Pain Assessment in Patients with Impaired Cognition, especially Dementia

Background: The number of older adults will increase considerably in the next decades. Since age is the main risk factor for dementia and untreated pain, the number of patients with both dementia and pain will also grow. When dementia and pain concur, the ir impact on the European society multiplies and asks for transnational solutions. Aim: This COST Action brings together leading researchers from a wide range of scientific disciplines. The major aim is the development of a comprehensive and internationa lly agreed-on assessment toolkit for older adults targeting the various subtypes of dementia and various aspects of pain, including pain diagnostics, cognitive examination and guidelines for proper assessment. Specification of achievements: The toolkit w ill target pain intensity, pain unpleasantness, pain sites, pain-concurrent behavioural and emotional problems - like agitation and aggression. Cognitive examination by neuropsychological methods will be included. It will be based mainly on observer ratin gs and will rely on self-report only in mild cases of cognitive impairment. The assembled tools will cover pain in general as well as the most prevalent specific forms of pain (toothache, headache, joint, etc.). The various stages of the disorders will be considered; particularly, specific tools for palliative care will be integrated. The development of the toolkit will require as final step a systematic testing of its validity and its sensitivity to analgesic treatment. Accordingly, multi-centre clinica l studies and controlled drug trials will be run. The necessary convergence of the toolkit with physiological and behavioural markers of pain such as motor and autonomic reflexes, brain electrical activity and magnetic resonance imaging will be investigat ed.