Delighted about the publication of a great piece of work from Peigí Askew on the Start Making Sense trauma psychoeducation group for people living with HIV, founded by Dr Kate Reilly. It was a privilege to be involved with the group and the research. https://t.co/SPRhQV1rvv

#quarto question: I can input of CRediT roles into a .qmd document YAML section, but I can't figure out how to get it to return this information within the rendered doc. Feels like I am missing something obvious...

Hope this is useful! I am not a regular Twitter user but will try to help with any questions. Thanks to my co-authors @jonathanjevans Lisa Gadon Breda Cullen and @Jess_McLaren4

Rather, what the paper does is give an indication what sorts of deficits might be typical for people attending a memory clinic who have a chronic pain (when dementia isn’t in the picture.)

NB we are not suggesting a direct causal link between ‘pain experience’ and cognitive screen test, as even with effective controls as in our low risk of bias studies, living with a pain condition may impact cognition via medication, sleep, direct neurological effects (arthritis).

This happens to tally with the clinical anecdotal experiences that kicked this all off, of memory complaints within young onset dementia services that seemed best explained by chronic pain.

Contrast this large effect size (1.52, CI 1.01-2.03] with that found for older participants (where mean age minus 1SD was above 55; an ‘oldest’ group using a 2SD adjustment is marked in grey), where effects are far smaller.

We used the weighted mean age (55) of the full dataset to create a ‘young’ subgroup containing studies where mean age + 1SD was below 55. You can see size of effects here (larger effect = more impairment):

One thing that we planned to do - and thanks to an unnamed reviewer at @tandfonline for encouraging us to think through a way to implement this - was to look at age effects (when submitted as part of my thesis I omitted this as too few studies used age-based inclusion criteria).

@IASPpain For instance, the 24 comparisons with low risk of bias showed a SMD 0.667 [95% CI 0.46 − 0.874], which could translate to two or three point differences on MMSE/MoCA.

@IASPpain Our review identified 51 studies and 62 effect size estimates (some studies had more than one relevant comparison), the majority for two screens: the MMSE and MoCA. We conducted a number of meta-analyses which all showed medium-to-large effect sizes.

You can consult the (OA) text for details of the review process, which involved use of @IASPpain criteria as well as pain chronicity for inclusion.

So our review addresses this. We wanted to know whether the presence of chronic pain (self-reported or based on diagnosis) was associated with poorer performance on these screens, and to identify the heterogeneity across groups and screens.

This suggests medium to large effect sizes with somewhat larger sizes for the MoCA. But arthritis may have specific mechanisms for impacting cognition apart from pain ( https://t.co/qM79HARphW) and we were interested in pain conditions more broadly.

One systematic review of cognition in rheumatoid arthritis, does include a meta-analysis of performance differences on two cognitive screens, the MMSE and MoCA.

But cognitive screens are different instruments designed for a different purpose, and whereas a dedicated assessment of, say, working memory (WM) might be sensitive to pain-related impairment, a screen with a small brief WM component might not pick this up.

We have a body of research on how these different domains are affected and to what degree, using both research-specific and clinically used tests.

This in itself is not new: the link between pain and cognitive impairment is well understood ( https://t.co/TyMo4mzPM1). Pain seizes our attention, disrupts our working memory and has downstream effects on other cognitive domains.

There are lots of possibilities, but we had been thinking about a feature observed clinically (especially in young onset dementia referrals): chronic pain. Patients would frequently report this, and sometimes explicitly link their pain to their complaints.

Middling-poor scores tend to lead to further investigation (more striking impairments can lead to a diagnosis outright) - so what could be a cause of such poor scores?