The objective is to investigate how dementia affects processing of pain. More precisely, we aim to investigate how dementia-related neurodegeneration (occurring in Alzheimer disease (AD), frontotemporal dementia (FTD) and vascular dementia (VD))…
ID
Source
Brief title
Condition
- Central nervous system vascular disorders
- Dementia and amnestic conditions
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Response to various mild pain stimuli (pressure pain will be applied to the
shoulder and temperature (heat) will be applied to the forearm )
- Self -report
- Facial expression (the face will be videotaped and analyzed using the Facial
Action Coding System)
- Heartrate and heartrate-variability
Secondary outcome
- structural MRI (grey and white matter (especially in frontal areas))
- Neuropsychology testing (attention, memory, executive functioning)
Background summary
It is widely acknowledged that pain management for patients with dementia is
inadequate, with many patients suffering from pain unnoticed and untreated.
This is due to the loss of verbal communication skills over the course of
dementia, with patients losing the ability to report about pain and thereby,
making it more challenging to assess and adequately treat pain. Besides
dementia affecting the communication of pain, there is also evidence that the
pain system itself might be altered across the course of dementia. So far, only
a few studies have been conducted that used experimental pain to investigate
nociceptive processing in patients with dementia (mostly in patients with mild
or moderate degrees of Alzheimer*s disease) and alarmingly found increased
responses to pain. Thus, patients with dementia might face the dilemma of being
more sensitive to pain compared to cognitively unimpaired individuals, while at
the same time being less able to verbally report about their pain. In order to
reduce unnecessary suffering from pain, exploring the manner by which
individuals with dementia process, experience and respond to pain is an
imperative ethical goal.
Study objective
The objective is to investigate how dementia affects processing of pain. More
precisely, we aim to investigate how dementia-related neurodegeneration
(occurring in Alzheimer disease (AD), frontotemporal dementia (FTD) and
vascular dementia (VD)) affects ascending and descending pain processes.
Study design
In order to investigate ascending and descending mechanisms of pain
processing, different experimental pain paradigms will be conducted in patients
with AD, FTD and VD that allow for investigating endogenous pain inhibitory
mechanisms as well as pain facilitation mechanisms. For this purpose, pressure
and heat stimuli of mild pain intensities will be applied and subjective,
facial, motor and autonomic responses will be assessed. Pain responses will
then be related to structural changes in grey and white matter using MRI
(magnetic resonance imaging).
Study burden and risks
This study entails no risk to the participant. The experimental pain is
non-invasive, of slight intensity and of short duration. Nevertheless, the pain
induction will be accompanied with unpleasant experiences, although they are of
short duration. Extra effort and care will be undertaken to monitor the
participants carefully for any signs of discomfort and stress and testing will
be immediately stopped if signs are present. The subjects will visit the
Neuroimaging Center (NIC) for the structural scan and the neuropsychological
testing (60 minutes) and will return for the experimental pain session (30
minutes). The investigation can contribute to a better understanding how pain
processing is altered in different types of dementia, which will be very
relevant for pain management strategies.
Hanzeplein 1
Griningen 9713 GZ
NL
Hanzeplein 1
Griningen 9713 GZ
NL
Listed location countries
Age
Inclusion criteria
In order to be eligible to participate in this study, a subject must meet all of the following criteria:;All subjects:
- Age from 55 * 85 yr
- Willingness to cooperate and sign written informed consent * or proxy consent with assent of participating subject;Normal Healthy Controls (CP):
- MMSE scores between 27-30
- Without subjective memory complaints;Alzheimers*s disease dementia (AD):
- Diagnosis of probable AD according to the Alzheimer*s disease and Related Disorders Associations (NINCDS-ADRDA) criteria and NIA-AA guidelines ( McKhann et al. 2011).;Frontotemporal dementia (FTD):
- Diagnosis of behavioral variant FTD (FTD-b) according to the revised consensus criteria (Rascovsky et al. 2011).
- Diagnosis of a subtype of FTD of Primary Progressive Aphasia (PPA), divided into Semantic Dementia (SD), Progressive Nonfluent Aphasia (PNFA) and LPA due to FTD (Gorno-Tempini et al. 2011). ;Vascular dementia (VD):
- Diagnosis of probable VD according to the NINDS-AIREN (National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l*Enseignement en Neurosciences) guidelines (Roman et al. 1993).
Exclusion criteria
All subjects:
- History of major psychiatric illness
- Medications which may affect pain processing (selective serotonin re-uptake inhibitors, opioids, other analgesics)
- Contraindications for MR-measurements (e.g. cochlear implants and most permanent pacemakers, red tattoos);Normal healthy Controls:
- abnormal results on neuropsychological tests
- subjective memory complaints;All patients:
- Cognitive deficits could be explained by non-neurodegenerative condition (e.g. stroke, neoplasm, head injury, hydrocephalus or other medical condition)
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL58624.042.16 |