Acute versus chronic, affective pain experience in Alzheimer's disease

The low use of analgesics in patients with Alzheimer’s disease (AD), compared to nondemented elderly persons, is generally explained by (1) a lower prevalence of painful conditions in the former group and (2) undertreatment of pain due to a decrease in communicative abilities in AD. However, considering the neuropathology in limbic areas in this disorder, a decline in pain affect may also explain this phenomenon. In the present study, a newly developed questionnaire was applied to 20 elderly persons without dementia, 20 patients in an early stage and 20 patients in a midstage of AD. The questionnaire includes 10 pairs of painful situations, each pair consisting of an acute and a chronic affective painful situation. It was hypothesized that, compared to controls, AD patients during the course of the disease would report to suffer increasingly more from an acute than from a chronic, affective painful situation. The results support our hypothesis. Limitations of the present study are discussed