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Qureshi R, Naaman K, Quan NG, Mayo-Wilson E, Page MJ, Cornelius V, Chou R, Boutron I, Golder S, Bero L, Doshi P, Vassar M, Meursinge Reynders R, Li T. Development and Evaluation of a Framework for Identifying and Addressing Spin for Harms in Systematic Reviews of Interventions. Ann Intern Med 2024; 177:1089-1098. [PMID: 39008854 DOI: 10.7326/m24-0771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
"Spin" refers to misleading reporting, interpretation, and extrapolation of findings in primary and secondary research (such as in systematic reviews). The study of spin primarily focuses on beneficial outcomes. The objectives of this research were threefold: first, to develop a framework for identifying spin associated with harms in systematic reviews of interventions; second, to apply the framework to a set of reviews, thereby pinpointing instances where spin may be present; and finally, to revise the spin examples, offering guidance on how spin can be rectified. The authors developed their framework through an iterative process that engaged an international group of researchers specializing in spin and reporting bias. The framework comprises 12 specific types of spin for harms, grouped by 7 categories across the 3 domains (reporting, interpretation, and extrapolation). The authors subsequently gathered instances of spin from a random sample of 100 systematic reviews of interventions. Of the 58 reviews that assessed harm and the 42 that did not, they found that 28 (48%) and 6 (14%), respectively, had at least 1 of the 12 types of spin for harms. Inappropriate extrapolation of the results and conclusions for harms to populations, interventions, outcomes, or settings not assessed in a review was the most common category of spin in 17 of 100 reviews. The authors revised the examples to remove spin, taking into consideration the context (for example, medical discipline, source population), findings for harms, and methodological limitations of the original reviews. They provide guidance for authors, peer reviewers, and editors in recognizing and rectifying or (preferably) avoiding spin, ultimately enhancing the clarity and accuracy of harms reporting in systematic review publications.
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Affiliation(s)
- Riaz Qureshi
- University of Colorado Anschutz Medical Campus, Denver, Colorado (R.Q., N.G.Q., L.B., T.L.)
| | - Kevin Naaman
- Indiana University Bloomington, Bloomington, Indiana (K.N.)
| | - Nicolas G Quan
- University of Colorado Anschutz Medical Campus, Denver, Colorado (R.Q., N.G.Q., L.B., T.L.)
| | - Evan Mayo-Wilson
- University of North Carolina, Chapel Hill, North Carolina (E.M.)
| | - Matthew J Page
- Monash University, Melbourne, Victoria, Australia (M.J.P.)
| | | | - Roger Chou
- Oregon Health & Science University, Portland, Oregon (R.C.)
| | | | - Su Golder
- University of York, York, United Kingdom (S.G.)
| | - Lisa Bero
- University of Colorado Anschutz Medical Campus, Denver, Colorado (R.Q., N.G.Q., L.B., T.L.)
| | - Peter Doshi
- University of Maryland, Baltimore, Maryland (P.D.)
| | - Matt Vassar
- Oklahoma State University, Tulsa, Oklahoma (M.V.)
| | | | - Tianjing Li
- University of Colorado Anschutz Medical Campus, Denver, Colorado (R.Q., N.G.Q., L.B., T.L.)
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Mills J. The Use of Trazodone for Insomnia and Other Sleep Disturbances. Issues Ment Health Nurs 2024; 45:658-662. [PMID: 38843027 DOI: 10.1080/01612840.2024.2356501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Jeremy Mills
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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Qin Y, Zhao Y, Hu X, Chen X, Jiang YP, Jin XJ, Li G, Li ZH, Yang JH, Zhang GL, Cui SY, Zhang YH. Ganoderma lucidum spore extract improves sleep disturbances in a rat model of sporadic Alzheimer's disease. Front Pharmacol 2024; 15:1390294. [PMID: 38720773 PMCID: PMC11076761 DOI: 10.3389/fphar.2024.1390294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction: Ganoderma lucidum (G. lucidum, Lingzhi) has long been listed as a premium tonic that can be used to improve restlessness, insomnia, and forgetfulness. We previously reported that a rat model of sporadic Alzheimer's disease (sAD) that was induced by an intracerebroventricular injection of streptozotocin (ICV-STZ) showed significant learning and cognitive deficits and sleep disturbances. Treatment with a G. lucidum spore extract with the sporoderm removed (RGLS) prevented learning and memory impairments in sAD model rats. Method: The present study was conducted to further elucidate the preventive action of RGLS on sleep disturbances in sAD rats by EEG analysis, immunofluorescence staining, HPLC-MS/MS and Western blot. Results: Treatment with 720 mg/kg RGLS for 14 days significantly improved the reduction of total sleep time, rapid eye movement (REM) sleep time, and non-REM sleep time in sAD rats. The novelty recognition experiment further confirmed that RGLS prevented cognitive impairments in sAD rats. We also found that RGLS inhibited the nuclear factor-κB (NF-κB)/Nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammatory pathway in the medial prefrontal cortex (mPFC) in sAD rats and ameliorated the lower activity of γ-aminobutyric acid (GABA)-ergic neurons in the parabrachial nucleus (PBN). Discussion: These results suggest that inhibiting the neuroinflammatory response in the mPFC may be a mechanism by which RGLS improves cognitive impairment. Additionally, improvements in PBN-GABAergic activity and the suppression of neuroinflammation in the mPFC in sAD rats might be a critical pathway to explain the preventive effects of RGLS on sleep disturbances in sAD.
