101
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Ehrenberg AJ, Nguy AK, Theofilas P, Dunlop S, Suemoto CK, Di Lorenzo Alho AT, Leite RP, Diehl Rodriguez R, Mejia MB, Rüb U, Farfel JM, de Lucena Ferretti-Rebustini RE, Nascimento CF, Nitrini R, Pasquallucci CA, Jacob-Filho W, Miller B, Seeley WW, Heinsen H, Grinberg LT. Quantifying the accretion of hyperphosphorylated tau in the locus coeruleus and dorsal raphe nucleus: the pathological building blocks of early Alzheimer's disease. Neuropathol Appl Neurobiol 2017; 43:393-408. [PMID: 28117917 DOI: 10.1111/nan.12387] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/19/2017] [Accepted: 01/24/2017] [Indexed: 01/02/2023]
Abstract
AIMS Hyperphosphorylated tau neuronal cytoplasmic inclusions (ht-NCI) are the best protein correlate of clinical decline in Alzheimer's disease (AD). Qualitative evidence identifies ht-NCI accumulating in the isodendritic core before the entorhinal cortex. Here, we used unbiased stereology to quantify ht-NCI burden in the locus coeruleus (LC) and dorsal raphe nucleus (DRN), aiming to characterize the impact of AD pathology in these nuclei with a focus on early stages. METHODS We utilized unbiased stereology in a sample of 48 well-characterized subjects enriched for controls and early AD stages. ht-NCI counts were estimated in 60-μm-thick sections immunostained for p-tau throughout LC and DRN. Data were integrated with unbiased estimates of LC and DRN neuronal population for a subset of cases. RESULTS In Braak stage 0, 7.9% and 2.6% of neurons in LC and DRN, respectively, harbour ht-NCIs. Although the number of ht-NCI+ neurons significantly increased by about 1.9× between Braak stages 0 to I in LC (P = 0.02), we failed to detect any significant difference between Braak stage I and II. Also, the number of ht-NCI+ neurons remained stable in DRN between all stages 0 and II. Finally, the differential susceptibility to tau inclusions among nuclear subdivisions was more notable in LC than in DRN. CONCLUSIONS LC and DRN neurons exhibited ht-NCI during AD precortical stages. The ht-NCI increases along AD progression on both nuclei, but quantitative changes in LC precede DRN changes.
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Affiliation(s)
- A J Ehrenberg
- University of California, San Francisco, California, USA.,University of California, Berkeley, California, USA
| | - A K Nguy
- University of California, San Francisco, California, USA.,University of California, Berkeley, California, USA
| | - P Theofilas
- University of California, San Francisco, California, USA
| | - S Dunlop
- University of California, San Francisco, California, USA
| | - C K Suemoto
- University of São Paulo Medical School, São Paulo, Brazil
| | - A T Di Lorenzo Alho
- University of São Paulo Medical School, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - R P Leite
- University of São Paulo Medical School, São Paulo, Brazil
| | | | - M B Mejia
- University of California, San Francisco, California, USA
| | - U Rüb
- University of Frankfurt, Frankfurt, Germany
| | - J M Farfel
- University of São Paulo Medical School, São Paulo, Brazil
| | | | - C F Nascimento
- University of São Paulo Medical School, São Paulo, Brazil
| | - R Nitrini
- University of São Paulo Medical School, São Paulo, Brazil
| | | | - W Jacob-Filho
- University of São Paulo Medical School, São Paulo, Brazil
| | - B Miller
- University of California, San Francisco, California, USA
| | - W W Seeley
- University of California, San Francisco, California, USA
| | - H Heinsen
- University of São Paulo Medical School, São Paulo, Brazil.,University of Wüerzburg, Wüerzburg, Germany
| | - L T Grinberg
- University of California, San Francisco, California, USA.,University of São Paulo Medical School, São Paulo, Brazil
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102
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Busche MA, Kekuš M, Förstl H. [Connections between sleep and Alzheimer's disease : Insomnia, amnesia and amyloid]. DER NERVENARZT 2017; 88:215-221. [PMID: 27251738 DOI: 10.1007/s00115-016-0122-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sleep plays an essential role in memory consolidation. Although sleep problems are common in Alzheimer's disease, they are not usually thought to be key features of the disease; however, new experimental research has shown that sleep disturbances not only occur before the onset of typical cognitive deficits but are also associated with the pathogenesis of Alzheimer's disease and may have a decisive influence on the symptoms and course. Thus, sleep disturbances may be potentially modifiable risk factors for Alzheimer's disease that deserve more attention in research, diagnostics and treatment.
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Affiliation(s)
- M A Busche
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Institut für Neurowissenschaften, Technische Universität München, München, Deutschland. .,Munich Cluster for Systems Neurology (SyNergy), München, Deutschland.
| | - M Kekuš
- Institut für Neurowissenschaften, Technische Universität München, München, Deutschland.,Munich Cluster for Systems Neurology (SyNergy), München, Deutschland
| | - H Förstl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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103
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Holth JK, Mahan TE, Robinson GO, Rocha A, Holtzman DM. Altered sleep and EEG power in the P301S Tau transgenic mouse model. Ann Clin Transl Neurol 2017; 4:180-190. [PMID: 28275652 PMCID: PMC5338139 DOI: 10.1002/acn3.390] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/21/2016] [Accepted: 12/27/2016] [Indexed: 11/16/2022] Open
Abstract
Objective Sleep disturbances are prevalent in human tauopathies yet despite the importance of sleep, little is known about its relationship with tau pathology. Here, we investigate this interaction by analyzing sleep and tau pathology throughout tauopathy disease progression in P301S human tau transgenic mice. Methods P301S and wild‐type mice were analyzed by electroencephalography (EEG)/electromyography at 3, 6, 9, and 11 months of age for sleep/wake time, EEG power, and homeostatic response. Cortical volume and tau pathology was also assessed by anti‐phospho‐tau AT8 staining. Results P301S tau mice had significantly decreased rapid eye movement (REM) sleep at 9 months of age and decreased REM and non‐REM (NREM) sleep as well as increased wakefulness at 11 months. Sleep loss was characterized by fewer wake, REM, and NREM bouts, increased wake bout duration, and decreased sleep bout duration. Decreased REM and NREM sleep was associated with increased brainstem tau pathology in the sublaterodorsal area and parafacial zone, respectively. P301S mice also showed increased EEG power at 6 and 9 months of age and decreased power at 11 months. Decreased EEG power was associated with decreased cortical volume. Despite sleep disturbances, P301S mice maintained homeostatic response to sleep deprivation. Interpretation Our results indicate that tau pathology is associated with sleep disturbances that worsen with age and these changes may be related to tau pathology in brainstem sleep regulating regions as well as neurodegeneration. Tau‐induced sleep changes could affect disease progression and be a marker for therapeutic efficacy in this and other tauopathy models.
