheimer' s Disease; Analgesics; Awareness; Behavioral; Biological; Blood Vessels; Clinical; Cognitive; Comorbidity; Cutaneous; Data; Data Set; Dementia; Detection; Development; Diagnosis; Dimensions; Disease; Elderly; Female; Foundations; Future; Gender; Goals; Health Care Costs; Health Personnel; High temperature of physical object; Impairment; Individual; Injury; Knowledge; Lateral; Lesion; Literature; Longevity; Malignant Neoplasms; Measures; Medial; Mediating; Mission; Observational Study; Pain; Pain Measurement; Pain Threshold; Pain intensity; Pain management; Pathology; Pathway interactions; Pilot Projects; Practice Management; Psychophysics; Public Health; Publishing; Quality of life; Reporting; Research; Risk; Sampling; Sensory; Sensory Thresholds; Stimulus; Symptoms; System; Techniques; Temperature; United States National Institutes of Health; Vascular Dementia; Woman; associated symptom; central pain; chronic pain; clinical practice; cohort; disorder control; end of life; enhancing factor; experience; gender difference; high risk; improved; male; men; multidisciplinary; nociceptive response; novel; psychosocial; public health relevance; relating to nervous system; response; white matter

 DESCRIPTION (provided by applicant): 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.

 描述（由申请人提供）：老年痴呆症患者的疼痛治疗不良是一个严重的公共卫生问题。与没有痴呆症的人相比，痴呆症患者在存在类似疼痛相关疾病的情况下接受的止痛药较少。在文献中报告了疼痛经历的性别相关差异，女性通常经历更多疼痛并报告敏感性增加。治疗不当的疼痛会导致许多相关症状，对生活质量产生负面影响，并增加医疗费用。探索疼痛处理改变的生物学原因对于增加我们对阿尔茨海默病（AD）和血管性痴呆（VaD）老年人疼痛的理解至关重要。缺乏证据支持不同类型痴呆症的老年人的最佳疼痛管理实践，使这些人面临疼痛管理实践不佳的风险。这个项目的目标是确定AD或VaD相关的心理生理和心理社会的差异，在处理疼痛的老年女性。我们在12名男性和12名女性（年龄匹配）认知正常的老年人（年龄65-81岁）样本中的试验数据表明，在对热痛的反应中，女性报告疼痛的感觉阈值降低，疼痛相关的不愉快减少。AD和VaD患者的第二个观察性疼痛试点样本表明，VaD患者可能有更多的疼痛行为指标。使用心理物理学（测量感觉阈值和情感不愉快），我们将在广泛的AD或VaD老年人（年龄66-95）中研究痴呆和热痛处理的性别相关差异。我们的总体假设是，实验性热痛反应的特定改变，反映了中枢疼痛处理的差异，并与临床疼痛反应相关，与痴呆亚型（AD，VaD）和白色血管病变负荷量相关。这些变化可能会使患有某些痴呆亚型的女性在受伤后无法检测到疼痛，疼痛治疗，慢性疼痛发展以及生命结束时生活质量差的风险增加。这项研究的结果将有助于开发更好的针对性 疼痛评估技术和疼痛管理方法。