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Affiliation(s)
- Yu Qin
- Department of Pharmacology, School of Basic Medical Science, Peking University, Beijing, China
| | - Yan Zhao
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, China
- Department of Pharmacy, Yanbian University Hospital, Yanji, China
| | - Xiao Hu
- Department of Pharmacology, School of Basic Medical Science, Peking University, Beijing, China
| | - Xi Chen
- Department of Pharmacology, School of Basic Medical Science, Peking University, Beijing, China
| | - Yan-Ping Jiang
- Department of Pharmacy, Yanbian University Hospital, Yanji, China
| | - Xue-Jun Jin
- Department of Pharmacy, Yanbian University Hospital, Yanji, China
| | - Gao Li
- Department of Pharmacy, Yanbian University Hospital, Yanji, China
| | - Zhen-Hao Li
- Zhejiang ShouXianGu Pharmaceutical Co., Ltd., Wuyi, Zhejiang, China
| | - Ji-Hong Yang
- Zhejiang ShouXianGu Pharmaceutical Co., Ltd., Wuyi, Zhejiang, China
| | - Guo-Liang Zhang
- Zhejiang ShouXianGu Pharmaceutical Co., Ltd., Wuyi, Zhejiang, China
| | - Su-Ying Cui
- Department of Pharmacology, School of Basic Medical Science, Peking University, Beijing, China
| | - Yong-He Zhang
- Department of Pharmacology, School of Basic Medical Science, Peking University, Beijing, China
- Department of Pharmacy, Yanbian University Hospital, Yanji, China
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Klatt T, Bauer I, Behrendt D, Berg A. [Structured case conference for sleep disturbances in nursing home residents with cognitive impairment]. Pflege 2024. [PMID: 38234247 DOI: 10.1024/1012-5302/a000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Structured case conference for sleep disturbances in nursing home residents with cognitive impairment Abstract: Background: Nursing home residents living with cognitive impairment often suffer from sleep disturbances. Pharmacological interventions are not recommended to be the first-choice therapy. In general, a wide variance of non-pharmacological interventions is available, but no clearly suitable intervention can currently be specified. Aim: The case report presents the procedure of a structured analysis to support the selection of non-pharmacological interventions to promote sleep. Methods: A structured case conference was held using a developed case management template to draw up an individual intervention plan. Results: Based on the description of the situation and the determination of causes, different interventions from six main topics were planned: "offering appropriate activations during daytime", "creating bedtime routines", "checking the sleep environment", "observation of potential physical and psychological causes", "reflection on night care routines", and "use of drug therapies only in exceptional cases". Conclusions: For a successful management of sleep disturbances in nursing home residents living with cognitive impairment, it is essential that the specific sleep-related symptoms and causes are assessed systematically and interprofessionally to be able to work towards an improvement with appropriate measures. In order to obtain adequate solutions, evidence-based expertise should be taken into consideration.