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Affiliation(s)
- Jerrah K Holth
- Department of Neurology Hope Center for Neurological Disorders, and the Knight Alzheimer's Disease Research Center Washington University School of Medicine St. Louis Missouri 63110
| | - Thomas E Mahan
- Department of Neurology Hope Center for Neurological Disorders, and the Knight Alzheimer's Disease Research Center Washington University School of Medicine St. Louis Missouri 63110
| | - Grace O Robinson
- Department of Neurology Hope Center for Neurological Disorders, and the Knight Alzheimer's Disease Research Center Washington University School of Medicine St. Louis Missouri 63110
| | - Andreia Rocha
- Department of Neurology Hope Center for Neurological Disorders, and the Knight Alzheimer's Disease Research Center Washington University School of Medicine St. Louis Missouri 63110
| | - David M Holtzman
- Department of Neurology Hope Center for Neurological Disorders, and the Knight Alzheimer's Disease Research Center Washington University School of Medicine St. Louis Missouri 63110
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104
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Cedernaes J, Osorio RS, Varga AW, Kam K, Schiöth HB, Benedict C. Candidate mechanisms underlying the association between sleep-wake disruptions and Alzheimer's disease. Sleep Med Rev 2017; 31:102-111. [PMID: 26996255 PMCID: PMC4981560 DOI: 10.1016/j.smrv.2016.02.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 12/13/2022]
Abstract
During wakefulness, extracellular levels of metabolites in the brain increase. These include amyloid beta (Aβ), which contributes to the pathogenesis of Alzheimer's disease (AD). Counterbalancing their accumulation in the brain, sleep facilitates the removal of these metabolites from the extracellular space by convective flow of the interstitial fluid from the para-arterial to the para-venous space. However, when the sleep-wake cycle is disrupted (characterized by increased brain levels of the wake-promoting neuropeptide orexin and increased neural activity), the central nervous system (CNS) clearance of extracellular metabolites is diminished. Disruptions to the sleep-wake cycle have furthermore been linked to increased neuronal oxidative stress and impaired blood-brain barrier function - conditions that have also been proposed to play a role in the development and progression of AD. Notably, recent human and transgenic animal studies have demonstrated that AD-related pathophysiological processes that occur long before the clinical onset of AD, such as Aβ deposition in the brain, disrupt sleep and circadian rhythms. Collectively, as proposed in this review, these findings suggest the existence of a mechanistic interplay between AD pathogenesis and disrupted sleep-wake cycles, which is able to accelerate the development and progression of this disease.
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Affiliation(s)
| | - Ricardo S Osorio
- Center for Brain Health, NYU Langone Medical Center, New York, NY, USA.
| | - Andrew W Varga
- NYU Sleep Disorders Center, NYU Langone Medical Center, New York, NY, USA
| | - Korey Kam
- NYU Sleep Disorders Center, NYU Langone Medical Center, New York, NY, USA
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105
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Zhao HY, Wu HJ, He JL, Zhuang JH, Liu ZY, Huang LQ, Zhao ZX. Chronic Sleep Restriction Induces Cognitive Deficits and Cortical Beta-Amyloid Deposition in Mice via BACE1-Antisense Activation. CNS Neurosci Ther 2017; 23:233-240. [PMID: 28145081 DOI: 10.1111/cns.12667] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022] Open
Abstract
AIMS To clarify the correlation between chronic sleep restriction (CSR) and sporadic Alzheimer disease (AD), we determined in wild-type mice the impact of CSR, on cognitive performance, beta-amyloid (Aβ) peptides, and its feed-forward regulators regarding AD pathogenesis. METHODS Sixteen nine-month-old C57BL/6 male mice were equally divided into the CSR and control groups. CSR was achieved by application of a slowly rotating drum for 2 months. The Morris water maze test was used to assess cognitive impairment. The concentrations of Aβ peptides, amyloid precursor protein (APP) and β-secretase 1 (BACE1), and the mRNA levels of BACE1 and BACE1-antisense (BACE1-AS) were measured. RESULTS Following CSR, impairments of spatial learning and memory consolidation were observed in the mice, accompanied by Aβ plaque deposition and an increased Aβ concentration in the prefrontal and temporal lobe cortex. CSR also upregulated the β-secretase-induced cleavage of APP by increasing the protein and mRNA levels of BACE1, particularly the BACE1-AS. CONCLUSIONS This study shows that a CSR accelerates AD pathogenesis in wild-type mice. An upregulation of the BACE1 pathway appears to participate in both cortical Aβ plaque deposition and memory impairment caused by CSR. BACE1-AS is likely activated to initiate a cascade of events that lead to AD pathogenesis. Our study provides, therefore, a molecular mechanism that links CSR to sporadic AD.
