Online ISSN : 2187-4697
Print ISSN : 0915-8588
ISSN-L : 0915-8588
Original Article
Is pain behavior affected by the degree of cognitive decline?—An investigation in mild cognitive impairment and dementia—
Kenta NakadaKazuhiro ShimoSatoshi OhgaTakako Matsubara
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2023 Volume 38 Issue 1 Pages 20-29


Pain behavior observation is recommended for pain assessment in the elderly with dementia. Pain behavior observation may be useful not only in patients with dementia but also those with cognitive impairment in general. However, the characteristics of pain behavior may differ depending on the degree of cognitive decline. This study examined the characteristics of pain behavior using the verbal rating scale (VRS) and the Abbey pain scale (APS) in elderly adults with mild cognitive impairment (MCI) and dementia.

This study enrolled 199 participants with MCI (n=41) and dementia (n=158). VRS and APS were used to assess the patient’s pain during walking or transferring by one assessor. VRS and APS were compared in both groups. The kappa coefficient was calculat­ed to determine the degree of agreement between VRS and APS. The item response theory was used to analyze the APS items and extract variables that reflect the presence of pain.

There were no significant differences in the demographic data, VRS, or APS between the two groups. The kappa coefficient was 0.109 (p=0.387) for the MCI group and 0.282 (p<0.001) for the dementia group. Using the item response theory, "Vocalization", "Facial expression", and "Change in body language" were commonly identified as characteristics of pain behavior in both patients with MCI and those with dementia.

The results indicated that among elderly adults with MCI, there are discrepancies between self–reported and observed pain behaviors. The results suggest that for the elderly with suspected cognitive decline, a combined assessment of pain behavior observation and patient–reported outcomes, such as VRS, is recommended. Moreover, pain assessment that focuses on the three behaviors of "Vocalization", "Facial expression", and "Change in body language" may improve pain assessment in elderly patients with cognitive decline.

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© 2023 Japanese Association for the Study of Pain
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