Background & Aims

The presence of pain has consistently been related to worse neuropsychological test performance[1,2]. From the aging literature, it is known that higher levels of cognitive reserve enable individuals to retain normal cognitive performance, despite reductions in brain health following normal or pathological aging[3]. Cognitive reserve (CR) builds-up over the adult lifespan, and is positively influenced by cognitively stimulating activities in the field of education, occupation and leisure time activities. To what extent cognitive reserve also protects against the negative effects of pain on cognition, is not clear[4]. Moreover, as CR increases over the adult lifespan, the protective effects may become stronger at an older age.

Methods

The current study examined the effect of pain intensity (current and during the last month) on cognitive test performance, and how this association is moderated by the level of cognitive reserve and age, in a sample of 280 adult volunteers aged 18-80. Cognitive domains examined included memory, processing speed and executive function. Cognitive reserve was assessed using the Cognitive Reserve Index questionnaire, which estimates cognitive reserve based on education, occupation and leisure activities. Pain was rated using 11-point numerical rating scales.

Results

Moderation analyses were run with pain as predictor, cognitive domain scores as independent variable, CR as moderator, and age and current chronic pain condition (yes/no) as covariates. These revealed (marginally significant) main effects of current pain for speed (p=0.07) and of pain during the last month for executive functioning (p<0.05). In both instances were higher pain scores related to worse performance. A main effect of CR was found for memory, showing higher CR estimates relate to better memory performance (p<0.03), with trends (p<0.07) showing a similar relationship for processing speed and executive functioning. No moderating effect of CR was found, and these findings were not different when age was included as an additional moderator. Additional analyses will be performed, assessing potential underlying neuroanatomical correlates of pain and cognitive reserve, including fronto-insular white matter tracts[5].

Conclusions

The present study demonstrates that whereas both pain and CR independently influence neuropsychological test performance, the effect of pain is not moderated by the level of CR. Moreover, these findings did not change with advancing age. We can therefore only confirm that pain negatively affects cognitive performance, and that CR appears to have beneficial effects on cognition. Future studies are needed examining these associations in patient groups with higher levels of clinical pain.

References

1. Lier et al. The interaction between pain and cognition: on the roles of task complexity and pain intensity. Scand J Pain. 2021 ;22(2):385-395.
2. Khera & Rangasamy. Cognition and Pain: A Review. Front Psychol. 2021;12:673962.
3. Stern et al. A framework for concepts of reserve and resilience in aging. Neurobiol Aging. 2023; 124:100-103.
4. Delgado-Gallén et al. Cognitive Reserve as a Protective Factor of Mental Health in Middle-Aged Adults Affected by Chronic Pain. Front Psychol. 2021; 12:752623.
5. Gomez-Beldarrain et al. Right fronto-insular white matter tracts link cognitive reserve and pain in migraine patients. J Headache Pain. 2015;17:4.

Presenting Author

Joukje Oosterman

Poster Authors

Joukje Oosterman

PhD

Donders Institute for Brain, Cognition and Behaviour

Lead Author

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