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Affiliation(s)
- Thomas Klatt
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Ivonne Bauer
- Altenpflegeheim "Am Georgengarten" des Städtischen Klinikums Dessau, Deutschland
| | - Daniel Behrendt
- Städtisches Klinikum Dessau, Akademisches Lehrkrankenhaus mit Hochschulklinik der Medizinischen Hochschule Brandenburg Theodor Fontane (MHB), Deutschland
| | - Almuth Berg
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Deutschland
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Beigh S, Adnan R, Abdulaziz AJ, Abdullah S, Nasser N, Ghazzay R, Abdulaziz R, Mohammed E, Ahmad RM, Ali Alshehri M. Dementia and Multimorbidity Trends in Al-Baha, Saudi Arabia: An Analytical Retrospective Study Using Records-Based Data. Cureus 2024; 16:e52507. [PMID: 38371043 PMCID: PMC10874241 DOI: 10.7759/cureus.52507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The prevalence of dementia is escalating significantly, posing a substantial societal burden. Currently, there exists a dearth of comprehensive health data about dementia patients in Saudi Arabia, particularly within Al-Baha City. METHODS A retrospective case-series study was undertaken to ascertain the prevalence of dementia within the populace of the Al-Baha region, Kingdom of Saudi Arabia. This investigation utilized hospital-based records encompassing individuals exhibiting symptoms or diagnosed with dementia and its related forms across the Al-Baha region. Furthermore, the study aimed to evaluate the burden of comorbidities among dementia patients and document the pharmacological therapeutic interventions administered to manage dementia and its associated concurrent health conditions. RESULTS Our investigation explored the prevalence rates of various forms of dementia and the accompanying comorbidities among affected individuals. The study spanned from August 2020 to August 2023. Our study encompassed 407 patients diagnosed with Alzheimer's disease (AD), Parkinson's disease, vascular dementia (VaD), or other forms of dementia who were either admitted to or attended tertiary hospitals in Al-Baha. Assessment of the comorbidity burden was conducted using the Charlson Comorbidity Index (CCI). Our findings revealed that among these patients, 13.3% presented with AD, 23.6% with VaD, 33.4% with Parkinson's disease, 15.75% with amnesia, and 14.0% with other types of dementia. The spectrum of comorbidities observed among dementia patients encompassed various conditions, with diabetes mellitus emerging as the predominant comorbidity (19.1%), followed by hypertension (16.4%). Additionally, manifestations of depression were noted in 14% of patients, while 9.82% suffered from paralysis. Chronic conditions such as cancer, chronic obstructive pulmonary disorder (COPD), and cervical spondylosis were also observed among individuals afflicted with dementia and its varied forms. Statistically significant correlations were established between gender, age, nationality, comorbidities, and the prevalence of dementia. Therapeutic interventions in the form of pharmacological treatments were prescribed for dementia patients with comorbidities. Commonly administered medications included Amlod (6.3%), Amlodipine (6.6%), Amlor (5.8%), Aspirin (10.5%), chemotherapeutic drugs (4.4%), Glipizide (8.5%), Lantus (11.3%), Levodopa (23.5%), Metformin (7.8%), acetylcholinesterase inhibitors (6.8%), and Pulmicort (7.86%). These medications aimed to alleviate symptoms associated with dementia and its accompanying comorbidities. CONCLUSIONS Our investigation underscores the substantial burden of comorbidities experienced by dementia patients. These findings offer crucial insights into the overall health status of individuals grappling with dementia, serving as a catalyst for increased awareness among clinicians and policymakers. Such awareness can drive improvements in medical care and support frameworks tailored to the specific needs of dementia patients.
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Affiliation(s)
- Saba Beigh
- Public Health, Albaha University, Al-Baha, SAU
| | - Remas Adnan
- Public Health, Albaha University, Al-Baha, SAU
| | | | | | - Nada Nasser
- Public Health, Albaha University, Al-Baha, SAU
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Tang M, Wu L, Shen Z, Chen J, Yang Y, Zhang M, Zhao P, Jiang G. Association between Sleep and Alzheimer's Disease: A Bibliometric Analysis from 2003 to 2022. Neuroepidemiology 2023; 57:377-390. [PMID: 37699365 DOI: 10.1159/000533700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) often presents with sleep disorders, which are also an important risk factor for AD, affecting cognitive function to a certain extent. This study aimed to reveal the current global status, present hotspots, and discuss emerging trends of sleep and AD using a bibliometric approach. METHODS Research and review articles related to sleep and AD from 2003 to 2022 were extracted from the Web of Science Core Collection. VOSviewer 1.6.18.0, Scimago Graphica, and CiteSpace 6.2.R2 were used to map the productive and highly cited countries, institutions, journals, authors, references, and keywords in the field. RESULTS Overall, 4,008 publications were included in this bibliometric analysis. The number of publications and citations showed an increasing trend over the past two decades. The USA and China had the largest and second largest, respectively, number of publications and citations and cooperated with other countries more closely. Ancoli-Israel Sonia published the most papers, and Holtzman David M was co-cited most frequently. The most productive journal was Journal of Alzheimer's Disease, and Neurology was the most frequently cited journal. The risk factors, β-amyloid (Aβ), tau, neuroinflammation, astrocytes, glymphatic system, orexin, functional connectivity, and management have been the main research directions of researchers over the past few years and may be the future trend of valuable research. CONCLUSION We identified hotspots and emerging trends including risk factors, Aβ, tau, neuroinflammation, the glymphatic system, orexin, and management, which may help identify new therapeutic targets and improve clinical efficacy of sleep and AD.
