Análise da cognição em pacientes com dor crônica por osteoartrite de joelho: estudo transversal
DOI:
https://doi.org/10.11606/issn.23170190.v33ae243289Palavras-chave:
Osteoartrite do Joelho, Dor Crônica, Cognição, Qualidade de Vida, ReabilitaçãoResumo
A osteoartrite de joelho (OAJ) é uma condição musculoesquelética crônica que, além de limitar a mobilidade, compromete a qualidade de vida e pode afetar o desempenho cognitivo. Objetivo: Investigar a correlação entre função cognitiva, avaliada pelo Montreal Cognitive Assessment (MoCA) e variáveis sociodemográficas (idade, sexo e nível educacional), clínicas (índice de massa corporal, hipertensão, diabetes e hipercolesterolemia) e dor (Escala de Catastrofização, Escala Visual Analógica - EVA, WOMAC dor, SF-36 dor, Questionário de Dor de McGill) em pacientes brasileiros com OAJ. Além disso, identificar os domínios cognitivos mais relacionados ao impacto da dor na qualidade de vida. Método: Estudo transversal com 106 pacientes diagnosticados com OAJ, conduzido entre agosto de 2020 e julho de 2022. Foram aplicadas regressão linear múltipla e correlação de Spearman (α<0,05) no software R. Resultados: Aproximadamente 98% dos participantes apresentaram escore MoCA <26, indicando possível comprometimento cognitivo leve. A amostra foi composta majoritariamente por mulheres (83,0%), com idade média de 68,5 anos. A escolaridade e a percepção do impacto da dor na qualidade de vida (SF-36) foram preditores significativos do desempenho cognitivo global, explicando 24% da variância MoCA (r²= 0,24). A escolaridade associou-se positivamente a função executiva (rho= 0,55; p<0,0001), linguagem (rho=0,38; p<0,0001) e habilidades visuoespaciais (rho= 0,35; p= 0,0002), enquanto maior impacto da dor correlacionou-se a déficits em linguagem (rho= 0,31; p= 0,0012) e visuoespacial (rho= 0,35; p= 0,0002). Conclusão: Níveis baixos de escolaridade e maior percepção da dor na qualidade de vida estão associadas a pior desempenho cognitivo, o que pode repercutir na adesão e nos resultados da reabilitação.
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Referências
GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e522. Doi: https://doi.org/10.1016/S2665-9913(23)00163-7
Miguel RCC, Machado LA, Costa-Silva L, Telles RW, Barreto SM. Performance of distinct knee osteoarthritis classification criteria in the ELSA-Brasil musculoskeletal study. Clin Rheumatol. 2019;38(3):793-802. Doi: https://doi.org/10.1007/s10067-018-4347-0
Abrahão G, Silva G, Silva ELD, Luciano AP. Análise do perfil epidemiológico das internações por osteoartrite no brasil de 2017 a 2021. RESP. 2023;1(2). Doi: https://doi.org/10.59788/resp.v1i2.15
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759. Doi: https://doi.org/10.1016/S0140-6736(19)30417-9
Wu R, Guo Y, Chen Y, Zhang J. Osteoarthritis burden and inequality from 1990 to 2021: a systematic analysis for the global burden of disease Study 2021. Sci Rep. 2025;15(1):8305. Doi: https://doi.org/10.1038/s41598-025-93124-z
Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press; 1976.
Turk DC, Gatchel RJ. Psychological approaches to pain management: a practitioner’s handbook. 2nd ed. New York: Guilford Press; 2002.
Flor H, Turk DC. Chronic pain: an integrated biobehavioral approach Seattle: IASP Press. 2011. Doi: https://doi.org/10.1016/j.cbpra.2012.10.001
Çalışkan E, Gökkaya F. Reviewing Psychological Practices to Enhance the Psychological Resilience Process for Individuals with Chronic Pain: Clinical Implications and Neurocognitive Findings. Curr Pain Headache Rep. 2025;29(1):68. Doi: https://doi.org/10.1007/s11916-025-01373-4
Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
Piva SR, Fitzgerald GK, Wisniewski S, Delitto A. Predictors of pain and function outcome after rehabilitation in patients with patellofemoral pain syndrome. J Rehabil Med. 2009;41(8):604-12. Doi: https://doi.org/10.2340/16501977-0372
Tseli E, Boersma K, Stålnacke BM, Enthoven P, Gerdle B, Äng BO, et al. Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Clin J Pain. 2019;35(2):148-173. Doi: https://doi.org/10.1097/AJP.0000000000000669
Imamura M, Imamura ST, Kaziyama HH, Targino RA, Hsing WT, de Souza LP, et al. Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: a controlled analysis. Arthritis Rheum. 2008;59(10):1424-31. Doi: https://doi.org/10.1002/art.24120
Ayres DVM, Uchiyama SST, Prates AO, Lopes RAF, Silva ABS, Tsukimoto DR, et al. The Knee-SCHOOL: a brief patient-centered multidisciplinary educational program for knee osteoarthritis. Front Med (Lausanne). 2025;11:1497774. Doi: https://doi.org/10.3389/fmed.2024.1497774
Wood MJ, Miller RE, Malfait AM. The Genesis of Pain in Osteoarthritis: Inflammation as a Mediator of Osteoarthritis Pain. Clin Geriatr Med. 2022;38(2):221-238. Doi: https://doi.org/10.1016/j.cger.2021.11.013
Tarasovs M, Skuja S, Svirskis S, Sokolovska L, Vikmanis A, Lejnieks A, et al. Interconnected pathways: exploring inflammation, pain, and cognitive decline in osteoarthritis. Int J Mol Sci. 2024;25(22):11918. Doi: https://doi.org/10.3390/ijms252211918
Crowley S, Mickle AM, Wiggins ME, Cardoso J, Lai S, Tanner JJ, et al. Relationships Between Cognitive Screening Composite Scores and Pain Intensity and Pain Disability in Adults With/At Risk for Knee Osteoarthritis. Clin J Pain. 2022;38(7):470-475. Doi: https://doi.org/10.1097/AJP.0000000000001042
Simis M, Imamura M, Sampaio de Melo P, Marduy A, Battistella L, Fregni F. Deficit of Inhibition as a Marker of Neuroplasticity (DEFINE Study) in Rehabilitation: A Longitudinal Cohort Study Protocol. Front Neurol. 2021;12:695406. Doi: https://doi.org/10.3389/fneur.2021.695406
World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 2000. (WHO Technical Report Series, 894).
