Assessment and understanding of pain in patients with dementia.

The literature on pain in dementia patients is reviewed. A summary of methods for assessment of pain in demented elderly persons and an examination of studies that used such methods are included. In addition, literature theorizing a decrease in affective pain in this population is discussed; management of pain in such patients is not discussed extensively. Research reveals 3 major findings: (a) a moderate decrease in pain occurs in cognitively impaired elderly persons, (b) communicative dementia patients' reports of pain tend to be as valid as those of cognitively intact patients, and (c) assessment scales developed thus far for noncommunicative patients require improvement in accuracy and facility. Many questions about pain in dementia patients remain, and the continued development of valid pain assessment techniques is a necessity.