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Affiliation(s)
- Ming Tang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Li Wu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Ziyi Shen
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Junwen Chen
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Yang Yang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Ming Zhang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Peilin Zhao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College; Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
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Falgàs N, Walsh CM, Yack L, Simon AJ, Allen IE, Kramer JH, Rosen HJ, Joie RL, Rabinovici G, Miller B, Spina S, Seeley WW, Ranasinghe K, Vossel K, Neylan TC, Grinberg LT. Alzheimer's disease phenotypes show different sleep architecture. Alzheimers Dement 2023; 19:3272-3282. [PMID: 36749893 PMCID: PMC10404632 DOI: 10.1002/alz.12963] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Sleep-wake disturbances are a prominent feature of Alzheimer's disease (AD). Atypical (non-amnestic) AD syndromes have different patterns of cortical vulnerability to AD. We hypothesized that atypical AD also shows differential vulnerability in subcortical nuclei that will manifest as different patterns of sleep dysfunction. METHODS Overnight electroencephalography monitoring was performed on 48 subjects, including 15 amnestic, 19 atypical AD, and 14 controls. AD was defined based on neuropathological or biomarker confirmation. We compared sleep architecture by visual scoring and spectral power analysis in each group. RESULTS Overall, AD cases showed increased sleep fragmentation and N1 sleep compared to controls. Compared to atypical AD groups, typical AD showed worse N3 sleep dysfunction and relatively preserved rapid eye movement (REM) sleep. DISCUSSION Results suggest differing effects of amnestic and atypical AD variants on slow wave versus REM sleep, respectively, corroborating the hypothesis of differential selective vulnerability patterns of the subcortical nuclei within variants. Optimal symptomatic treatment for sleep dysfunction in clinical phenotypes may differ. HIGHLIGHTS Alzheimer's disease (AD) variants show distinct patterns of sleep impairment. Amnestic/typical AD has worse N3 slow wave sleep (SWS) impairment compared to atypical AD. Atypical AD shows more rapid eye movement deficits than typical AD. Selective vulnerability patterns in subcortical areas may underlie sleep differences. Relatively preserved SWS may explain better memory scores in atypical versus typical AD.
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Affiliation(s)
- Neus Falgàs
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Christine M Walsh
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Leslie Yack
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Alexander J Simon
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Isabel E Allen
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
| | - Joel H Kramer
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Howard J Rosen
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
| | - Renaud La Joie
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Gil Rabinovici
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Bruce Miller
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
| | - Salvatore Spina
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
| | - William W Seeley
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Kamalini Ranasinghe
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Keith Vossel
- Mary S. Easton Center for Alzheimer's Disease Research, University of California Los Angeles, Los Angeles, California, USA
| | - Thomas C Neylan
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Lea T Grinberg
- Department of Neurology, Memory & Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Pathology, University of California, San Francisco, California, USA
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Tseng PT, Zeng BS, Suen MW, Wu YC, Correll CU, Zeng BY, Kuo JS, Chen YW, Chen TY, Tu YK, Lin PY, Carvalho AF, Stubbs B, Li DJ, Liang CS, Hsu CW, Sun CK, Cheng YS, Yeh PY, Wu MK, Shiue YL, Su KP. Efficacy and acceptability of anti-inflammatory eicosapentaenoic acid for cognitive function in Alzheimer's dementia: A network meta-analysis of randomized, placebo-controlled trials with omega-3 fatty acids and FDA-approved pharmacotherapy. Brain Behav Immun 2023; 111:352-364. [PMID: 37150266 DOI: 10.1016/j.bbi.2023.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/20/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023] Open
Abstract
Alzheimer's dementia (AD) is a major contributor to global disability, and effective therapies to modify disease progression are currently lacking. The neuro-inflammatory theory is a potential etiology underlying this neurodegenerative disease. Previous randomized, controlled trials (RCTs) have provided inconclusive results regarding efficacy of omega-3 polyunsaturated fatty acids (PUFAs) regimens, which might provide anti-inflammatory benefits in the management of AD, in improving cognitive function among participants with AD. The objective of this frequentist-model based network meta-analysis (NMA) was to evaluate the potential advantages of omega-3 PUFAs and currently FDA-approved medications for AD on overall cognitive function in AD individuals. The primary outcomes were: (1) changes in cognitive function, and (2) acceptability, which refers to all-cause discontinuation. Additionally, secondary outcomes included quality of life, behavioral disturbances and safety/tolerability, which was assessed through the frequency of any reported adverse event. This NMA included 52 RCTs (6 with omega-3 PUFAs and 46 with FDA-approved medications) involving 21,111 participants. The results showed that long-term high-dose (1500-2000 mg/day) of eicosapentaenoic acid (EPA)-dominant omega-3 PUFAs augmented with anti-oxidants had the highest potential for cognitive improvement among all investigated treatments [standardized mean difference = 3.00, 95% confidence intervals (95 %CIs) = 1.84-4.16]. Compared to placebo, omega-3 PUFAs had similar acceptability [odds ratio (OR) = 0.46, 95 %CIs = 0.04 to 5.87] and safety profiles (OR = 1.24, 95 %CIs = 0.66 to 2.33)o. These findings support the potential neurotherapeutic effects of high dosage EPA-dominant omega-3 PUFAs for the amelioration of cognitive decline in patients with AD. Future large-scale, long-term RCTs should focus on different dosages of EPA-dominant omega-3 PUFAs regimens on improving cognitive dysfunction in patients with AD at different levels of inflammatory status and psychopathology.
