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Saliva biomarkers can detect pain in dementia patients

Study among older people who cannot communicate found pain was detected effectively and non-invasively



Biomarkers found in saliva can help diagnose pain in people with dementia and other communication problems, a new study has established.

Two pain biomarkers in patients over 65 who had dementia and were unable to communicate were established as effectively and non-invasively detecting pain. 

Biomarkers sTNFR2and sIgA are related to pain through inflammation, and that inflammatory process is related to dementia.

The research, from the University of Cordoba, breaks new ground in supporting people with pain in the absence of them being able to communicate this. 

Until now, the usual way to detect pain in patients with reduced communication was using the PAINAD scale, a methodology of pain observation in patients with advanced dementia, based on five behavioral indicators: breathing, vocalisation, facial expression, body language and consolability. 

The saliva biomarkers proposed can now be corroborated with the data obtained through the scale, thus confirming their efficacy.

Pain is an underdiagnosed and undertreated problem in people with dementia, especially if they are in an advanced stage of the disease that prevents them from being able to communicate effectively. The prevalence of pain and dementia increases with age.

The nursing department at the University of Cordoba has been studying pain in the context of neurodegenerative diseases, such as Alzheimer’s disease, for many years, and this study – in collaboration with the University of Jaén – establishes saliva as an effective detection method. 

The study involved the group of over-65s with a control group of people over 65 years of age without dementia, making it possible to compare observational pain scales

“The fact that we can determine these biomarkers in saliva is very auspicious, since most of the people from whom we have been able to obtain the samples were in a very advanced state, bedridden with advanced dementia, so the less irritating and invasive it is for the patient to obtain the sample, the better,” explained researcher María Pilar Carrera.

This first determination of pain biomarkers in saliva – previously it had involved using blood or plasma – “helps treat an unresolved problem in patients with dementia, which we consider the fifth vital sign: pain,” pointed out Vanesa Cantón, the study’s lead author.

The results of the test described the levels of these biomarkers, with a decrease in sTNFR2in patients with dementia compared to the control group, which “indicates how inflammation is modulated.” 

In the case of sIgA, the team observed “an increase in this immunoglobulin in people with dementia, showing that there is an alteration of the immune system response.” 

Therefore, they establish the usefulness of these biomarkers to evaluate the development of the pain process throughout the evolution of the disease and during its moderate-advanced stage.