Khaleghi AA, Salari N, Darvishi N, Bokaee S, Jafari S, Hemmati M, et al. Global prevalence of obesity in the older adults: A meta-analysis. Public Health Pract (Oxf). 2025;9:100585. Doi: https://doi.org/10.1016/j.puhip.2025.100585
Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7(4):524-32. Doi: https://doi.org/10.1037/1040-3590.7.4.524
Robinson CL, Phung A, Dominguez M, Remotti E, Ricciardelli R, Momah DU, et al. Pain Scales: What Are They and What Do They Mean. Curr Pain Headache Rep. 2024;28(1):11-25. Doi: https://doi.org/10.1007/s11916-023-01195-2
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833-40.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Brazilian-Portuguese version of the SF-36: a reliable and valid quality of life outcome measure. Rev Bras Reumatol. 1997;37(6):143–150.
Melzack R. The McGill Pain Questionnaire: major proper-ties and scoring methods. Pain. 1975;1(3):277-299. Doi: https://doi.org/10.1016/0304-3959(75)90044-5
Pimenta CAM, Teixeira MJ. Questionário de dor McGill: proposta de adaptação para a língua portuguesa. Rev Esc Enferm USP. 1996;30(3):473-83. Doi: https://doi.org/10.1590/S0080-62341996000300009
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9. Doi: https://doi.org/10.1111/j.1532-5415.2005.53221.x
Memória CM, Yassuda MS, Nakano EY, Forlenza OV. Brief screening for mild cognitive impairment: validation of the Brazilian version of the Montreal cognitive assessment. Int J Geriatr Psychiatry. 2013;28(1):34-40. Doi: https://doi.org/10.1002/gps.3787
Apolinario D, Dos Santos MF, Sassaki E, Pegoraro F, Pedrini AVA, Cestari B, et al. Normative data for the Montreal Cognitive Assessment (MoCA) and the Memory Index Score (MoCA-MIS) in Brazil: Adjusting the nonlinear ef-fects of education with fractional polynomials. Int J Geriatr Psychiatry. 2018;33(7):893-899. Doi: https://doi.org/10.1002/gps.4866
Field A. Discovering statistics using IBM SPSS statistics. 4th ed. London: Sage; 2013
R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2024.
Nishigami T, Tanaka S, Mibu A, Imai R, Wand BM. Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis. Sci Rep. 2021;11(1):5835. Doi: https://doi.org/10.1038/s41598-021-85307-1
Seminowicz DA, Moayedi M. The Dorsolateral Prefrontal Cortex in Acute and Chronic Pain. J Pain. 2017;18(9):1027-1035. Doi: https://doi.org/10.1016/j.jpain.2017.03.008
Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Which psychological factors are involved in the onset and/or persistence of musculoskeletal pain? an umbrella review of systematic reviews and meta-analyses of prospective cohort studies. Clin J Pain. 2020;36(8):626-637. Doi: https://doi.org/10.1097/AJP.0000000000000838
Stern Y. Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurol. 2012;11(11):1006-12. Doi: https://doi.org/10.1016/S1474-4422(12)70191-6
Kuner R, Flor H. Structural plasticity and reorganisation in chronic pain. Nat Rev Neurosci. 2016;18(1):20-30. Doi: https://doi.org/10.1038/nrn.2016.162
Baek W, Suh Y, Ji Y. Impact of frailty severity and severe pain on cognitive function for community-dwelling older adults with arthritis: a cross-sectional study in Korea. Sci Rep. 2024;14(1):2874. Doi: https://doi.org/10.1038/s41598-024-53431-3
Moriarty O, McGuire BE, Finn DP. The effect of pain on cognitive function: a review of clinical and preclinical re-search. Prog Neurobiol. 2011;93(3):385-404. Doi: https://doi.org/10.1016/j.pneurobio.2011.01.002
Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med. 2017;177(8):1146-1153. Doi: https://doi.org/10.1001/jamainternmed.2017.1622
Urquhart DM, Phyomaung PP, Dubowitz J, Fernando S, Wluka AE, Raajmaakers P, et al. Are cognitive and behavioural factors associated with knee pain? A systematic review. Semin Arthritis Rheum. 2015;44(4):445-55. Doi: https://doi.org/10.1016/j.semarthrit.2014.07.005
Chen J, Wang X, Xu Z. The relationship between chronic pain and cognitive impairment in the elderly: a review of current evidence. J Pain Res. 2023;16:2309-2319. Doi: https://doi.org/10.2147/JPR.S416253
Sociedade Brasileira de Reumatologia. Guidelines for the treatment of knee osteoarthritis. Rev Bras Reumatol. 2022.
Barbosa SP, Marques L, Sugawara A, Toledo F, Imamura M, Battistella L, et al. Predictors of the Health-Related Quality of Life (HRQOL) in SF-36 in Knee Osteoarthritis Patients: A Multimodal Model With Moderators and Mediators. Cureus. 2022;14(7):e27339. Doi: https://doi.org/10.7759/cureus.27339
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