Visual Analogue Scales for Pain Assessment in Alzheimer's Disease

Background: In earlier studies, pain assessment in patients with Alzheimer's disease (AD) was conducted by interview, for which reliability is questionable considering the decline in expressive and receptive language abilities in AD. As similar language problems occur in young children, the reliability of pain assessment in this latter population is increased by employing visual analogue scales.

Objective: By employing visual analogue scales, the current study investigated whether (1) nondemented elderly persons and AD patients comprehend the purpose of the scales and (2) AD patients, compared to nondemented elderly persons, report suffering less pain intensity and pain affect.

Methods: Three visual analogue scales, i.e. the Colored Analogue Scale (CAS), the Faces Pain Scale (FPS), and the Facial Affective Scale (FAS) were administered to patients in an early and midstage of AD and to nondemented elderly persons.

Results: The results show that the percentage of subjects who comprehended the CAS, FAS and FPS was for the nondemented elderly persons 100, 75 and 100%, respectively, for the early AD group 100, 50 and 60%, respectively, and for the midstage AD group 80, 20 and 30%, respectively. Furthermore, elderly persons without dementia reported experiencing more intense pain and pain affect than the early and midstage AD group. Interestingly, the early and midstage AD patients did not differ in reporting pain affect.

Conclusion: Visual analogue scales may improve pain assessment in those AD patients who fully comprehend the meaning of the scales. As only the minority of midstage AD patients understood the purpose of the FAS and FPS, the search for tools, particularly to assess pain affect in this population, must continue.