Observing pain in individuals with cognitive impairment: A pilot comparison attempt across countries and across different types of cognitive impairment

Miriam Kunz*, Petra Crutzen-Braaksma, Lydia Giménez-Llort, Sara Invitto, Gaya Villani, Marina Detommaso, Laura Petrini, Lene Vase, Susan Tomczak Matthiesen, Hanne Gottrup, Jone Ansuategui Echeita, Stefan Lautenbacher, Ruth Defrin

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    Facial expression is a key aspect in observational scales developed to improve pain assessment in individuals with cognitive impairments. Although these scales are used internationally in individuals with different types of cognitive impairments, it is not known whether observing facial expressions of pain might differ between regions or between different types of cognitive impairments. In a pilot study, facial responses to standardized experimental pressure pain were assessed among individuals with different types of cognitive impairments (dementia, mild cognitive impairment, Huntington’s disease, and intellectual disability) from different countries (Denmark, Germany, Italy, Israel, and Spain) and were analyzed using facial descriptors from the PAIC scale (Pain Assessment in Impaired Cognition). We found high inter-rater reliability between observers from different countries. Moreover, facial responses to pain did not differ between individuals with dementia from different countries (Denmark, Germany, and Spain). However, the type of cognitive impairment had a significant impact; with individuals with intellectual disability (all being from Israel) showing the strongest facial responses. Our pilot data suggest that the country of origin does not strongly affect how pain is facially expressed or how facial responses are being scored. However, the type of cognitive impairment showed a clear effect in our pilot study, with elevated facial responses in individuals with intellectual disability.

    Original languageEnglish
    Article number1455
    Number of pages13
    JournalBrain Sciences
    Issue number11
    Publication statusPublished - Nov-2021


    • Cognitive impairment
    • Cultural differences
    • Dementia
    • Facial expression
    • Intellectual disability
    • Mild cognitive impairment
    • PAIC
    • Pain
    • Pain observation

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