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Affiliation(s)
- Ping-Tao Tseng
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Bing-Syuan Zeng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Gender Equality Education and Research Center, Asia University, Taichung, Taiwan; Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bing-Yan Zeng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - John S Kuo
- Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Andre F Carvalho
- Senior Researcher, IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Shian Cheng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
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Morrone CD, Raghuraman R, Hussaini SA, Yu WH. Proteostasis failure exacerbates neuronal circuit dysfunction and sleep impairments in Alzheimer's disease. Mol Neurodegener 2023; 18:27. [PMID: 37085942 PMCID: PMC10119020 DOI: 10.1186/s13024-023-00617-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/29/2023] [Indexed: 04/23/2023] Open
Abstract
Failed proteostasis is a well-documented feature of Alzheimer's disease, particularly, reduced protein degradation and clearance. However, the contribution of failed proteostasis to neuronal circuit dysfunction is an emerging concept in neurodegenerative research and will prove critical in understanding cognitive decline. Our objective is to convey Alzheimer's disease progression with the growing evidence for a bidirectional relationship of sleep disruption and proteostasis failure. Proteostasis dysfunction and tauopathy in Alzheimer's disease disrupts neurons that regulate the sleep-wake cycle, which presents behavior as impaired slow wave and rapid eye movement sleep patterns. Subsequent sleep loss further impairs protein clearance. Sleep loss is a defined feature seen early in many neurodegenerative disorders and contributes to memory impairments in Alzheimer's disease. Canonical pathological hallmarks, β-amyloid, and tau, directly disrupt sleep, and neurodegeneration of locus coeruleus, hippocampal and hypothalamic neurons from tau proteinopathy causes disruption of the neuronal circuitry of sleep. Acting in a positive-feedback-loop, sleep loss and circadian rhythm disruption then increase spread of β-amyloid and tau, through impairments of proteasome, autophagy, unfolded protein response and glymphatic clearance. This phenomenon extends beyond β-amyloid and tau, with interactions of sleep impairment with the homeostasis of TDP-43, α-synuclein, FUS, and huntingtin proteins, implicating sleep loss as an important consideration in an array of neurodegenerative diseases and in cases of mixed neuropathology. Critically, the dynamics of this interaction in the neurodegenerative environment are not fully elucidated and are deserving of further discussion and research. Finally, we propose sleep-enhancing therapeutics as potential interventions for promoting healthy proteostasis, including β-amyloid and tau clearance, mechanistically linking these processes. With further clinical and preclinical research, we propose this dynamic interaction as a diagnostic and therapeutic framework, informing precise single- and combinatorial-treatments for Alzheimer's disease and other brain disorders.
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Affiliation(s)
- Christopher Daniel Morrone
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
| | - Radha Raghuraman
- Taub Institute, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - S Abid Hussaini
- Taub Institute, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA.
