373: Association of Chronic Joint Pain With Incident Cognitive Impairment in a US Population-Based Cohort

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Epidemiology

Background and Aims: Chronic joint pain is highly prevalent worldwide and may contribute to cognitive vulnerability in aging, yet longitudinal population-based evidence is limited. Identifying behavioral and psychological pathways may reveal modifiable targets for dementia prevention. This study aims to evaluate the association between chronic joint pain and incident cognitive impairment and to examine behavioral and affective moderators and mediators of this relationship. This is a population-based cohort study using data from the Health and Retirement Study (HRS), a nationally representative longitudinal study of US adults aged ≥50 years.

Methods: Participants free of cognitive impairment in 2006 with complete pain assessment and cognitive follow-up through 2020 were included. Chronic joint pain defined as self-reported joint pain present most days. Incident cognitive impairment was assessed biennially and modeled as an interval-censored event using validated HRS cognitive cutoffs. Primary analyses used interval-censored proportional hazards models adjusting for demographic, clinical, and behavioral covariates. Effect modification by moderate physical activity and positive affect was evaluated using interaction terms. Mediation analyses quantified indirect effects through depressive symptoms, sleep-related complaints, and moderate physical activity.

Results: Among 14 789 participants (mean age, 66.6 years; 60.0% women), 9 216 (62.3%) reported chronic joint pain. Over 14 years, 12.8% developed cognitive impairment. Chronic joint pain was associated with increased risk of incident cognitive impairment (aHR, 1.16; 95% CI, 1.05–1.29). Moderate physical activity (interaction HR, 0.74; P = .01) and higher positive affect (interaction HR, 0.79; P = .045) attenuated this risk. Mediation analyses showed that depressive symptoms (20% of total effect), sleep complaints (15%), and reduced physical activity (12%) significantly mediated the association. The PAF suggested that 8.6% of cognitive impairment cases could be attributed to chronic joint pain.

Conclusions: Chronic joint pain was associated with elevated risk of cognitive impairment, partly explained by depressive symptoms, sleep disturbances, and lower physical activity, and moderated by behavioral and affective resilience factors. These findings support chronic pain as a potentially modifiable risk factor for dementia and highlight pain rehabilitation as a promising strategy for cognitive health promotion.

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Presenting Author: Kevin Pacheco-Barrios
Submitting Author: Kevin Pacheco-Barrios

Senior Author: Felipe Fregni

IASP 2026 Global Year theme of Neuropathic Pain: No

• Laura Soledad Samudio Sanchez: MD - Universidad del Pacífico Privada, Asunción, Paraguay.
• Carolina Matté Dagostini: MD - Santa Casa de Porto Alegre Hospital, Rio Grande do Sul, Brazil.
• Mayra Ayala Zurita: MD - Universidad Internacional de Ecuador, Quito, Ecuador.
• Areerat Suputtitada: MD - Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
• Felipe Fregni: MD, PhD - Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA.