Final answer:
The PAINAD scale does not include 'lack of fear' as an indicator of pain in dementia patients.
Step-by-step explanation:
PAINAD (Pain Assessment in Advanced Dementia) is a tool commonly used to assess pain in dementia patients. Among the options listed, lack of fear is not typically considered a manifestation of pain and is not included in the PAINAD assessment. The other options, such as breathing independent of vocalization, difficulty sleeping, negative vocalization, facial expression, body language, and consolability, are all indicators of pain that are assessed in the PAINAD scale.