Advancing pain assessment in Alzheimer's disease and related dementias: Functional near-infrared spectroscopy for investigating brain activity.

IF 1.5 Q4 CLINICAL NEUROLOGY

British Journal of Pain Pub Date : 2025-09-27 DOI:10.1177/20494637251384009

Juyoung Park, Samuel Montero-Hernandez, Allison J Huff, Chiyoung Lee, Luca Pollonini, Lindsey Park, Lifeng Lin, Ilknur Telkes, James E Galvin, Jason Hoang, Hyochol Ahn

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引用次数: 0

Abstract

Background: Pain assessment in Alzheimer's disease and related dementias (ADRD) is challenging due to cognitive decline and communication barriers, limiting the reliability of self-report and observational tools. Functional near-infrared spectroscopy (fNIRS) offers a noninvasive measure of cerebral hemodynamic responses and may serve as an objective biomarker for pain. This pilot study evaluated the feasibility of fNIRS for pain assessment in ADRD, using transcranial direct current stimulation (tDCS) solely as a controlled cortical modulation paradigm to test fNIRS sensitivity, rather than as a therapeutic intervention.

Methods: Forty older adults with mild to moderate ADRD were randomized to active (n = 20) or sham (n = 20) tDCS for 5 consecutive days to generate controlled cortical modulation. Pain was assessed using the Numerical Rating Scale (NRS), Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2), and fNIRS responses to standardized pain stimuli. Hemodynamic changes in prefrontal and somatosensory cortices were analyzed to determine whether fNIRS detected pain-related brain activity.

Results: NRS and MOBID-2 scores were significantly correlated at baseline (r = .605, p < .001) and post-intervention (r = .567, p < .001). In the active tDCS condition, pain stimulation elicited significant cortical hemodynamic changes that correlated with pain scores (p < .05), supporting fNIRS's sensitivity for detecting pain-related neural responses. In the sham group, only a few significant correlations were observed post-intervention (e.g., frontal cortex r = .44, p = .049; prefrontal cortex r = .52, p = .017), which were less consistent compared to the active condition.

Conclusion: fNIRS demonstrated feasibility as an objective pain assessment tool in ADRD. tDCS served only as a probe to induce cortical modulation for evaluating fNIRS performance. In this study, tDCS functioned as a probe to induce cortical modulation for evaluating fNIRS sensitivity, not as a therapeutic intervention. Larger trials are needed to confirm fNIRS validity for clinical application.

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阿尔茨海默病及相关痴呆的疼痛评估进展：功能性近红外光谱研究脑活动

背景：由于认知能力下降和沟通障碍，阿尔茨海默病及相关痴呆（ADRD）的疼痛评估具有挑战性，限制了自我报告和观察工具的可靠性。功能近红外光谱（fNIRS）提供了一种无创的脑血流动力学反应测量方法，可以作为疼痛的客观生物标志物。本初步研究评估了fNIRS用于ADRD疼痛评估的可行性，使用经颅直流电刺激（tDCS）单独作为受控的皮质调节范式来测试fNIRS的敏感性，而不是作为治疗干预。方法：40例轻度至中度ADRD的老年人随机分为活动（n = 20）或假（n = 20） tDCS组，连续5天产生可控制的皮质调节。采用数值评定量表（NRS）、活动-观察-行为-强度-痴呆-2 （MOBID-2）和fNIRS对标准化疼痛刺激的反应来评估疼痛。分析前额叶和体感觉皮层的血流动力学变化，以确定fNIRS是否检测到与疼痛相关的大脑活动。结果：NRS和MOBID-2评分在基线（r = 0.605, p < 0.001）和干预后（r = 0.567, p < 0.001）具有显著相关性。在活动tDCS状态下，疼痛刺激引起明显的皮质血流动力学变化，与疼痛评分相关（p < 0.05），支持fNIRS检测疼痛相关神经反应的敏感性。在假手术组中，干预后仅观察到少数显著相关性（例如，额叶皮质r = 0.44, p = 0.049；前额叶皮质r = 0.52, p = 0.017），与活动条件相比不太一致。结论：fNIRS作为ADRD的客观疼痛评估工具是可行的。tDCS仅作为诱发皮层调制的探针来评估fNIRS的性能。在这项研究中，tDCS作为一种探针来诱导皮层调节以评估fNIRS敏感性，而不是作为一种治疗干预。需要更大规模的试验来证实fNIRS在临床应用中的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Pain CLINICAL NEUROLOGY-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.