Pain as a cause of agitation in older subjects with cognitive impairment

Aim of the study
To analyse the pain and the behavioural symptoms in elderly individuals with cognitive impairment in the context of applied treatment.

Material and methods
The analysis involves 92 nursing home residents (age: 83.8 ±8.7 years, 74 women) with cognitive impairment (Abbreviated Mental Test Score – AMTS < 7 pts), in whom behavioural symptoms were assessed (Cohen-Mansfield Agitation Inventory – CMAI). Then, based on the presence of pain (Abbey Pain Scale – APS), all subjects were divided into two groups: group I – individuals without pain, group II – with pain. The evaluation of psychotropic drugs and the doses of analgesics was also performed.

Results
The mean CMAI in studied subjects was 40.7 ±15.2 pts and APS was 4.1 ±4.2 pts. As many as 65 people (70.7%) took psychotropic drugs, 34 of which (52.3% of those taking psychotropic drugs) were second generation neuroleptics, and 19 (29.2%) were first generation neuroleptics. Twenty-four subjects (36.9%) simultaneously used more than one group of psychotropic drugs. The individuals of group II had higher CMAI scores (p = 0.0001), but the frequency of taking psychotropic drugs did not differ between groups. The frequency of use of analgesics was also comparable, but in subjects of group II the minimum doses of analgesics were more frequently used (p < 0.05).

Conclusions
Our study indicates that behavioural symptoms in subjects with severe cognitive impairment may be induced by pain. This has important implications for pharmacotherapy because one can speculate that effective pain control may reduce the usage of psychotropic drugs.