Mediating Roles of Sleep Disturbances and Depressive Symptoms in the Association Between Chronic Pain and Cognitive Dysfunction in Older Adults

OBJECTIVES: To identify the associations between chronic pain and cognitive dysfunction and the mediating roles of sleep disturbances and depressive symptoms among older adults. METHODS: Eight electronic databases were searched for studies reporting pairwise correlation coefficients among chronic pain, sleep disturbances, depressive symptoms, and cognitive dysfunction in older adults. Two reviewers independently conducted study screening, data extraction, and quality assessment. Two-stage structural equation modeling was applied to integrate correlation evidence across studies and estimate direct, indirect, and serial pathways. RESULTS: Thirty-eight studies involving 34,126 older adults were included. The pooled correlation matrices showed significant correlations between chronic pain and cognitive dysfunction, sleep disturbances, and depressive symptoms. TSSEM further identified a significant direct association between chronic pain and cognitive dysfunction, as well as significant indirect pathways through depressive symptoms and through the serial pathway involving sleep disturbances and depressive symptoms. CONCLUSIONS: Chronic pain, sleep disturbances, depressive symptoms, and cognitive dysfunction were interrelated in older adults. These findings support a focused biopsychosocial interpretation of the association between chronic pain and cognitive dysfunction.