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Affiliation(s)
- Hong-Yi Zhao
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hui-Juan Wu
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jia-Lin He
- Academy of Clinical Medicine, Second Military Medical University, Shanghai, China
| | - Jian-Hua Zhuang
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhen-Yu Liu
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liu-Qing Huang
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhong-Xin Zhao
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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106
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Carvalho DZ, St Louis EK, Boeve BF, Mielke MM, Przybelski SA, Knopman DS, Machulda MM, Roberts RO, Geda YE, Petersen RC, Jack CR, Vemuri P. Excessive daytime sleepiness and fatigue may indicate accelerated brain aging in cognitively normal late middle-aged and older adults. Sleep Med 2016; 32:236-243. [PMID: 28065685 DOI: 10.1016/j.sleep.2016.08.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/30/2016] [Accepted: 08/04/2016] [Indexed: 12/29/2022]
Abstract
Excessive daytime sleepiness (EDS) and fatigue increases with age. The aim of this study was to investigate the association between EDS and fatigue with cortical thickness and hippocampal volume in cognitively normal, late middle-aged and older adults. We performed a cross-sectional observational study of 1374 cognitively-normal subjects aged 50 years and older who had a structural MRI. Regional cortical thickness and hippocampal volume were measured. Multiple linear regression models were fit to explore associations between EDS and fatigue and structural MRI measures in different brain regions, adjusting for multiple covariates. EDS was defined as Epworth Sleepiness Scale ≥10. Fatigue severity was assessed with the Beck Depression Inventory-2. 208 participants had EDS, 27 had significant fatigue, and 11 had both. Participants with EDS or fatigue had significantly lower cognitive scores, more disturbed sleep, and medical comorbidities. The presence of EDS was associated with both global and regional atrophy, whereas fatigue was more associated with frontal and temporal changes. Cortical thinning predicted by EDS and fatigue was maximal in the temporal region with average reduction of 34.2 μm (95% CI, -54.1, -14.3; P = 0.001) and 90.2 μm (95% CI, -142.1, -38.2; P = 0.001), respectively. Fatigue was also associated with hippocampal volume reduction of -374.2 mm3 (95% CI, -670.8, -77.7; P = 0.013). Temporal cortical thinning predicted by presence of EDS and fatigue was equivalent to more than 3.5 and 9 additional years of aging, respectively. EDS and fatigue were associated with cortical thickness reduction primarily in regions with increased age-susceptibility, which may indicate accelerated brain aging.
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Affiliation(s)
| | | | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Yonas E Geda
- Department of Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Mayo Clinic, Scottsdale, AZ, USA; Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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107
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Luojus MK, Lehto SM, Tolmunen T, Brem AK, Lönnroos E, Kauhanen J. Self-reported sleep disturbance and incidence of dementia in ageing men. J Epidemiol Community Health 2016; 71:329-335. [DOI: 10.1136/jech-2016-207764] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/30/2016] [Accepted: 10/01/2016] [Indexed: 01/30/2023]
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108
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de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. The Relationship between Sleep Complaints, Depression, and Executive Functions on Older Adults. Front Psychol 2016; 7:1547. [PMID: 27774078 PMCID: PMC5054021 DOI: 10.3389/fpsyg.2016.01547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022] Open
Abstract
Aim: In this manuscript, we report data on the association between executive functions screened by Frontal Assessment Battery, Five Digit Test and Digit Span with self-reported depressive symptoms and sleep complaints in non-demented older adults. Methods: A total sample of 95 non-demented older adults performed Geriatric Depression Scale short version, Frontal Assessment Battery, Five Digit Test, Digit Span, and clinical interview. We split participants in groups stratified by age according to: young-old (60–69 years of age), old-old (70–79 years), and oldest-old (>80 years) and compared these three groups on the sociodemographic characteristics and executive functions performance. We carried out Poisson regression with robust error variance to verify sleep complaints and depression effects on executive functions performance. Gender, age, years of formal education, use of antidepressants and of benzodiazepines were considered as confounding variables, taking into account executive functions as dependent and sleep complaints and depression as independent variables. Results: Controlling the effect of age, gender, years of formal education, use of benzodiazepines and of antidepressants there was a significant influence of depression in motor programming, inhibitory control, and working memory. Individuals without depression show motor programming scores 68.4% higher, inhibitory control scores 3 times greater and working memory scores also 3 times greater than individuals without depression. There was a significant influence of sleep complaints in phonemic fluency, motor programming, inhibitory control, and working memory. Individuals without sleep complaints show phonemic fluency scores 2 times greater than, motor programming scores 85.9% higher, inhibitory control scores 3 times greater and working memory scores also 3 times greater than individuals without sleep complaints. Conclusions: Sleep complaints are associated with phonemic fluency, motor programming, inhibitory control, and working memory impairment. Depression symptoms presence are associated with motor programming and working memory performances. Depression and sleep complaints interaction would determine worse phonemic fluency, inhibitory control and working memory cognitive performance than these two conditions alone.
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Affiliation(s)
- Katie M de Almondes
- Group of Research Neuroscience Applied, Basic Process and Chronobiolog, Department of Psychology, Federal University of Rio Grande do Norte Natal, Brazil
| | - Mônica V Costa
- Laboratory for Investigations in Clinical Neuroscience, School of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Leandro F Malloy-Diniz
- Department of Mental Health, School of Medicine, National Institute of Science & Technology Molecular Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Breno S Diniz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston Houston, TX, USA
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109
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Abstract
Sleep disorders are prevalent in Alzheimer's disease (AD) and a major cause of institutionalization. Like AD pathology, sleep abnormalities can appear years before cognitive decline and may be predictive of dementia. A bidirectional relationship between sleep and amyloid β (Aβ) has been well established with disturbed sleep and increased wakefulness leading to increased Aβ production and decreased Aβ clearance; whereas Aβ deposition is associated with increased wakefulness and sleep disturbances. Aβ fluctuates with the sleep-wake cycle and is higher during wakefulness and lower during sleep. This fluctuation is lost with Aβ deposition, likely due to its sequestration into amyloid plaques. As such, Aβ is believed to play a significant role in the development of sleep disturbances in the preclinical and clinical phases of AD. In addition to Aβ, the influence of tau AD pathology is likely important to the sleep disturbances observed in AD. Abnormal tau is the earliest observable AD-like pathology in the brain with abnormal tau phosphorylation in many sleep regulating regions such as the locus coeruleus, dorsal raphe, tuberomammillary nucleus, parabrachial nucleus, and basal forebrain prior to the appearance of amyloid or cortical tau pathology. Furthermore, human tau mouse models exhibit AD-like sleep disturbances and sleep changes are common in other tauopathies including frontotemporal dementia and progressive supranuclear palsy. Together these observations suggest that tau pathology can induce sleep disturbances and may play a large role in the sleep disruption seen in AD. To elucidate the relationship between sleep and AD it will be necessary to not only understand the role of amyloid but also tau and how these two pathologies, together with comorbid pathology such as alpha-synuclein, interact and affect sleep regulation in the brain.
