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Chronic non-specific low back pain (CNSLBP) is a common condition among older adults and has been associated with an increased risk of executive function impairment. Research shows that older adults experiencing chronic pain are more likely to show worse cognitive performance compared to healthy individuals. While there is a bidirectional relationship between pain and executive functions, cognitive performance especially for some executive functions (e.g. inhibition, switching, working memory) is crucial for managing pain in older adults. Furthermore, executive dysfunctions are associated with decline in functional status among the population, particularly in performing instrumental activities in daily living. Therefore, maintaining executive function emerges as a pivotal consideration for older adults with CNSLBP.
Studies provide preliminary evidence that connects brain changes with chronic pain and cognitive functions. For instance, multisite chronic pain may increase the risk of cognitive decline through structural changes like hippocampal atrophy. Besides, functional brain changes in chronic pain may reduce deactivation several key default mode network regions, predisposing individuals to cognitive impairments. Despite the aforementioned brain changes, no direct evidence supports the hypothesis that structural and functional brain changes caused by CNSLBP in older adults may be associated with cognitive decline. It remains unclear that whether structural changes (e.g. reduced hippocampal, cerebellar gray matter, white matter volume in the right frontal region) and/or functional changes (e.g. deactivation of default mode network regions, heightened activation in the anterior cingulate cortex) cause by CNSLBP are associated with cognitive decline. With neuroimaging techniques, brain mechanisms connecting CNSLBP and executive function deficits can be explained.
To deepen understanding of the brain mechanisms underlying executive function decline in older adults with CNSLBP, this study will directly compare pain intensity, executive functions, brain structure, and functional changes of the brain between older adults with CNSLBP and age-matched healthy controls. A longitudinal approach is established to quantify the relationship between CNSLBP-related brain changes and executive functions in older adults, providing insights into the development of new treatment strategies to improve or prevent executive function decline in older adults with CNSLBP.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Chronic non-specific low back pain group | Participants with chronic non-specific low back pain (CNSLBP) should have: (1) CNSLBP that has lasted for at least 3 months, typically occurs in the area between the 12th rib to the iliac crest may or may not accompanied by leg pain and without a known pathoanatomical cause; (2) an average pain intensity of ≥ 5 out of 10 on an 11-point numerical rating scale (NRS) in the last 7 days, where 0 means "no pain"and 10 means "worst pain imaginable"; and (3) pain occurring more than 3 days per week. |
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| Healthy group | Healthy controls should not have CNSLBP in the last 36 months. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Participants are not assigned an intervention | Other | For observational studies, participants are not assigned an intervention as part of the study. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity assessment | 11-point numerical rating scale, ranged from 0 to 10, higher scores indicate higher pain intensity. | Baseline and 6 months |
| Brain imaging | Perform the following MRI sequences: T1-weighted, T2-weighted, DTI (diffusion tensor imaging), resting-state fMRI, and task-related fMRI. | Baseline, 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Depression, anxiety, and stress test | The Chinese version of the short Depression Anxiety Stress Scales, scores ranged from 0 to 13, higher scores for each domain (depression, anxiety, and stress) indicate more respective problems. | Baseline and 6 months |
| Disability evaluation |
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Inclusion Criteria:
Exclusion Criteria:
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Participants with chronic non-specific low back pain (CNSLBP) should have:
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Frank F Huang, MD | Contact | 852-5303-7752 | fan2023.huang@connect.polyu.hk | |
| Chun Liang HSU, PhD | Contact | chun-liang.hsu@polyu.edu.hk |
| Name | Affiliation | Role |
|---|---|---|
| Chun Liang Hsu, PhD | The Hong Kong Polytechnic University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Rehabilitation Sciences | Recruiting | Hong Kong | 999077 | Hong Kong |
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The Hong Kong Chinese Version of the Roland-Morris Disability Questionnaire has 24 items. Scores ranged from 0 to 24, higher scores indicate worse disability. |
| Baseline and 6 months |
| Cognitive flexibility test inside magnetic resonance imaging scanning | The More Odd Shifting task, It requires participants to switch between different mental sets or rules, such as identifying odd numbers or shifting between different categories. Better response accuracy indicates better cognitive flexibility | Baseline and 6 months |
| Perseveration and abstract reasoning test outside magnetic resonance imaging scanning | The Modified Wisconsin Card Sorting Test, more correct matching of cards indicate better perseveration and abstract reasoning. | Baseline and 6 months |
| Working memory Test outside magnetic resonance imaging scanning | The Verbal Digits Forward and Backward Test, more correct recall of digits indicate better working memory and executive function | Baseline and 6 months |
| Cognitive flexibility test outside magnetic resonance imaging scanning | The Trail Making Tests, a neuropsychological test of visual attention and task switching, completing the trail correctly within a shorter period of time means better cognitive flexibility. | Baseline and 6 months |
| Inhibition test outside magnetic resonance imaging scanning | Go/NoGo task, more response accuracy indicates better control of inhibition. | Baseline and 6 months |
| Pain catastrophizing assessment | The Chinese version of Pain Catastrophizing Score. The scores ranged from 0 to 13, higher scores indicate more pain catatrophizing thought. | Baseline and 6 months |
| Frailty status assessment | Fatigue, Resistance, Ambulation, Illness, and Loss, the presence of 3 of 5 item characteristics indicate the presence of frailty, scores ranged from 0 to 5. Lower scores mean more frailty. | Baseline and 6 months |
| Sleep quality assessment | Pittsburgh Sleep Quality Index. It has 7 domains to measure sleep quality , sleep latency, sleep duration, habital sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Scores ranged from 0 to 21, higher scores indicate poorer sleep quality. | Baseline and 6 months |
| Cognitive function screening | Hong Kong Montreal Cognitive Assessment. It is a cognitive screening tool specifically adapted for Chinese older adults in Hong Kong. It is designed to detect mild cognitive impairment and dementia. A score < 26 suggests participant has mild cognitive impairment. | Baseline and 6 months |
| Balance, lower extremity strength and functional capacity assessment | Short Physical Performance Battery (SPPB). It consists of three components: balance test, gait speed test, and chair stand test. The SPPB scores range from 0 to 12. Individuals with SPPB scores between 10 and 12 can exercise at home and in the community while those with more severe mobility limitations (scores < 10) require further assessment and supervision for exercise. | Baseline and 6 months |
| Mobility and balance assessment | Timed Up and Go (TUG) test. It measures the time taken for an individual to rise from a chair, walk 3 meters, turn around, walk back, and sit down again. The TUG test helps identify individuals at risk of falls and mobility impairments. A shorter completion time indicates a better balance and functional mobility. | Baseline and 6 months |
| ID | Term |
|---|---|
| D060825 | Cognitive Dysfunction |
| ID | Term |
|---|---|
| D003072 | Cognition Disorders |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
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