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA.
| | - Wai Haung Yu
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Geriatric Mental Health Research Services, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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10
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Balan I, Bilger N, Saparov D, Hryb I, Abdyraimov A. Sleep Deprivation in Middle Age May Increase Dementia Risk: A Review. Cureus 2023; 15:e37425. [PMID: 37181993 PMCID: PMC10174673 DOI: 10.7759/cureus.37425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Neurodegenerative diseases present increasing interest in clinical practice for the aging population and involve dysregulation of sleep-wake behaviors. Approximately 5.8 million adults aged 65 and older were living with Alzheimer's disease (AD) in the United States in 2020 with increased mortality compared to the declining cardiovascular and cancer death rates. We conducted an extensive literature review to evaluate and synthesize evidence regarding the association between short sleep duration or sleep deprivation and the risk of developing all-cause dementia and Alzheimer's disease. There are multiple mechanisms describing brain damage, such as brain hypoxia, oxidative stress, or blood-brain barrier (BBB) impairment, induced by chronic sleep restriction (CSR) and the potential correlation with future cognitive decline and dementia. More studies are necessary to identify the specific factors involved in the sleep loss-cognitive decline association that could be taken into consideration while elaborating recommendations for dementia prevention measures.
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Affiliation(s)
- Irina Balan
- Geriatrics, Montefiore Medical Center, Wakefield Campus, Bronx, USA
| | - Nataliya Bilger
- Clinical Simulation Center, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Dosbai Saparov
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ihor Hryb
- Neuroscience, University of Minnesota, Minneapolis, USA
| | - Azamat Abdyraimov
- Biostatistics and Epidemiology, Ala-Too International University, Bishkek, KGZ
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11
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Wilfling D, Berg A, Dörner J, Bartmann N, Klatt T, Meyer G, Halek M, Möhler R, Köpke S, Dichter MN. Attitudes and knowledge of nurses working at night and sleep promotion in nursing home residents: multicenter cross-sectional survey. BMC Geriatr 2023; 23:206. [PMID: 37003974 PMCID: PMC10066004 DOI: 10.1186/s12877-023-03928-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Sleep disturbances are common in nursing home residents and challenging for their nurses. Knowledge about sleep and sleep promoting factors is essential to provide adequate sleep management, where nurses play a key role. Therefore, nurses' knowledge and attitudes towards sleep and sleep promoting interventions is important as enabling or inhibiting factor for successful sleep management. METHODS A multicenter cross-sectional study was conducted among nurses working wholly or partially at night in nursing homes in Germany. Data were collected between February and April 2021 via online or paper and pencil questionnaires, comprising 56 items. Nursing homes were recruited through existing cooperation with the study centers as well as via nursing home registers. RESULTS Finally, 138 nursing homes participated and 271 nurses completed the survey. Nurses agreed that sleep disturbances are an important topic with important impact on resident' health. Although, the assessment of sleep was seen as nurses' responsibility, only 40 nurses (14.7%) stated that residents' sleep was always documented. Only 21.7% reported the availability of policy documents providing guidance regarding the management of sleep disturbances. The vast majority (93.2%) reported never having received training about sleep and management of sleep disturbances after their basic nursing training. CONCLUSIONS Our results indicate that nurses working at night can play an important role in residents' sleep promotion. The findings indicate nurses' educational needs regarding sleep and sleep promotion. Nursing homes should implement institutional guidelines in order to promote residents' sleep based on adequate evidence-based non-pharmacological interventions.
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Affiliation(s)
- Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany.
| | - Almuth Berg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle- Wittenberg, Halle (Saale), Germany
| | - Jonas Dörner
- German Center of Neurodegenerative Diseases (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Natascha Bartmann
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Thomas Klatt
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle- Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle- Wittenberg, Halle (Saale), Germany
| | - Margareta Halek
- German Center of Neurodegenerative Diseases (DZNE), Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin N Dichter
- German Center of Neurodegenerative Diseases (DZNE), Witten, Germany
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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12
