Increasing Pain Interference Is Associated With Cognitive Decline Over Four Years Among Older Puerto Rican Adults

Sadaf Arefi Milani, Tyler R. Bell, Michael Crowe, Caitlin N. Pope, Brian Downer

Research output: Contribution to journalReview articlepeer-review


Background: Pain is associated with cognitive decline among older adults, but few studies have investigated bidirectional associations between pain and cognitive decline, especially in older Hispanic populations. Our objective was to assess the bidirectional association between pain interference and cognitive performance in a sample of older Puerto Rican adults. Methods: Data came from baseline and 4-year follow-up of the Puerto Rican Elderly: Health Conditions Study, a longitudinal representative study of Puerto Rican older adults aged 60 and older. Pain and cognitive performance were assessed at each wave. A pain interference variable was created using the sum of pain status (yes/no) and pain interference (yes/no; range 0–2). Global cognitive performance was assessed with the Mini-Mental Cabán. We tested bidirectional associations using a path model with concurrent and cross-lagged paths between pain and cognitive performance, adjusting for sociodemographic and health factors (n = 2 349). Results: Baseline pain interference was not associated with baseline cognitive performance (p = .636) or with cognitive performance at follow-up (p = .594). However, increased pain interference at follow-up was associated with greater cognitive decline at follow-up (β = −0.07, standard error [SE] = 0.02, p = .003). Greater baseline cognitive performance was associated with lower pain interference at follow-up (β = −0.07, SE = 0.02, p = .007). Conclusions: These findings highlight the importance of worsening pain interference as a potentially modifiable risk factor for cognitive decline, as pain treatment options exist. Additionally, better baseline cognitive performance may be a protective factor for pain, providing further evidence of the dynamic relationship between pain and cognitive performance.

Original languageEnglish (US)
Pages (from-to)1005-1012
Number of pages8
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Issue number6
StatePublished - Jun 1 2023


  • Aging
  • Bidirectional
  • Cognitive function
  • Longitudinal
  • Pain

ASJC Scopus subject areas

  • General Medicine


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