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

 描述(由申请人提供)：老年痴呆症患者治疗不当的疼痛是一个严重的公共卫生问题。与非痴呆症患者相比，在出现类似疼痛相关疾病的情况下，痴呆症患者接受的止痛药较少。文献中报道了疼痛体验的性别差异，女性通常经历更多的疼痛，并报告更多的敏感性。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，并增加医疗成本。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)老年患者疼痛的了解至关重要。缺乏证据支持患有不同类型痴呆症的老年人的最佳疼痛管理做法，这使这些人面临不良疼痛管理做法的风险。该项目的目标是确定AD或VAD相关的心理物理和心理社会差异在老年女性疼痛处理过程中的差异。我们的试点数据在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)的样本中显示，在对热痛的反应中，女性报告疼痛的感觉阈值降低，疼痛相关的不快减少。对AD和VAD患者观察到的疼痛的第二个试点样本表明，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)，我们将检查痴呆和性别相关的差异，在广泛的AD或VAD老年人(66-95岁)的热痛处理。我们的总体假设是，实验性热疼痛反应的特定变化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)和白质血管病变负荷量有关。这些变化可能会增加患有某些痴呆症亚型的妇女在受伤后未发现疼痛、接受疼痛治疗、发展成慢性疼痛以及生命末期生活质量较差的风险。这项研究的结果将有助于改进针对性的开发 疼痛评估技术和疼痛管理方法。

 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.