Pain in Alzheimer's disease: nursing assistants’ and patients’ evaluations


  • Erik Scherder PhD,

  • Femke Van Manen MSc

Erik Scherder,
Clinical Neuropsychology,
Vrije Universiteit,
Van der Boechorststraat 1,
Amsterdam 1081 BT,
The Netherlands.


Aim.  This paper reports on a study examining the level of agreement between the pain perceptions of nursing assistants, older people without dementia and patients with Alzheimer's dementia. It was hypothesized that nursing assistants would overestimate the pain experience of patients with Alzheimer's dementia.

Background.  There is now increasing evidence that, in contrast to other subtypes of dementia, patients with Alzheimer's disease might experience a decrease in pain. It is unfortunate that these latest insights into the complex relationship between subtypes of dementia and pain are not always included in education programmes for nursing assistants.

Method.  Twenty patients with Alzheimer's disease and 17 older people with arthrosis and/or osteoporosis but no dementia and their personal nursing assistants participated in the study. Pain experience was assessed using the Coloured Analogue Scale for the assessment of Pain Intensity and Pain Affect, the Faces Pain Scale, and the Checklist of Non-verbal Pain Indicators. The data were collected in 2002–2003.

Results.  Before and after walking, the absolute difference in pain evaluation between nursing assistants and older people without dementia was statistically significantly less than the difference in pain evaluation between nursing assistants and patients with Alzheimer's disease on the Coloured Analogue Scale for Pain Intensity (P = 0·007 and P = 0·04, respectively) and on the Coloured Analogue Scale for Pain Affect (P = 0·009 and P = 0·01, respectively).

Conclusion.  Nursing assistants may overestimate the extent of suffering from pain of patients with Alzheimer's disease. They might be very well able to estimate this pain, provided they were educated about new insights into the influence of the various subtypes of dementia on pain.