Pain, Cognition, and Culture in Dementia research: A Critical synthesis of empirical and methodological literature

Research examining relationships between pain and cognition in dementia and cognitive impairment has expanded, yet methodological and cultural limitations remain insufficiently explored. This paper critically synthesises findings from two scoping reviews focusing on pain-cognition relationships in dementia, methodological approaches used in assessing these constructs, and the influence of cultural factors on pain and cognition. Across the included reviews, evidence suggests chronic pain was generally associated with poorer cognitive performance, particularly in domains such as executive functioning and processing speed, although findings varied across studies. This variation may partly reflect differences in measurement tools and study design, particularly the use of global screening tools versus domain-specific cognitive assessments. The synthesis indicates that interpretation of evidence in this area is shaped by inconsistent cognitive assessment practices and reliance on pain measures that become less appropriate with cognitive decline. The review argues that culturally informed and multimodal approaches are required to improve assessment validity and advance dementia research and care.