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110
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Theofilas P, Ehrenberg AJ, Dunlop S, Di Lorenzo Alho AT, Nguy A, Leite REP, Rodriguez RD, Mejia MB, Suemoto CK, Ferretti-Rebustini REDL, Polichiso L, Nascimento CF, Seeley WW, Nitrini R, Pasqualucci CA, Jacob Filho W, Rueb U, Neuhaus J, Heinsen H, Grinberg LT. Locus coeruleus volume and cell population changes during Alzheimer's disease progression: A stereological study in human postmortem brains with potential implication for early-stage biomarker discovery. Alzheimers Dement 2016; 13:236-246. [PMID: 27513978 DOI: 10.1016/j.jalz.2016.06.2362] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/01/2016] [Accepted: 06/22/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) progression follows a specific spreading pattern, emphasizing the need to characterize those brain areas that degenerate first. The brainstem's locus coeruleus (LC) is the first area to develop neurofibrillary changes (neurofibrillary tangles [NFTs]). METHODS The methods include unbiased stereological analyses in human brainstems to estimate LC volume and neuronal population in controls and individuals across all AD stages. RESULTS As the Braak stage increases by 1 unit, the LC volume decreases by 8.4%. Neuronal loss started only midway through AD progression. Age-related changes spare the LC. DISCUSSION The long gap between NFT accumulation and neuronal loss suggests that a second trigger may be necessary to induce neuronal death in AD. Imaging studies should determine whether LC volumetry can replicate the stage-wise atrophy observed here and how these changes are specific to AD. LC volumetry may develop into a screening biomarker for selecting high-yield candidates to undergo expensive and less accessible positron emission tomography scans and to monitor AD progression from presymptomatic stages.
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Affiliation(s)
- Panos Theofilas
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Alexander J Ehrenberg
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Dunlop
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ana T Di Lorenzo Alho
- Hospital Albert Einstein, São Paulo, Brazil; Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, Brazil
| | - Austin Nguy
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Maria B Mejia
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Claudia K Suemoto
- Division of Geriatrics, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Livia Polichiso
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, Brazil
| | - Camila F Nascimento
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, Brazil
| | - William W Seeley
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ricardo Nitrini
- Department of Neurology, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Jacob Filho
- Division of Geriatrics, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Udo Rueb
- University of Frankfurt, Frankfurt, Germany
| | - John Neuhaus
- Department of Biostatistics, University of California, San Francisco, CA, USA
| | - Helmut Heinsen
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, Brazil; University of Wuerzburg, Wuerzburg, Germany
| | - Lea T Grinberg
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, Brazil.
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111
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Abstract
Sleep disorders are common in neurology practice, but are often undiagnosed and untreated. Specific patient cohorts, such as older adults, patients residing in nursing homes, and patients with underlying chronic neurologic and psychiatric disorders, are at particular risk. If these sleep problems are not properly evaluated and managed the patient may experience exacerbation of the underlying neurologic disorder. This article highlights some of the key sleep disorders relevant to practicing neurologists, emphasizing hypersomnolence, insomnia, and sleep-related movement disorders in the setting of neurologic disorders to enhance the tools available for evaluation, and discusses management strategies.
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Affiliation(s)
- Lori Ani Panossian
- Sleep Laboratory, East Bay Division, Department of Neurology, Veterans Affairs Northern California Health Care System, 150 Muir Road, Martinez, CA 94553, USA
| | - Alon Y Avidan
- Department of Neurology, UCLA Sleep Disorders Center, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, Room 1-145 RNRC, Los Angeles, CA 90095-1769, USA.
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112
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Leoutsakos JMS, Forrester SN, Lyketsos CG, Smith GS. Latent Classes of Neuropsychiatric Symptoms in NACC Controls and Conversion to Mild Cognitive Impairment or Dementia. J Alzheimers Dis 2016; 48:483-93. [PMID: 26402012 DOI: 10.3233/jad-150421] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND A number of studies have linked neuropsychiatric symptoms to increase risk of dementia. OBJECTIVE To determine if risk of conversion to mild cognitive impairment or dementia among healthy controls varied as a function of their pattern of neuropsychiatric symptoms. METHOD We studied individuals in the National Alzheimer Coordinating Center dataset collected from 34 Alzheimer Disease Centers between 2005 and 2013. The analysis included 4,517 volunteers who were ≥60 years old, cognitively normal, and had complete Neuropsychiatric Inventory data at their baseline visit, and had at least one follow-up. We used latent class analysis to identify four classes based on patterns of NPI symptoms. We used a Cox proportional hazards model to determine if time to MCI or dementia varied by baseline latent class membership. RESULTS We identified four latent classes of neuropsychiatric symptoms: irritable, depressed, complex (depression, apathy, irritability, and nighttime behaviors) and asymptomatic. 873 participants converted to MCI or dementia. Hazard ratios for conversion by class were 1.76 (95% CI: 1.34, 2.33) for the irritable class, 3.20 (95% CI: 2.24, 4.58) for the complex class, and 1.90 (95% CI: 1.49, 2.43) for the depressed class, with the asymptomatic class as the reference. CONCLUSIONS Membership in all three symptomatic classes was associated with greater risk of conversion to MCI or dementia; the complex class had the greatest risk. Different patterns of neuropsychiatric symptoms may represent different underlying neuropathological pathways to dementia. Further work imaging and pathology research is necessary to determine if this is the case.
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113
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de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. Insomnia and risk of dementia in older adults: Systematic review and meta-analysis. J Psychiatr Res 2016; 77:109-15. [PMID: 27017287 DOI: 10.1016/j.jpsychires.2016.02.021] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 01/13/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
There are cross-sectional evidences of an association between sleep disorders and cognitive impairment on older adults. However, there are no consensus by means of longitudinal studies data on the increased risk of developing dementia related to insomnia. We conduct a systematic review and meta-analysis to evaluate the risk of incident all-cause dementia in individuals with insomnia in population-based prospective cohort studies. Five studies of 5.242 retrieved references were included in the meta-analysis. We used the generic inverse variance method with a random effects model to calculate the pooled risk of dementia in older adults with insomnia. We assessed heterogeneity in the meta-analysis by means of the Q-test and I2 index. Study quality was assessed with the Newcastle-Ottawa Scale The results showed that Insomnia was associated with a significant risk of all-cause dementia (RR = 1.53 CI95% (1.07-2.18), z = 2.36, p = 0.02). There was evidence for significant heterogeneity in the analysis (q-value = 2.4, p < 0.001 I2 = 82%). Insomnia is associated with an increased risk for dementia. This results provide evidences that future studies should investigate dementia prevention among elderly individuals through screening and proper management of insomnia.
