Tyler R Bell, Jeremy A Elman, Daniel E Gustavson, Michael J Lyons, Christine Fennema-Notestine, McKenna E Williams, Matthew S Panizzon, Rahul C Pearce, Chandra A Reynolds, Mark Sanderson-Cimino, Rosemary Toomey, Amy Jak, Carol E Franz, William S Kremen
{"title":"慢性疼痛和阿片类药物使用史与认知能力下降和轻度认知障碍有关。","authors":"Tyler R Bell, Jeremy A Elman, Daniel E Gustavson, Michael J Lyons, Christine Fennema-Notestine, McKenna E Williams, Matthew S Panizzon, Rahul C Pearce, Chandra A Reynolds, Mark Sanderson-Cimino, Rosemary Toomey, Amy Jak, Carol E Franz, William S Kremen","doi":"10.1017/S1355617725101057","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.</p><p><strong>Methods: </strong>Men in the Vietnam Era Twin Study of Aging (VETSA; <i>n</i> = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.</p><p><strong>Results: </strong>Moderate-to-severe, but not mild, chronic pain intensity (<i>β</i> = -.10) and interference (<i>β</i> = -.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (<i>HR</i> = 1.75) and interference (<i>HR</i> = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (<i>β</i> = -.18) and a higher risk of amnestic MCI (<i>HR</i> = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all <i>p</i>-values > .05).</p><p><strong>Discussion: </strong>Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"1-11"},"PeriodicalIF":2.6000,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404075/pdf/","citationCount":"0","resultStr":"{\"title\":\"History of chronic pain and opioid use is associated with cognitive decline and mild cognitive impairment.\",\"authors\":\"Tyler R Bell, Jeremy A Elman, Daniel E Gustavson, Michael J Lyons, Christine Fennema-Notestine, McKenna E Williams, Matthew S Panizzon, Rahul C Pearce, Chandra A Reynolds, Mark Sanderson-Cimino, Rosemary Toomey, Amy Jak, Carol E Franz, William S Kremen\",\"doi\":\"10.1017/S1355617725101057\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.</p><p><strong>Methods: </strong>Men in the Vietnam Era Twin Study of Aging (VETSA; <i>n</i> = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.</p><p><strong>Results: </strong>Moderate-to-severe, but not mild, chronic pain intensity (<i>β</i> = -.10) and interference (<i>β</i> = -.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (<i>HR</i> = 1.75) and interference (<i>HR</i> = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (<i>β</i> = -.18) and a higher risk of amnestic MCI (<i>HR</i> = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all <i>p</i>-values > .05).</p><p><strong>Discussion: </strong>Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.</p>\",\"PeriodicalId\":49995,\"journal\":{\"name\":\"Journal of the International Neuropsychological Society\",\"volume\":\" \",\"pages\":\"1-11\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-07-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404075/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the International Neuropsychological Society\",\"FirstCategoryId\":\"102\",\"ListUrlMain\":\"https://doi.org/10.1017/S1355617725101057\",\"RegionNum\":4,\"RegionCategory\":\"心理学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the International Neuropsychological Society","FirstCategoryId":"102","ListUrlMain":"https://doi.org/10.1017/S1355617725101057","RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
History of chronic pain and opioid use is associated with cognitive decline and mild cognitive impairment.
Background: The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.
Methods: Men in the Vietnam Era Twin Study of Aging (VETSA; n = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.
Results: Moderate-to-severe, but not mild, chronic pain intensity (β = -.10) and interference (β = -.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (HR = 1.75) and interference (HR = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (β = -.18) and a higher risk of amnestic MCI (HR = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all p-values > .05).
Discussion: Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.
期刊介绍：
The Journal of the International Neuropsychological Society is the official journal of the International Neuropsychological Society, an organization of over 4,500 international members from a variety of disciplines. The Journal of the International Neuropsychological Society welcomes original, creative, high quality research papers covering all areas of neuropsychology. The focus of articles may be primarily experimental, applied, or clinical. Contributions will broadly reflect the interest of all areas of neuropsychology, including but not limited to: development of cognitive processes, brain-behavior relationships, adult and pediatric neuropsychology, neurobehavioral syndromes (such as aphasia or apraxia), and the interfaces of neuropsychology with related areas such as behavioral neurology, neuropsychiatry, genetics, and cognitive neuroscience. Papers that utilize behavioral, neuroimaging, and electrophysiological measures are appropriate.
To assure maximum flexibility and to promote diverse mechanisms of scholarly communication, the following formats are available in addition to a Regular Research Article: Brief Communication is a shorter research article; Rapid Communication is intended for "fast breaking" new work that does not yet justify a full length article and is placed on a fast review track; Case Report is a theoretically important and unique case study; Critical Review and Short Review are thoughtful considerations of topics of importance to neuropsychology and include meta-analyses; Dialogue provides a forum for publishing two distinct positions on controversial issues in a point-counterpoint format; Special Issue and Special Section consist of several articles linked thematically; Letter to the Editor responds to recent articles published in the Journal of the International Neuropsychological Society; and Book Review, which is considered but is no longer solicited.
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