Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Participants reporting a greater number of chronic pain sites had a higher proportion of developing incident all-cause dementia, AD, and vascular dementia than those without chronic pain in this prospective cohort study.

Evidence Rating Level: 2 (Good)

Dementia is a major public health concern, and there is no current cure or effective disease-modifying agent. Therefore, identifying and targeting modifiable risk factors continues to be a mainstay in preventive care. Existing literature supports a link between chronic musculoskeletal pain and accelerated cognitive and memory decline, though current evidence is still lacking. This prospective cohort study sought to explore whether the number of chronic pain sites could be associated with increased risk of dementia. Data on 356,383 individuals aged 40 to 69 years who did not have dementia at baseline were obtained from the UK Biobank, a large population-based cohort study. Patients were classified into six groups: no chronic pain lasting over three months, 1, 2, 3, and 4 sites of chronic pain (choosing from hip, knee, back, or neck/shoulder), or chronic pain ‘all over the body’. All-cause dementia and its subtypes were ascertained using hospital inpatient and death registry records. After follow-up (median of 13.3 years), there were 4959 new dementia events recorded. There was a significant association between the number of chronic pain sites and an increased risk of incident all-cause dementia (hazard ratio [HR]=1.08 per 1 site increase, 95% confidence interval [CI] 1.05–1.11), even when adjusted for covariates including SES, BMI, lifestyle, comorbidities, pain medications, psychological problems, and sleep. This was observed as a dose-response relationship, with each increase in sites affected by chronic pain reflecting incremental increases in risk for all-cause dementias and Alzheimer’s disease, but not vascular or frontotemporal subtypes of dementia (possibly due to small sample sizes and lower statistical power in these subgroups). There was a cumulative incidence of dementia >40% higher in those with pain in four sites or ‘all over the body’ compared to those without chronic musculoskeletal pain. Limitations to this study include a lack of generalizability to other ethnicities given the high proportion of Caucasian individuals registered in the UK Biobank, as well as a lack of access to detailed neuropsychological assessments in confirming the recorded diagnoses of dementia in these patients. Baseline cognitive status was also not fully accounted for. Overall, study findings suggest that musculoskeletal pain may be an underrecognized risk factor for dementia.

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