Dementia-related pain: What caregivers need to know

Dementia isn’t a specific disease. Instead, it describes a collection of symptoms that affect a person’s thinking and social abilities enough to interfere with daily life. There are more than 55 million people worldwide living with dementia. Of these, 50% to 60% have Alzheimer’s disease. Dementia is the seventh leading cause of death worldwide.

There is a constellation of dementia symptoms, and memory loss is the primary feature. Other common symptoms are physical functional decline and difficulty with mental tasks, like planning or spatial ability. Pain is another frequent symptom, although it is often overlooked and undertreated.

Dementia-related pain

As dementia progresses, so does the likelihood that patients are experiencing pain. Between 50% and 80% of patients with moderate to severe dementia experience pain daily. Many patients receive inadequate treatment due lack of recognition. Alzheimer’s disease causes the person to develop a mask-like facial expression. This minimizes typical facial expressions of pain, like a drawn mouth or furrowed brows. Also, patients may have lost the cognitive ability to tell caregivers about their pain with phrases such as “this hurts” or “I am in pain.”

Unfortunately, many patients with dementia are left with only basic expressions of pain presented through negative behaviors. These include screaming, cursing or striking out, particularly at caregivers.

Untreated pain also may cause patients to become more withdrawn or fatigued. This may be due to their discomfort or lack of solid sleep. Even though patients may feel drowsy and sleep more than before, their sleep is disturbed and not restorative. Patients may become more alert and interactive once their pain is treated, even if medications have a possible side effect of drowsiness.

Importantly, there is a marked increase in caregiver stress in those caring for patients experiencing pain.

Types of dementia-related pain

Chronic pain is pain that lasts longer than three months. It is associated with cognitive, emotional and social decline. The link between chronic pain and Alzheimer’s disease is widely accepted despite not being fully understood.

Chronic pain affects some of the same areas of the brain that are affected by Alzheimer’s disease. The changes occur in the area called locus coeruleus and affect a chemical messenger called norepinephrine. As this messenger is released, it causes the pain-relaying cells in the brain to become inflamed.

…continued

swipe to next page