Clinical Manifestations

Area of Science:

• Neuroscience
• Gerontology
• Public Health

Background:

• Chronic pain (CP) and depression frequently co-occur in elderly individuals, particularly those with Alzheimer's disease (AD).
• Overlapping neurobiological pathways in CP and depression can accelerate functional decline and cognitive deficits in AD.
• Adverse social determinants of health (SDH) can compound the effects of CP and depression, yet their interplay with AD in Latin American (LA) populations is poorly understood.

Purpose of the Study:

• To investigate the triadic relationship between chronic pain, depression, and Alzheimer's disease in older adults from Latin America.
• To explore the mediating role of depression in the association between chronic pain and AD.
• To examine the influence of social determinants of health on this relationship within a diverse LA cohort.

Main Methods:

• A cohort of 320 older adults (146 with AD, 174 healthy controls) was recruited from multiple sites in Latin America.
• Data collection included neuropsychological assessments, validated scales for CP and depression, and SDH measures.
• Structural equation modeling (SEM) was employed to analyze the complex relationships between variables.

Main Results:

• Depression significantly mediated the relationship between CP and AD.
• Strong associations were found between depression and AD (p=0.001), and a marginally significant association between depression and CP (p=0.050).
• CP and depression scores demonstrated high explanatory power for dementia risk, and unfavorable SDH correlated positively with higher CP and depression.

Conclusions:

• Depression plays a critical mediating role in the CP-AD relationship among older adults in LA.
• Adverse social determinants of health exacerbate this relationship, highlighting health disparities.
• Interventions targeting social disparities and improving access to mental health and pain management are essential for mitigating dementia risk and improving health outcomes.