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Affiliation(s)
| | - Mônica Vieira Costa
- Laboratory of Investigations in Clinical Neurosciences, Federal University of Minas Gerais, School of Medicine, Belo Horizonte, MG, Brazil.
| | - Leandro Fernandes Malloy-Diniz
- Laboratory of Investigations in Clinical Neurosciences, Federal University of Minas Gerais, School of Medicine, Belo Horizonte, MG, Brazil; Department of Mental Health, Federal University of Minas Gerais School of Medicine, Belo Horizonte, MG, Brazil.
| | - Breno Satler Diniz
- Laboratory of Investigations in Clinical Neurosciences, Federal University of Minas Gerais, School of Medicine, Belo Horizonte, MG, Brazil; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.
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Abstract
Lifestyle factors in midlife have an important influence on the risk of developing a neurodegenerative disease during later life. Data on lifestyle factors exist for Alzheimer's disease and Parkinson's disease. Continuous physical and cognitive activity, a balanced or Mediterranean diet with a high proportion of unsaturated fatty acids, the pharmacological treatment of arterial hypertension, sufficient and unfragmented sleep and possibly treatment with lipophilic statins reduce the risk of developing dementia later in life. Several studies in recent years have provided evidence that during the last decades the age-adjusted incidence of dementia has decreased. This is probably due to a healthier lifestyle and the treatment of risk factors. Continuous physical activity also decreases the likelihood of developing Parkinson's disease. Whether lifestyle factors also have an influence on the course and the progression of Alzheimer's and Parkinson's diseases in the symptomatic stages is unknown.
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115
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LoPresti ML, Anderson JA, Saboe KN, McGurk DL, Balkin TJ, Sipos ML. The Impact of Insufficient Sleep on Combat Mission Performance. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/21635781.2016.1181585] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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116
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Shastri A, Bangar S, Holmes J. Obstructive sleep apnoea and dementia: is there a link? Int J Geriatr Psychiatry 2016; 31:400-5. [PMID: 26266479 DOI: 10.1002/gps.4345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 07/12/2015] [Accepted: 07/17/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Obstructive sleep apnoea is a common sleep disturbance in people of all ages, while dementia is an increasing entity among the ageing population of the world. Recent studies have established a link between sleep apnoea and cognitive decline. This literature review explores this relationship and examines the mechanisms, neurobiology and treatment modalities. DESIGN The study was conducted with the use of narrative literature overview. RESULTS AND CONCLUSIONS While there are numerous studies that establish a clear relationship between obstructive sleep apnoea, cognitive decline and dementia, more work is needed in understanding the mechanism and processes involved. A detailed understanding of pathophysiology of sleep and the relationship with cognitive decline will be vital in addressing the possibility of averting a likely reversible cause of dementia or cognitive decline.
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Affiliation(s)
| | - Santosh Bangar
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - John Holmes
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK.,Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds, UK
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117
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Qiu H, Zhong R, Liu H, Zhang F, Li S, Le W. Chronic Sleep Deprivation Exacerbates Learning-Memory Disability and Alzheimer’s Disease-Like Pathologies in AβPPswe/PS1ΔE9 Mice. J Alzheimers Dis 2016; 50:669-85. [PMID: 26757041 DOI: 10.3233/jad-150774] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hongyan Qiu
- Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Rujia Zhong
- The Center for Translational Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, P.R. China
| | - Hui Liu
- Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Feng Zhang
- The Center for Translational Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, P.R. China
| | - Song Li
- The Center for Translational Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, P.R. China
| | - Weidong Le
- Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- The Center for Translational Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, P.R. China
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118
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Urrestarazu E, Iriarte J. Clinical management of sleep disturbances in Alzheimer's disease: current and emerging strategies. Nat Sci Sleep 2016; 8:21-33. [PMID: 26834500 PMCID: PMC4716729 DOI: 10.2147/nss.s76706] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sleep and circadian disorders in Alzheimer's disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock.
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Affiliation(s)
- Elena Urrestarazu
- Sleep Unit, Clinical Neurophysiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jorge Iriarte
- Sleep Unit, Clinical Neurophysiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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119
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Waller KL, Mortensen EL, Avlund K, Osler M, Fagerlund B, Lauritzen M, Jennum P. Subjective sleep quality and daytime sleepiness in late midlife and their association with age-related changes in cognition. Sleep Med 2016; 17:165-73. [DOI: 10.1016/j.sleep.2015.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/04/2014] [Accepted: 01/05/2015] [Indexed: 12/13/2022]
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120
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Ishii M, Iadecola C. Metabolic and Non-Cognitive Manifestations of Alzheimer's Disease: The Hypothalamus as Both Culprit and Target of Pathology. Cell Metab 2015; 22:761-76. [PMID: 26365177 PMCID: PMC4654127 DOI: 10.1016/j.cmet.2015.08.016] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alzheimer's disease (AD) is increasingly recognized as a complex neurodegenerative disease beginning decades prior to the cognitive decline. While cognitive deficits remain the cardinal manifestation of AD, metabolic and non-cognitive abnormalities, such as alterations in body weight and neuroendocrine functions, are also present, often preceding the cognitive decline. Furthermore, hypothalamic dysfunction can also be a driver of AD pathology. Here we offer a brief appraisal of hypothalamic dysfunction in AD and provide insight into an underappreciated dual role of the hypothalamus as both a culprit and target of AD pathology, as well as into new opportunities for therapeutic interventions and biomarker development.
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Affiliation(s)
- Makoto Ishii
- Feil Family Brain and Mind Research Institute, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10065, USA.
