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 is 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+. 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=0.636) or with cognitive performance at follow-up (p=0.594). However, increased pain interference at follow-up was associated with greater cognitive decline at follow-up (β = -0.07, SE = 0.02, p = 0.003). Greater baseline cognitive performance was associated with lower pain interference at follow-up (β = -0.07, SE= 0.02, p = 0.007). 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.

中文翻译：

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波多黎各老年人四年来不断增加的疼痛干扰与认知能力下降有关

背景疼痛与老年人认知能力下降有关，但很少有研究调查疼痛与认知能力下降之间的双向关联，特别是在老年西班牙裔人群中。我们的目标是评估波多黎各老年人样本中疼痛干扰与认知表现之间的双向关联。方法数据来自波多黎各老年人健康状况研究的基线和 4 年随访，这是一项针对 60 岁以上波多黎各老年人的纵向代表性研究。每波均评估疼痛和认知表现。使用疼痛状态（是/否）和疼痛干扰（是/否）（范围 0-2）之和创建疼痛干扰变量。使用 Mini-Mental Cabán 评估整体认知表现。我们使用路径模型测试了双向关联，该路径模型具有疼痛和认知表现之间的并发和交叉滞后路径，并根据社会人口统计和健康因素进行调整（n = 2,349）。结果 基线疼痛干扰与基线认知表现 (p=0.636) 或随访时的认知表现 (p=0.594) 无关。然而，随访时疼痛干扰的增加与随访时更大的认知能力下降相关（β = -0.07，SE = 0.02，p = 0.003）。更好的基线认知表现与随访时较低的疼痛干扰相关（β = -0.07，SE = 0.02，p = 0.007）。结论 这些发现强调了随着疼痛治疗方案的存在，疼痛干扰恶化作为认知能力下降的潜在可改变危险因素的重要性。此外，更好的基线认知表现可能是疼痛的保护因素，为疼痛和认知表现之间的动态关系提供了进一步的证据。