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Wilfling D, Calo S, Dichter MN, Meyer G, Möhler R, Köpke S. Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane Database Syst Rev 2023; 1:CD011881. [PMID: 36594432 PMCID: PMC9808594 DOI: 10.1002/14651858.cd011881.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sleep disturbances occur frequently in people with dementia with a reported prevalence of up to 40%. Common problems are increased number and duration of awakenings and increased percentage of light sleep. Sleep disturbances are associated with a number of problems for people with dementia, their relatives, and carers. In people with dementia, they may lead to worsening of cognitive symptoms, challenging behaviours such as restlessness or wandering, and further harms, such as accidental falls. Sleep disturbances are also associated with significant carer distress and have been reported as a factor contributing to institutionalisation of people with dementia. As pharmacological approaches have shown unsatisfactory results, there is a need to synthesise the research evidence on non-pharmacological strategies to improve sleep in people with dementia. As interventions are often complex, consisting of more than one active component, and implemented in complex contexts, it may not be easy to identify effective intervention components. OBJECTIVES To evaluate the benefits and harms of non-pharmacological interventions on sleep disturbances in people with dementia compared to usual care, no treatment, any other non-pharmacological intervention, or any drug treatment intended to improve sleep, and to describe the components and processes of any complex intervention included. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 13 January 2022. SELECTION CRITERIA We included individually or cluster-randomised controlled trials in people with dementia comparing non-pharmacological interventions to improve sleep compared to usual care or to other interventions of any type. Eligible studies had to have a sleep-related primary outcome. We included people with a diagnosis of dementia and sleep problems at baseline irrespective of age, type of dementia, severity of cognitive impairment, or setting. Studies reporting results on a mixed sample (e.g. in a nursing home) were only considered for inclusion if at least 80% of participants had dementia. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. objective sleep-related outcomes (e.g. total nocturnal sleep time, consolidated sleep time at night, sleep efficiency, total wake time at night (or time spent awake after sleep onset), number of nocturnal awakenings, sleep onset latency, daytime/night-time sleep ratio, night-time/total sleep ratio over 24 hours) and 2. ADVERSE EVENTS Our secondary outcomes were 3. subjective sleep-related outcomes, 4. behavioural and psychological symptoms of dementia, 5. quality of life, 6. functional status, 7. institutionalisation, 8. compliance with the intervention, and 9. attrition rates. We used GRADE to assess the certainty of evidence and chose key outcomes to be included in summary of findings tables. MAIN RESULTS We included 19 randomised controlled trials with 1335 participants allocated to treatment or control groups. Fourteen studies were conducted in nursing homes, three included community residents, one included 'inpatients', one included people from a mental health centre, and one included people from district community centres for older people. Fourteen studies were conducted in the US. We also identified nine ongoing studies. All studies applied one or more non-pharmacological intervention aiming to improve physiological sleep in people with dementia and sleep problems. The most frequently examined single intervention was some form of light therapy (six studies), five studies included physical or social activities, three carer interventions, one daytime sleep restriction, one slow-stroke back massage, and one transcranial electrostimulation. Seven studies examined multimodal complex interventions. Risk of bias of included studies was frequently unclear due to incomplete reporting. Therefore, we rated no study at low risk of bias. We are uncertain whether light therapy has any effect on sleep-related outcomes (very low-certainty evidence). Physical activities may slightly increase the total nocturnal sleep time and sleep efficiency, and may reduce the total time awake at night and slightly reduce the number of awakenings at night (low-certainty evidence). Social activities may slightly increase total nocturnal sleep time and sleep efficiency (low-certainty evidence). Carer interventions may modestly increase total nocturnal sleep time, may slightly increase sleep efficiency, and may modestly decrease the total awake time during the night (low-certainty evidence from one study). Multimodal interventions may modestly increase total nocturnal sleep time and may modestly reduce the total wake time at night, but may result in little to no difference in number of awakenings (low-certainty evidence). We are uncertain about the effects of multimodal interventions on sleep efficiency (very low-certainty evidence). We found low-certainty evidence that daytime sleep restrictions, slow-stroke back massage, and transcranial electrostimulation may result in little to no difference in sleep-related outcomes. Only two studies reported information about adverse events, detecting only few such events in the intervention groups. AUTHORS' CONCLUSIONS Despite the inclusion of 19 randomised controlled trials, there is a lack of conclusive evidence concerning non-pharmacological interventions for sleep problems in people with dementia. Although neither single nor multimodal interventions consistently improved sleep with sufficient certainty, we found some positive effects on physical and social activities as well as carer interventions. Future studies should use rigorous methods to develop and evaluate the effectiveness of multimodal interventions using current guidelines on the development and evaluation of complex interventions. At present, no single or multimodal intervention can be clearly identified as suitable for widespread implementation.
