Bidirectional associations between mental health conditions and cognitive impairment in patients with pain conditions of the back, neck, and spine: A population-based study

by Mohammad Alipour-Vaezi, Jyoti Savla, Margaret R. Rukstalis, Daniel B.

Rukstalis, Kwok-Leung Tsui, Donald B. Penzien, Robert S.

McNamara, Huaiyang Zhong Background Pain conditions (PCs) of the back, neck, and spine are frequently accompanied by psychiatric and cognitive comorbidities in older adults. However, the directionality and magnitude of the associations between psychiatric disorders and cognitive impairment in this population remain insufficiently characterized.

Objective This population-based study examines the bidirectional relationship between Mental Health Conditions (MHCs) and Cognitive Impairment (CI) among patients with back, neck, and spine pain. It assesses whether MHCs—including depression, Bipolar Disorder (BD), Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), Panic Disorder (PaD), Persistent Mood Disorder (PMD), Suicidal Behavior (SB), Schizophrenia (SCZ), and Substance Use Disorder (SUD)—are associated with subsequent incident CI, and conversely, whether prior CI is associated with subsequent incident MHCs.

Methods Data were drawn from the TriNetX US Collaborative Network (2016/01/01–2021/12/31), comprising over 119 million patients. Cohorts of patients with PCs were defined using ICD-10 codes.

Propensity score matching was applied to balance demographics and comorbidities.