Intended for healthcare professionals

Clinical Review

Recent developments in pain in dementia

BMJ 2005; 330 doi: (Published 24 February 2005) Cite this as: BMJ 2005;330:461
  1. Erik Scherder (, professor in movement sciences and ageing1,
  2. Joukje Oosterman, clinical neuropsychologist2,
  3. Dick Swaab, professor in neurobiology3,
  4. Keela Herr, professor in nursing4,
  5. Marcel Ooms, associate professor in nursing home medicine5,
  6. Miel Ribbe, professor in nursing home medicine5,
  7. Joseph Sergeant, professor in clinical neuropsychology2,
  8. Gisele Pickering, clinical pharmacologist6,
  9. Fabrizio Benedetti, professor in physiology7
  1. 1 Centre of Human Movement Sciences, Rijksuniversiteit Groningen, A Deusinglaan 1, 9713 AV Groningen, Netherlands,
  2. 2 Department of Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands,
  3. 3 Netherlands Institute of Brain Research, 1105 AZ Amsterdam,
  4. 4 College of Nursing, University of Iowa, Iowa City, IA 52333, USA,
  5. 5 Department of Nursing Home Medicine and EMGO-Institute, VU Medical Centre, 1081 BT Amsterdam,
  6. 6 Clinical Pharmacology Centre, University Hospital, 63000 Clermont-Ferrand, France,
  7. 7 Department of Neuroscience, University of Turin Medical School, 10125 Turin, Italy
  1. Correspondence to: E Scherder
  • Accepted 17 January 2005


Epidemiological studies show that, worldwide, the number of people aged over 65 will increase substantially in the next decades and that a considerable proportion of this population will develop dementia.1 Ample evidence shows that ageing is associated with a high rate of painful conditions, irrespective of cognitive status.2 The number of patients with dementia who will experience painful conditions is therefore likely to increase. A key question relates to whether and how patients with dementia perceive pain. Patients with dementia may express their pain in ways that are quite different from those of elderly people without dementia.3 Particularly in the more severe stages of dementia, therefore, the complexity and consequent (frequent) inadequacy of pain assessment leads to the undertreatment of pain.

The most commonly used pain assessment instruments seem to be selected primarily according to the communicative capacity of the patient (self report pain rating scales for communicative patients and observation scales for non-communicative patients) instead of according to two main aspects of pain—the sensory-discriminative and motivational-affective aspects. In particular, the motivational-affective aspects of pain are assessed by observation scales, which should therefore be applied to every patient, irrespective of ability to communicate. Distinction between the sensory-discriminative and motivational-affective aspects of pain is of great clinical relevance, as the motivational-affective aspects are particularly likely to reflect pain that needs treatment.4 Moreover, differentiating between these two aspects of pain in relation to the neuropathology of the various subtypes of dementia provides insight into the basis of the alterations in the pain experiences of elderly people with dementia. Future experimental and clinical studies should not only focus on subtypes of dementia but should go a step further and assess pain in disorders in which pain is already present at a stage without cognitive impairment and during the course …

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