We aimed to investigate the potential causal association between CBP and cognitive decline in older adults using four population-based databases. Furthermore, we sought to explore whether sleep duration could mediate this association.
Data on CBP and cognitive function were extracted from four cohort databases [the China Health and Retirement Longitudinal Study, the English Longitudinal Study of Ageing, the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE)]. Individuals were eligible if they were 60 years or older and were free for memory-related diseases (MDs) at baseline. Primary outcomes included subjective cognitive decline (SCD) and MDs, while secondary outcomes were performance of cognitive function. Time-varying Cox proportional hazards regression models, multivariable generalized estimating equation binary logistic regression models and linear mixed-effects models were employed to investigate the longitudinal association between CBP and cognitive outcomes, with additional analyses including subgroup, mediation, and meta-analyses.
Our analysis involved 18,558 individuals from 2010 to 2023 with a median follow-up of 8.4 years in 17 countries. The results revealed that CBP was associated with the occurrence of SCD and MDs in Europe and the United States [HRS: hazard ratio (HR) = 1.033, 95% confidence interval (CI): (1.029, 1.037); SHARE: HR = 1.021, 95% CI: (1.011, 1.032)] and [HRS: odds ratio (OR) = 1.230, 95% CI: (1.031, 1.469); SHARE: OR = 1.592, 95% CI: (1.180, 2.148)], respectively. Moreover, a significant association was identified between CBP and some types of cognitive function performance among individuals across the four databases. In Europe, sleep duration was recognized as a mediator between CBP and cognitive function performance, meaning that shorter sleep duration was associated with lower overall cognitive scores among older adults with CBP. The association between CBP and SCD [HR = 1.02, 95% CI: (1.00, 1.03)], MDs [OR = 1.35, 95% CI: (1.03, 1.68)], and delayed word recall memory [β = -0.050, 95% CI: (-0.09, -0.02)] was confirmed by meta-analyses across four databases.
CBP is associated with cognitive decline in older adults across various regions, making it crucial to prevent cognitive decline in older adults with CBP. Sleep duration could partially mediate this association.
These findings emphasize the significance of cognitive decline assessments for older adults with CBP management. Moreover, interventions targeting sleep duration could potentially benefit individuals with chronic back pain and their cognitive decline. Subsequent studies should validate our results and delve into the neurophysiological mechanisms.
Cognitive decline
Older adults
