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Dementia was diagnosed according to DSM-5 criteria and staged using the Clinical Dementia Rating (CDR). Pain was assessed with the Pain Assessment in Advanced Dementia (PAIN-AD) scale. Frailty (Clinical Frailty Scale) and quality of life (EQ-5D-3L) were evaluated. Analyses included correlation, linear and Cox regression, and Kaplan\u2013Meier survival methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 292 hospitalized older adults with major neurocognitive disorder were included (mean age 87.8\u2009\u00b1\u20096.2\u00a0years; 63.4% women). Clinically relevant pain-related behaviours (PAIN-AD\u2009\u2265\u20092) were observed in 62.4% of participants and increased progressively with dementia severity. Despite this high prevalence, only 20.3% of patients with PAIN-AD\u2009\u2265\u20092 were receiving pharmacological analgesic treatment at hospital admission. Compared with participants with PAIN-AD\u2009\u2264\u20091, those with PAIN-AD\u2009\u2265\u20092 showed lower functional autonomy, poorer nutritional status, higher frailty levels, greater acute clinical severity, and longer hospital stay. PAIN-AD scores were positively associated with frailty and poorer health-related quality of life, controlled for multiple covariates. At 3-month follow-up, mortality was significantly higher among patients with PAIN-AD\u2009\u2265\u20092 (40.1% vs 16.3%). In Cox regression analysis, PAIN-AD\u2009\u2265\u20092 remained independently associated with increased short-term mortality (HR 2.39, 95% CI 1.20\u20134.74), after adjustment for demographic factors, dementia severity, nutritional status, acute illness severity, and analgesic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pain assessed by observational tools is frequent and clinically relevant in hospitalized older adults with major neurocognitive disorder and is associated with increased vulnerability and adverse short-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s41999-026-01450-w","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T05:48:19Z","timestamp":1773121699000},"page":"1479-1488","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pain as an underrecognized geriatric syndrome in hospitalized older adults with major neurocognitive disorder: clinical correlates and outcomes"],"prefix":"10.1007","volume":"17","author":[{"given":"Francesca","family":"Mancinetti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma Giulia","family":"Travaglini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Speziali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Gaspari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Ercolani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Mecocci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2134-1122","authenticated-orcid":false,"given":"Virginia","family":"Boccardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"1450_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/J.EXPNEUROL.2022.114287","author":"H Blanton","year":"2023","unstructured":"Blanton H, Reddy PH, Benamar K (2023) Chronic pain in Alzheimer\u2019s disease: endocannabinoid system. 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