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10065, USA
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121
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Tsapanou A, Gu Y, Manly J, Schupf N, Tang MX, Zimmerman M, Scarmeas N, Stern Y. Daytime Sleepiness and Sleep Inadequacy as Risk Factors for Dementia. Dement Geriatr Cogn Dis Extra 2015; 5:286-95. [PMID: 26273244 PMCID: PMC4521063 DOI: 10.1159/000431311] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background/Aims To examine the association between self-reported sleep problems and incidence of dementia in community-dwelling elderly people. Methods 1,041 nondemented participants over 65 years old were examined longitudinally. Sleep problems were estimated using the RAND Medical Outcomes Study Sleep Scale examining sleep disturbance, snoring, sleep short of breath or with a headache, sleep adequacy, and sleep somnolence. Cox regression analysis was used to examine the association between sleep problems and risk for incident dementia. Age, gender, education, ethnicity, APOE-ε4, stroke, heart disease, hypertension, diabetes, and depression were included as covariates. Results Over 3 years of follow-up, 966 (92.8%) participants remained nondemented, while 78 (7.2%) developed dementia. In unadjusted models, sleep inadequacy (‘Get the amount of sleep you need’) at the initial visit was associated with increased risk of incident dementia (HR = 1.20; 95% CI 1.02-1.42; p = 0.027). Adjusting for all the covariates, increased risk of incident dementia was still associated with sleep inadequacy (HR = 1.20; 95% CI 1.01-1.42; p = 0.040), as well as with increased daytime sleepiness (‘Have trouble staying awake during the day’) (HR = 1.24; 95% CI 1.00-1.54; p = 0.047). Conclusion Our results suggest that sleep inadequacy and increased daytime sleepiness are risk factors for dementia in older adults, independent of demographic and clinical factors.
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Affiliation(s)
- Angeliki Tsapanou
- Cognitive Neuroscience Division, Department of Neurology, New York, N.Y., USA ; The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, N.Y., USA
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, New York, N.Y., USA ; The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, N.Y., USA
| | - Jennifer Manly
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, N.Y., USA ; Department of Neurology, Columbia University College of Physicians and Surgeons, New York, N.Y., USA
| | - Nicole Schupf
- Cognitive Neuroscience Division, Department of Neurology, New York, N.Y., USA ; The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, N.Y., USA ; The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, N.Y., USA ; Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, N.Y., USA
| | - Ming-Xin Tang
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, N.Y., USA ; Department of Biostatistics, Joseph P. Mailman School of Public Health, Columbia University, New York, N.Y., USA
| | - Molly Zimmerman
- Department of Psychology, Fordham University, Bronx, N.Y., USA
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division, Department of Neurology, New York, N.Y., USA ; The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, N.Y., USA ; The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, N.Y., USA ; Department of Neurology, Columbia University College of Physicians and Surgeons, New York, N.Y., USA ; National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, New York, N.Y., USA ; The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, N.Y., USA ; The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, N.Y., USA ; Department of Neurology, Columbia University College of Physicians and Surgeons, New York, N.Y., USA
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122
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Chen JC, Espeland MA, Brunner RL, Lovato LC, Wallace RB, Leng X, Phillips LS, Robinson JG, Kotchen JM, Johnson KC, Manson JE, Stefanick ML, Sarto GE, Mysiw WJ. Sleep duration, cognitive decline, and dementia risk in older women. Alzheimers Dement 2015; 12:21-33. [PMID: 26086180 DOI: 10.1016/j.jalz.2015.03.004] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/03/2014] [Accepted: 03/02/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Consistent evidence linking habitual sleep duration with risks of mild cognitive impairment (MCI) and dementia is lacking. METHODS We conducted a prospective study on 7444 community-dwelling women (aged 65-80 y) with self-reported sleep duration, within the Women's Health Initiative Memory Study in 1995-2008. Incident MCI/dementia cases were ascertained by validated protocols. Cox models were used to adjust for multiple sociodemographic and lifestyle factors, depression, cardiovascular disease (CVD), and other clinical characteristics. RESULTS We found a statistically significant (P = .03) V-shaped association with a higher MCI/dementia risk in women with either short (≤6 hours/night) or long (≥8 hours/night) sleep duration (vs. 7 hours/night). The multicovariate-adjusted hazard for MCI/dementia was increased by 36% in short sleepers irrespective of CVD, and by 35% in long sleepers without CVD. A similar V-shaped association was found with cognitive decline. DISCUSSION In older women, habitual sleep duration predicts the future risk for cognitive impairments including dementia, independent of vascular risk factors.
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Affiliation(s)
- Jiu-Chiuan Chen
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
| | - Mark A Espeland
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert L Brunner
- Department of Family and Community Medicine, University of Nevada School of Medicine, Reno, NV, USA
| | - Laura C Lovato
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert B Wallace
- Departments of Epidemiology & Medicine, University of Iowa, Iowa City, IA, USA
| | - Xiaoyan Leng
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lawrence S Phillips
- Atlanta VA Medical Center and Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer G Robinson
- Departments of Epidemiology & Medicine, University of Iowa, Iowa City, IA, USA
| | - Jane M Kotchen
- Department of Population Health, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gloria E Sarto
- University of Wisconsin Center for Women's Health Research, Madison, WI, USA
| | - W Jerry Mysiw
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH, USA
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123
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Sleep, circadian rhythms, and the pathogenesis of Alzheimer disease. Exp Mol Med 2015; 47:e148. [PMID: 25766617 PMCID: PMC4351409 DOI: 10.1038/emm.2014.121] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/19/2014] [Indexed: 01/16/2023] Open
Abstract
Disturbances in the sleep–wake cycle and circadian rhythms are common symptoms of Alzheimer Disease (AD), and they have generally been considered as late consequences of the neurodegenerative processes. Recent evidence demonstrates that sleep–wake and circadian disruption often occur early in the course of the disease and may even precede the development of cognitive symptoms. Furthermore, the sleep–wake cycle appears to regulate levels of the pathogenic amyloid-beta peptide in the brain, and manipulating sleep can influence AD-related pathology in mouse models via multiple mechanisms. Finally, the circadian clock system, which controls the sleep–wake cycle and other diurnal oscillations in mice and humans, may also have a role in the neurodegenerative process. In this review, we examine the current literature related to the mechanisms by which sleep and circadian rhythms might impact AD pathogenesis, and we discuss potential therapeutic strategies targeting these systems for the prevention of AD.
