Subjective Memory: A Clinical Marker for Cognitive Decline and Depression in Older Puerto Ricans With Chronic Pain

TL;DR

Chronic pain in older Puerto Ricans is linked to memory issues and depression, which may signal future cognitive decline.

Contribution

This study identifies subjective memory as a clinical marker linking chronic pain to cognitive and emotional health decline in aging adults.

Findings

Chronic pain is associated with worse subjective memory and increased depressive symptoms.

Subjective memory problems mediate the relationship between chronic pain and cognitive decline.

Chronic pain also predicts increases in depressive symptoms over time.

Abstract

Chronic pain has been linked to subjective memory problems in older Puerto Rican adults, yet its relationship to objective cognitive decline and depressive symptoms remains unclear. This study examined these associations using data from Waves 1 (2002/2003), 2 (2006/2007), 3 (2020/2021), and 4 (2022/2024) of the Puerto Rican Elderly: Health Conditions Study (PREHCO), a longitudinal, population-based study of Puerto Rican adults aged 60 and older. The sample included individuals who were cognitively unimpaired at baseline with at least one follow-up (n = 2,630, Mage=71.33, SD = 8.25; 59.5% female). Chronic pain was defined as bodily pain reported at both Waves 1 and 2. Subjective memory was assessed using the Health and Retirement Study item, “How would you rate your memory at the present time?” (1 = excellent to 5 = poor). Cognitive function and depressive symptoms were measured using the Mini-Mental Caban and the 15-item Geriatric Depression Scale, respectively. Structural equation modeling examined how chronic pain at Wave 2 influenced subjective memory concerns at Wave 3 and cognitive decline at Wave 4, accounting for prior cognitive function. Chronic pain was associated with worse subjective memory problems (β=.31, p<.001) and greater depressive symptoms (β=.31, p<.001) at Wave 3. By Wave 4, chronic pain predicted increases in depressive symptoms (β=-.08, p=.038). Bootstrap methods confirmed that subjective memory problems mediated the relationship between chronic pain and cognitive decline (β=-.27, p=.035) and depressive symptoms (β=.23, p=.008). These findings highlight subjective memory as a potential intermediatory step between declines in cognitive and emotional health in aging Puerto Rican adults.