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      Prevalence of pain-related diagnoses in patients with dementia: a nationwide study

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          To investigate the prevalence of pain-related diagnoses in patients with dementia and evaluate the association of pain-related diagnoses with demographic characteristics and dementia subtypes.

          Patients and methods

          In this population-based retrospective cohort study, participants were recruited from a cohort of 2 million people randomly sampled from the general population in the National Health Insurance Research Database of Taiwan from 2000 to 2013. The index year was defined as the period of 1 year from the date of the first diagnosis of dementia.


          The study group comprised 28,450 patients with the dementia subtypes of vascular dementia, Alzheimer’s disease, or other dementia subtypes. The mean age of patients with dementia was 76.75 years. Of all patients with dementia, 49.07% had at least one pain-related diagnosis documented in their outpatient or inpatient claim records within the index year. The top three pain-related diagnoses were osteoarthritis (29.27%), headache (12.53%), and osteoporosis (11.43%). Musculoskeletal diagnosis was more likely in female patients with vascular dementia. Although patients with vascular dementia had a significantly lower prevalence of pain-related diagnosis, they had a significantly higher risk of 1-year mortality than patients with other dementia subtypes.


          During the index year, 49.07% of patients with dementia had at least one pain-related diagnosis. To investigate the differences of the use of pain medication in patients with different dementia subtypes and the difference of pain-related diagnosis and treatment in patients with and without dementia, future studies are recommended.

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          Most cited references 26

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          A Nationwide Survey of Mild Cognitive Impairment and Dementia, Including Very Mild Dementia, in Taiwan

          An increasing population of dementia patients produces substantial societal impacts. We assessed the prevalence of mild cognitive impairment (MCI) and all-cause dementia, including very mild dementia (VMD), in Taiwan. In a nationwide population-based cross-sectional survey, participants were selected by computerized random sampling from all 19 Taiwan counties and were enrolled between December 2011 and March 2013. Cases were identified through in-person interviews based on the National Institute on Aging-Alzheimer’s Association clinical criteria. Demographic data and histories involving mental status and function in daily living were collected. The principal objective assessments were the Taiwanese Mental Status Examination and Clinical Dementia Rating. In all, 10,432 people aged 65 years or older (mean age 76.2±6.7, 52.3% women) were interviewed. The age-adjusted prevalence of all-cause dementia was 8.04% (95% CI 7.47–8.61), including a 3.25% (95% CI 2.89–3.61) prevalence of VMD; that of MCI was 18.76% (95% CI 17.91–19.61). Women had a higher prevalence than men of both all-cause dementia (9.71% vs. 6.36%) and MCI (21.63% vs. 15.57%). MCI affects a considerable portion of the population aged 65 and above in Taiwan. The inclusion of VMD yields dementia prevalence rates higher than those previously reported from Taiwan. Old age, female gender, and a low educational level are significant associated factors.
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            Pain assessment in elderly adults with dementia.

            Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. The systematic study of facial expressions through a computerised system has identified core features that are highly specific to the experience of pain, with potential future effects on assessment practices in people with dementia. Various observational-behavioural pain assessment instruments have been reported to be both reliable and valid in individuals with dementia. These techniques need to be interpreted in the context of observer bias, contextual variables, and the overall state of the individual's health and wellbeing.
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              Education and Risk of Dementia: Dose-Response Meta-Analysis of Prospective Cohort Studies.

              Educational level has been regarded as one of the most widely accepted risk factors in the epidemiological studies for dementia, despite with discordant qualitative results. However, the dose-response relation between education and incident dementia was still unknown. To quantitatively evaluate the association between exposure level to high and low education and risk of dementia, we searched PubMed, EMBASE, and the Cochrane Library up to November 2014 and references of retrieved literatures. Specific prospective cohort studies, in which educational attainment was categorized into at least three levels, were included. Newcastle-Ottawa scale was used to assess the quality of included studies. Fifteen prospective cohort studies with 55655 for low education and eight prospective cohort studies with 20172 for high education were included. In the qualitative analysis, both low and high education showed a dose-response trend with risk of dementia and Alzheimer's disease (AD). In the quantitative analysis, the dementia risk was reduced by 7 % for per year increase in education (RR, 0.93; 95 % CI, 0.92-0.94; p for overall trend = 0.000; p for nonlinearity = 0.0643). Nonetheless, we did not find statistically significant association between per year decrease in education and dementia (RR, 1.03; 95 % CI, 0.96-1.10; p for overall trend = 0.283; p for nonlinearity = 0.0041) or AD (RR, 1.03; 95 % CI, 0.97-1.10; p for overall trend = 0.357; p for nonlinearity = 0.0022). Both low and high education showed a trend of dose-response relation with risk of dementia and AD. The dementia risk was reduced by 7 % for per year increase in education.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                03 September 2018
                : 11
                : 1589-1598
                [1 ]School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
                [2 ]Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
                [3 ]Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
                [4 ]Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
                [5 ]International Medical Service Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
                [6 ]Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, lichan2009@ 123456gmail.com
                Author notes
                Correspondence: Li-Chan Lin, Institute of Clinical Nursing, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City 11221, Taiwan, Tel +88 622 826 7159, Email lichan2009@ 123456gmail.com
                © 2018 Lin et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Anesthesiology & Pain management

                pain, prevalence, diagnosis, hospital, alzheimer’s, dementia


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