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Table 5 Correlates of pain with neuropsychiatric symptoms

From: Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis

Correlates of pain and Specified NPS  
First author N Pain: prevalence Neuropsychiatric symptoms: prevalence Correlates of pain with NPS Quality of study
Ahn 2013 [ 36 ] 56577 Not reported Wandering 9% AOR 0.77 (95% CI: 0.73-0.81) with wandering Subsample without psychotropic medication AOR 0.72 (95% CI: 0.63-0.83) with wandering (Adjusted for cognition, ADL, sociodemographics) 10
Kunik 2005 [ 34 ] 99 Pain mean 2.4 (SD 1.2) Delusions/hallucinations mean 0.35 (SD 0.48) r=0.15 (p>0.05) with psychosis 8.5
Leong 2007 [ 35 ] 225 Pain 44%, chronic pain 34% Anxiety 48% SOR 1.8 (95% CI: 1.0-3.0) with anxiety 8.5
Norton 2010 [ 42 ] 161 Not reported BEHAVE-AD mean 6..4 (SD 29.2) RMBPC-NH mean 1.45 (SD 0.64) r=0.15 (p=0.08) for pain intensity and emotional behaviour problems r=0.05 (p=0.58) for pain intensity and resistiveness to care 9
Torvik 2010 [ 52 ] 106 Current pain in total group 55%, in cognitive impaired group 52% Negative affect index (DQoL) mean 2.0 (SD 0.75), positive affect/humour index (DQoL) mean 3.4 (SD 0.9) p<0.01 for current pain and negative affect p=0.11 for current pain and with positive affect/humour 6.5
Tosato 2012 [ 3 ] 2822 Any pain 19% (moderate/severe/excruciating pain 13%) Behavioural symptoms 37% Psychiatric symptoms 21% AOR=0.74 (95% CI: 0.55-1.0) with wandering AOR=1.4 (95% CI: 1.08-1.8) with resistance to care AOR 1.5 (95% CI: 1.07-2.03) with delusions AOR 1.06 (95% CI: 0.80-1.41) with verbal abuse AOR 1.08 (95% CI: 0.75-1.55) with physical abuse (Adjusted for age, gender, country, cognitive impairment, number of diseases, ischemic heart disease, stroke, falls, communication problems, and a flare-up of a chronic or recurrent condition) 11.5
Volicer 2009 [ 37 ] 929 Daily pain 29%, less than daily pain 19% Verbally abusive not easily altered 2%, physically abusive not easily altered 12%, Delusions 8%, Hallucinations 9% r=0.07 (p=0.03) for pain frequency and verbal abuse AOR=0.9(p=0.53) with resisting care AOR=0.7 (p=1.2) with verbal abuse AOR=0.7 (p=0.16) with physical abuse (Both multivariate models among others controlled for resisting care.) 11
Zieber 2005 [ 38 ] 58 Not reported Not reported r=0.46 (p<0.01) for DS-DAT scores and resisting care r=0.42 (p<0.01) for DS-DAT scores and aberrant vocalization Pain rating by palliative care nurse consultants: r=0.51 (p<0.01) with resisting care r=0.40 (p<0.01) with aberrant vocalizations Pain rating by facility nurse: r=0.48 (p<0.01) with resisting care r=0.065 (p<0.63) with aberrant vocalizations 8
Correlates of pain and Unspecified NPS
Black 2006 [ 39 ] 123 Pain 63% Psychiatric disorders or behaviour problems 85%, behaviour problems 67% SOR 1.9 (95% CI: 0.7-5.3) with psychiatric/ behaviour problems SOR 1.2 (95% CI: 0.5-2.5) with behaviour problems 6.5
Brummel-Smith 2002 [ 40 ] 104 (excluding those unable to self-report pain) Moderate-severe pain 60% No-mild pain 40% 50 subject unable to answer ≥1 disruptive behaviours (wandering, verbal disruption, physical aggression, regressive behaviour, hallucinations) 70% in dementia sample n=154 SOR 1.8 (95% CI: 0.8-4.0) with ≥1 disruptive behaviour 7
Cipher 2004 [ 4 ] 234 Persistent pain 72% Dysfunctional behaviours mean 4.4 (SD 0.76) r=0.22 (p<0.05) with dysfunctional behaviours 7.5
Cipher 2006 [ 41 ] 277 Acute pain 29% Chronic pain 59% - r=0.18 (p<0.05) with GLDS mean behavioural intensity 7.5
Norton 2010 [ 42 ] 161 Not reported BEHAVE-AD mean 61.4 (SD 29.2) RMBPC-NH mean 1.45 (SD 0.64) r=0.18 (p=0.03) for pain intensity and disruptive behaviour problems 9
r=0.05 (p=0.53) for pain intensity and global need driven behaviours
2012 [ 3 ] 2822 Any pain 19% (moderate/severe/excruciating pain 13%) Behavioural symptoms 37% Psychiatric symptoms 21% AOR=1.4 (95% CI: 1.04-1.8) with socially inappropriate behaviour (Adjusted for age, gender, country, cognitive impairment, number of diseases, ischemic heart disease, stroke, falls, communication problems, and a flare-up of a chronic or recurrent condition) 11.5
Williams 2005 [ 39 ] 331 Pain 21%, in nh 23%, in rc/al 20% (self-report for subgroup mmse>10 was higher: 39% and 25%) Behavioural symptoms 58% OR=1.1 (95% CI: 0.49-2.29) and AOR=1.2 (95% CI: 0.57-2.36) with behavioural symptoms 10
(Adjusted for: sex, race, age, cognitive status, number of 10 comorbidities, impairments of 7 activities of daily living)
  1. Abbreviations: AOR, Adjusted Odds Ratio; ADL, Activities of Daily Living; SD, Standard Deviation; r, correlation coefficient; SOR, Self-Calculated Odds Ratio; BEHAVE-AD, Behavioural Pathology in Alzheimer’s disease RMBPC-NH, Revised Memory and Behaviour Problems Checklist-Nursing Home; DQoL, Dementia Quality of life; DS-DAT, Discomfort Scale - Dementia of Alzheimer Type; GLDS, Geriatric Level of Dysfunction Scale; rc/al, residential care/assisted living; MMSE, Mini Mental State Examination; OR, Odds Ratio.