Joint pain associated with depression accelerates cognitive decline in elderly

Elderly people who have symptoms of depression and moderate or severe joint pain tend to show faster cognitive decline, especially in the area of memory, shows a new study.

The analyses show that people who had both pain and depression together had a faster decline in memory and global cognition over the 12 years of follow-up than those who had neither. On the other hand, those who had only one of the conditions did not have an accelerated decline in memory and global cognition.

The conclusions are based on data from 4,718 participants aged 50 and older who were followed up over 12 years.

“Both pain and symptoms of depression act on areas of the brain [mainly the hippocampus] associated with cognitive processing,” said Patrícia Silva Tofani, researcher at the Federal University of Sergipe (UFS).

“Therefore, there’s an overlap of information, causing the brain to become ‘congested’ and have to delegate some functions to process the pain response and the symptoms of depression. This would interfere with formation of memory and global cognitive performance. In the study, we saw that over the years, this overload leads to faster cognitive decline.”

“This was surprising. In fact, we expected cognitive decline to be greater in people with depressive symptoms combined with chronic joint pain than in those with only one of the conditions. But we didn’t expect that only the first group [pain + depression] would show faster memory impairment. Following the evolution of this issue for 12 years has allowed us to see that the problem lies in the combination of the two conditions,” said UFSCar Professor Tiago da Silva Alexandre.

As the authors explain, there are at least six cognitive domains: executive function, language, attention, memory, perceptomotor, and social cognition. In the study, there was a decline in global cognition, with memory standing out – precisely because it is associated with the same brain regions affected by depressive symptoms and chronic joint pain.

Although the researchers found a decline in memory and global cognition, they found no damage to executive function.

“This is important because memory and executive function are the two most important domains for autonomy, in other words, for older people to live alone, for example,” says Tofani.

It is estimated that both depressive symptoms and joint pain are highly prevalent in the elderly population. As with depression, depressive symptoms – such as depressed mood, reduced energy, decreased activity, and reduced ability to concentrate – are underreported.

Chronic joint pain, the other condition focused on in the study, is generally associated with osteoarthritis, which is very common in the elderly.

The findings underscore the need to pay more attention to depressive symptoms and joint pain in older adults in primary care settings.

“It’s relatively common for people to mistakenly attribute symptoms of depression and pain as normal factors of aging. And they’re not,” Alexandre said.

“This belief leads professionals who are not specialists in gerontology and geriatrics to minimise the complaints of older people in primary care and to fail to diagnose and treat modifiable conditions. But in our study, we showed that when this is not valued in the consultation, it not only damages mood and mobility [in the case of pain], but also the individual’s cognitive issues.”