Abstract
Chronic pain is the most common health challenge for older adults and a significant risk factor for cognitive impairments and dementia. This study examined the relationship between high-impact pain (pain that limits daily activities) and subjective cognitive decline (SCD) in 13,763 adults aged 50 and older from the Health and Retirement Study (2004-2020). High-impact pain was associated with a higher prevalence and incidence of SCD as compared to no pain and low-impact pain, adjusted for sociodemographic and clinical factors. Additionally, high-impact pain predicted an increased risk of objective cognitive impairment, particularly in individuals without the APOE4 allele. Our findings suggest that high-impact pain is a stronger predictor of future cognitive impairments than SCD alone in most of the population who do not carry the APOE4 allele. Interventions targeting high-impact pain, starting in middle age, may help mitigate the risk of cognitive decline and dementia. Future research is needed to understand potential mechanisms and develop effective cognitive aging strategies considering the impact of pain itself on cognition.