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124
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Scullin MK, Bliwise DL. Sleep, cognition, and normal aging: integrating a half century of multidisciplinary research. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 10:97-137. [PMID: 25620997 PMCID: PMC4302758 DOI: 10.1177/1745691614556680] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep is implicated in cognitive functioning in young adults. With increasing age, there are substantial changes to sleep quantity and quality, including changes to slow-wave sleep, spindle density, and sleep continuity/fragmentation. A provocative question for the field of cognitive aging is whether such changes in sleep physiology affect cognition (e.g., memory consolidation). We review nearly a half century of research across seven diverse correlational and experimental domains that historically have had little crosstalk. Broadly speaking, sleep and cognitive functions are often related in advancing age, though the prevalence of null effects in healthy older adults (including correlations in the unexpected, negative direction) indicates that age may be an effect modifier of these associations. We interpret the literature as suggesting that maintaining good sleep quality, at least in young adulthood and middle age, promotes better cognitive functioning and serves to protect against age-related cognitive declines.
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Affiliation(s)
- Michael K Scullin
- Department of Psychology and Neuroscience, Baylor University Department of Neurology, Emory University School of Medicine
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125
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126
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Abstract
PURPOSE OF REVIEW Trouble falling or staying asleep, poor sleep quality, and short or long sleep duration are gaining attention as potential risk factors for cognitive decline and dementia, including Alzheimer's disease. Sleep-disordered breathing has also been linked to these outcomes. Here, we review recent observational and experimental studies investigating the effect of poor sleep on cognitive outcomes and Alzheimer's disease, and discuss possible mechanisms. RECENT FINDINGS Observational studies with self-report and objective sleep measures (e.g. wrist actigraphy, polysomnography) support links between disturbed sleep and cognitive decline. Several recently published studies demonstrate associations between sleep variables and measures of Alzheimer's disease pathology, including cerebrospinal fluid measures of Aβ and PET measures of Aβ deposition. In addition, experimental studies suggest that sleep loss alters cerebrospinal fluid Aβ dynamics, decrements in slow-wave sleep may decrease the clearance of Aβ from the brain, and hypoxemia characteristic of sleep-disordered breathing increases Aβ production. SUMMARY Findings indicate that poor sleep is a risk factor for cognitive decline and Alzheimer's disease. Although mechanisms underlying these associations are not yet clear, healthy sleep appears to play an important role in maintaining brain health with age, and may play a key role in Alzheimer's disease prevention.
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Affiliation(s)
- Adam P. Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lenis P. Chen-Edinboro
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mark N. Wu
- Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA
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127
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Benedict C, Byberg L, Cedernaes J, Hogenkamp PS, Giedratis V, Kilander L, Lind L, Lannfelt L, Schiöth HB. Self-reported sleep disturbance is associated with Alzheimer's disease risk in men. Alzheimers Dement 2014; 11:1090-7. [PMID: 25438949 DOI: 10.1016/j.jalz.2014.08.104] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/29/2014] [Accepted: 08/13/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the association between self-reported sleep disturbances and dementia risk. METHODS Self-reported sleep disturbances and established risk factors for dementia were measured in men at ages 50 (n = 1574) and 70 (n = 1029) years. Dementia incidence was determined by reviewing their patient history between ages 50 and 90 years. In addition, plasma levels of β-amyloid (Aβ) peptides 1-40 and 1-42 were measured at ages 70, 77, and 82 years. RESULTS Cox regression demonstrated that men with self-reported sleep disturbances had a higher risk of developing dementia (+33%) and Alzheimer's disease (AD, +51%) than men without self-reported sleep disturbances (both P < .05). Binary logistic regression showed the increased risk for both dementia (+114%) and AD (+192%) were highest when sleep disturbance was reported at age 70 years (both P < .001). No group differences were found in Aβ levels. CONCLUSION Improving sleep quality may help reduce the neurodegenerative risk in older men.
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Affiliation(s)
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | | | | | - Vilmantas Giedratis
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, University Hospital, Uppsala University, Uppsala, Sweden
| | - Lars Lannfelt
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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128
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Benito-León J, Louis ED, Villarejo-Galende A, Romero JP, Bermejo-Pareja F. Long sleep duration in elders without dementia increases risk of dementia mortality (NEDICES). Neurology 2014; 83:1530-7. [PMID: 25253755 DOI: 10.1212/wnl.0000000000000915] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine in a population-based study whether long sleep duration was associated with increased risk of dementia mortality. METHODS In this prospective, population-based study of 3,857 people without dementia aged 65 years and older (NEDICES [Neurological Disorders in Central Spain]), participants reported their daily sleep duration. The average daily total sleep duration was grouped into 3 categories: ≤5 hours (short sleepers), 6-8 hours (reference category), and ≥9 hours (long sleepers). Community-dwelling elders were followed for a median of 12.5 years, after which the death certificates of those who died were examined. RESULTS A total of 1,822 (47.2%) of 3,857 participants died, including 201 (11.0%) deaths among short sleepers, 832 (45.7%) among long sleepers, and 789 (43.3%) among those participants in the reference category. Of 1,822 deceased participants, 92 (5.1%) had a dementia condition reported on the death certificate (49 [53.3%] were long sleepers, 36 [39.1%] reported sleeping between 6 and 8 hours, and 7 [7.6%] were short sleepers). In an unadjusted Cox model, risk of dementia-specific mortality was increased in long sleepers (hazard ratio for dementia mortality in long sleepers = 1.58, p = 0.04) when compared with the reference group. In a Cox model that adjusted for numerous demographic factors and comorbidities, the hazard ratio for dementia mortality in long sleepers was 1.63 (p = 0.03). CONCLUSIONS Self-reported long sleep duration was associated with 58% increased risk of dementia-specific mortality in this cohort of elders without dementia. Future studies are required to confirm these findings.
