People with dementia often experience changes in how they feel and report pain. These shifts can make it harder for caregivers and doctors to know when someone is hurting and how to help.
In dementia, the brain’s ability to process pain signals can weaken. Parts of the brain that handle pain perception, like those for attention and memory, get damaged over time. This means a person might not notice pain as strongly or might not express it clearly. For example, they could have a painful injury but show no sign of discomfort, or they might seem agitated without an obvious reason because the pain is there but hard to pinpoint.
Research shows links between chronic pain and cognitive problems, which are early signs of dementia. Chronic pain can lead to issues like trouble with attention, memory, and executive function, where planning and decision-making happen. In turn, as dementia progresses, pain perception changes further. Older adults with high-impact chronic pain sometimes report lower pain intensity at the start compared to younger adults, but treatments can still reduce pain and improve daily function over time.
Veterans with chronic pain are more likely to notice early cognitive decline, called subjective cognitive decline. This is an early warning for dementia. Pain might speed up these changes through inflammation in the brain, fatigue from focusing on the pain, or mood issues like anxiety. Sleep problems from pain also play a role, as poor sleep affects brain health and worsens cognitive risks.
In conditions like temporomandibular disorder with chronic pain, people show weaknesses in visuospatial skills, attention, and executive tasks. This suggests pain and brain function influence each other in a cycle. Similarly, ongoing pain from low back issues or migraines takes up mental resources, leaving less for other thinking tasks.
These connections highlight why pain management matters in dementia care. Addressing pain early might slow cognitive decline and improve quality of life. Doctors often watch for indirect signs of pain, like changes in behavior or facial expressions, since verbal reports become unreliable.
Sources
https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2025.1694007/full
https://pmc.ncbi.nlm.nih.gov/articles/PMC12696289/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12705290/
https://academic.oup.com/braincomms/advance-article/doi/10.1093/braincomms/fcaf486/8376909?searchresult=1
https://www.neurologyadvisor.com/news/neuropsychiatric-symptoms-cognitive-decline-down-syndrome/
