ConclusionsĪssessing pain in dementia is complex, which is why scarcity of the analgesic treatment is underprescribed in dementias. The placebo response is related to activity in the ACC and PG, but because these areas are commonly affected by dementia, higher doses of analgesics will be necessary. This negates the placebo effect, which in addition to the drug's pharmacokinetic action is an inherent part of the analgesic response. Finally, dementia patients expect nothing from analgesic treatments. They are attributed to early damage to the LC, which reduces its antinociceptive activity. In Parkinson's disease, painful conditions are common. In frontotemporal dementias, there is a reduction in pain expression linked to lesions in the orbitofrontal and anterior temporal areas, which are responsible for the emotional component of pain. Vascular dementias feature a cortico-subcortical deafferentation secondary to white matter lesions, resulting in a state of hyperpathy and hyperalgesia. These alterations are essentially secondary to degenerative changes in the medial temporal lobe (pain memory) and ACC (cognitive and affective dimensions) areas. Alzheimer disease (AD) manifests with reduced anticipatory and avoidance responses and flattening of the autonomic responses. Since these locations are affected by dementia lesions, pain features controlled by these areas will be compromised: the cognitive-evaluative and affective dimensions, pain memory, and autonomic responses. The medial pain pathway includes the intralaminar thalamic nuclei, the pons (locus coeruleus: LC), the mesencephalon (periaqueductal grey: PG), the hypothalamus (paraventricular nuclei, mammillary bodies) and different areas of the parietal (primary, secondary, operculum), temporal (amygdala, hippocampus) and frontal (anterior cingulate cortex: ACC). Overall pain perception, including pain intensity and threshold, thus remains unmodified. The lateral pain pathway (lateral thalamus and primary parietal cortex), which is in charge of primary pain perception, is preserved in dementia. For this reason, the pain experienced is different and distinctive for every lesion type. Dementia lesions are also situated on the nociceptive pathways. Nevertheless, utility analgesics are underused in dementia patients due to their difficulty communicating. Ver más Opción Open AccessĪgeing, which commonly underlies dementia, is usually associated with painful conditions. El formato de artículos incluye Editoriales, Originales, Revisiones y Cartas al Editor, Neurología es el vehículo de información científica de reconocida calidad en profesionales interesados en la neurología que utilizan el español, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo. Los artículos publicados en Neurología siguen un proceso de revisión por doble ciego a fin de que los trabajos sean seleccionados atendiendo a su calidad, originalidad e interés y así estén sometidos a un proceso de mejora. Las áreas temáticas de la revistas incluyen la neurologia infantil, la neuropsicología, la neurorehabilitación y la neurogeriatría. Los contenidos de Neurología abarcan desde la neuroepidemiología, la clínica neurológica, la gestión y asistencia neurológica y la terapéutica, a la investigación básica en neurociencias aplicada a la neurología. Neurología es la revista oficial de la Sociedad Española de Neurología y publica, desde 1986 contribuciones científicas en el campo de la neurología clínica y experimental.
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