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Affiliation(s)
- Julián Benito-León
- From the Department of Neurology (J.B.-L., A.V.-G., J.P.R., F.B.-P.), University Hospital 12 de Octubre, Madrid; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L., F.B.-P.), Spain; Department of Medicine (J.B.-L., A.V.-G., J.P.R., F.B.-P.), Complutense University, Madrid, Spain; G.H. Sergievsky Center (E.D.L.), Department of Neurology (E.D.L.), and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (E.D.L.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (E.D.L.), Mailman School of Public Health, Columbia University, New York; and Faculty of Biosanitary Sciences (J.P.R.), Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain.
| | - Elan D Louis
- From the Department of Neurology (J.B.-L., A.V.-G., J.P.R., F.B.-P.), University Hospital 12 de Octubre, Madrid; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L., F.B.-P.), Spain; Department of Medicine (J.B.-L., A.V.-G., J.P.R., F.B.-P.), Complutense University, Madrid, Spain; G.H. Sergievsky Center (E.D.L.), Department of Neurology (E.D.L.), and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (E.D.L.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (E.D.L.), Mailman School of Public Health, Columbia University, New York; and Faculty of Biosanitary Sciences (J.P.R.), Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Alberto Villarejo-Galende
- From the Department of Neurology (J.B.-L., A.V.-G., J.P.R., F.B.-P.), University Hospital 12 de Octubre, Madrid; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L., F.B.-P.), Spain; Department of Medicine (J.B.-L., A.V.-G., J.P.R., F.B.-P.), Complutense University, Madrid, Spain; G.H. Sergievsky Center (E.D.L.), Department of Neurology (E.D.L.), and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (E.D.L.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (E.D.L.), Mailman School of Public Health, Columbia University, New York; and Faculty of Biosanitary Sciences (J.P.R.), Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Juan P Romero
- From the Department of Neurology (J.B.-L., A.V.-G., J.P.R., F.B.-P.), University Hospital 12 de Octubre, Madrid; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L., F.B.-P.), Spain; Department of Medicine (J.B.-L., A.V.-G., J.P.R., F.B.-P.), Complutense University, Madrid, Spain; G.H. Sergievsky Center (E.D.L.), Department of Neurology (E.D.L.), and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (E.D.L.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (E.D.L.), Mailman School of Public Health, Columbia University, New York; and Faculty of Biosanitary Sciences (J.P.R.), Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Félix Bermejo-Pareja
- From the Department of Neurology (J.B.-L., A.V.-G., J.P.R., F.B.-P.), University Hospital 12 de Octubre, Madrid; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L., F.B.-P.), Spain; Department of Medicine (J.B.-L., A.V.-G., J.P.R., F.B.-P.), Complutense University, Madrid, Spain; G.H. Sergievsky Center (E.D.L.), Department of Neurology (E.D.L.), and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (E.D.L.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (E.D.L.), Mailman School of Public Health, Columbia University, New York; and Faculty of Biosanitary Sciences (J.P.R.), Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
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Mendelsohn AR, Larrick JW. Sleep facilitates clearance of metabolites from the brain: glymphatic function in aging and neurodegenerative diseases. Rejuvenation Res 2014; 16:518-23. [PMID: 24199995 DOI: 10.1089/rej.2013.1530] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Decline of cognition and increasing risk of neurodegenerative diseases are major problems associated with aging in humans. Of particular importance is how the brain removes potentially toxic biomolecules that accumulate with normal neuronal function. Recently, a biomolecule clearance system using convective flow between the cerebrospinal fluid (CSF) and interstitial fluid (ISF) to remove toxic metabolites in the brain was described. Xie and colleagues now report that in mice the clearance activity of this so-called "glymphatic system" is strongly stimulated by sleep and is associated with an increase in interstitial volume, possibly by shrinkage of astroglial cells. Moreover, anesthesia and attenuation of adrenergic signaling can activate the glymphatic system to clear potentially toxic proteins known to contribute to the pathology of Alzheimer disease (AD) such as beta-amyloid (Abeta). Clearance during sleep is as much as two-fold faster than during waking hours. These results support a new hypothesis to answer the age-old question of why sleep is necessary. Glymphatic dysfunction may pay a hitherto unsuspected role in the pathogenesis of neurodegenerative diseases as well as maintenance of cognition. Furthermore, clinical studies suggest that quality and duration of sleep may be predictive of the onset of AD, and that quality sleep may significantly reduce the risk of AD for apolipoprotein E (ApoE) ɛ4 carriers, who have significantly greater chances of developing AD. Further characterization of the glymphatic system in humans may lead to new therapies and methods of prevention of neurodegenerative diseases. A public health initiative to ensure adequate sleep among middle-aged and older people may prove useful in preventing AD, especially in apolipoprotein E (ApoE) ɛ4 carriers.
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Affiliation(s)
- Andrew R Mendelsohn
- Panorama Research Institute and Regenerative Sciences Institute , Sunnyvale, California
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Schroeder AM, Colwell CS. How to fix a broken clock. Trends Pharmacol Sci 2013; 34:605-19. [PMID: 24120229 PMCID: PMC3856231 DOI: 10.1016/j.tips.2013.09.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/10/2013] [Accepted: 09/11/2013] [Indexed: 12/29/2022]
Abstract
Fortunate are those who rise out of bed to greet the morning light well rested with the energy and enthusiasm to drive a productive day. Others, however, depend on hypnotics for sleep and require stimulants to awaken lethargic bodies. Sleep/wake disruption is a common occurrence in healthy individuals throughout their lifespan and is also a comorbid condition to many diseases (neurodegenerative) and psychiatric disorders (depression and bipolar). There is growing concern that chronic disruption of the sleep/wake cycle contributes to more serious conditions including diabetes (type 2), cardiovascular disease, and cancer. A poorly functioning circadian system resulting in misalignments in the timing of clocks throughout the body may be at the root of the problem for many people. In this article we discuss environmental (light therapy) and lifestyle changes (scheduled meals, exercise, and sleep) as interventions to help fix a broken clock. We also discuss the challenges and potential for future development of pharmacological treatments to manipulate this key biological system.
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Affiliation(s)
- Analyne M Schroeder
- Laboratory of Circadian and Sleep Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90024, USA
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