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Affiliation(s)
- Denise Wilfling
- Nursing Research Group, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Martin N Dichter
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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13
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Xiao SY, Liu YJ, Lu W, Sha ZW, Xu C, Yu ZH, Lee SD. Possible Neuropathology of Sleep Disturbance Linking to Alzheimer's Disease: Astrocytic and Microglial Roles. Front Cell Neurosci 2022; 16:875138. [PMID: 35755779 PMCID: PMC9218054 DOI: 10.3389/fncel.2022.875138] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Sleep disturbances not only deteriorate Alzheimer’s disease (AD) progress by affecting cognitive states but also accelerate the neuropathological changes of AD. Astrocytes and microglia are the principal players in the regulation of both sleep and AD. We proposed that possible astrocyte-mediated and microglia-mediated neuropathological changes of sleep disturbances linked to AD, such as astrocytic adenosinergic A1, A2, and A3 regulation; astrocytic dopamine and serotonin; astrocyte-mediated proinflammatory status (TNFα); sleep disturbance-attenuated microglial CX3CR1 and P2Y12; microglial Iba-1 and astrocytic glial fibrillary acidic protein (GFAP); and microglia-mediated proinflammatory status (IL-1b, IL-6, IL-10, and TNFα). Furthermore, astrocytic and microglial amyloid beta (Aβ) and tau in AD were reviewed, such as astrocytic Aβ interaction in AD; astrocyte-mediated proinflammation in AD; astrocytic interaction with Aβ in the central nervous system (CNS); astrocytic apolipoprotein E (ApoE)-induced Aβ clearance in AD, as well as microglial Aβ clearance and aggregation in AD; proinflammation-induced microglial Aβ aggregation in AD; microglial-accumulated tau in AD; and microglial ApoE and TREM2 in AD. We reviewed astrocytic and microglial roles in AD and sleep, such as astrocyte/microglial-mediated proinflammation in AD and sleep; astrocytic ApoE in sleep and AD; and accumulated Aβ-triggered synaptic abnormalities in sleep disturbance. This review will provide a possible astrocytic and microglial mechanism of sleep disturbance linked to AD.
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Affiliation(s)
- Shu-Yun Xiao
- Department of Mental Diseases, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi-Jie Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wang Lu
- Department of Traditional Treatment, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhong-Wei Sha
- Department of Mental Diseases, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Che Xu
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi-Hua Yu
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shin-Da Lee
- Department of Mental Diseases, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan.,Department of Physical Therapy, Asia University, Taichung, Taiwan
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14
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Ma H, Lu X, Zhou A, Wang F, Zuo X, Zhan M, Zou Q, Gong S, Chen Y, Lyu J, Jia L, Jia J, Wei C. Clinical Practice Guidelines for the Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review With AGREE II. Front Neurol 2022; 13:799723. [PMID: 35693007 PMCID: PMC9174457 DOI: 10.3389/fneur.2022.799723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/22/2022] [Indexed: 12/20/2022] Open
Abstract
Background High-quality clinical practice guidelines (CPGs) are important for the effective treatment of behavioral and psychological symptoms of dementia (BPSD). However, recommendations provided by different quality guidelines may lead to varied clinical practice outcomes. Objective To assess the quality of available CPGs for the management of BPSD and summarize the best recommendations for treating BPSD. Methods This was a systematic review of CPGs for the management of BPSD with data obtained from electronic databases and evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument, consisting of six domains: "Scope and purpose", "Stakeholder involvement", "Rigor of development", "Clarity of presentation", "Applicability", and "Editorial independence". The criteria for high-quality guidelines were set as: the score of high-quality guidelines in the "Rigor of development" domain should be ≥60% and as well as a score of >60% in at least three other domains. High-quality guidelines were selected for recommendation extraction, and the final recommendations were formed in combination with the latest meta-analysis and randomized clinical-trial results. Results In term of median scores in each domain for the six included CPGs, "Scope and purpose" (87.5%) scored better than all others, whereas "Applicability" (46.5%) was the domain with the lowest score. Four CPGs (2015 APA, 2018 NICE, 2018 CANADA, 2020 EAN) met the criteria of high-quality guidelines and were used to extract recommendations. From these four CPGs, nine specific recommendations related to the management of BPSD were summarized, of which seven were related to pharmacological treatment and two to non-pharmacological treatment. These recommendations covered the applicability of antipsychotic drugs, medication recommendations, withdrawal times, and several suitable non-pharmacological therapies. Conclusion The quality of CPGs for the management of BPSD requires improvement, especially for the "Applicability" domain. For psychotic-like symptoms in dementia, the use of antipsychotics should be based on the individual's risk-benefit ratio, and the use of atypical antipsychotics seems to be a better choice. Non-pharmacological treatments may be suitable for emotional symptoms and sleep disorders. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209204.
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Affiliation(s)
- Huixuan Ma
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xinliang Lu
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Aihong Zhou
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Fen Wang
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xiumei Zuo
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Minmin Zhan
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Qi Zou
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Cooperation of Chinese and Western Medicine Institute, Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Shuting Gong
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yufei Chen
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jihui Lyu
- Beijing Geriatric Hospital, Beijing, China
| | - Longfei Jia
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jianping Jia
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Cuibai Wei
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
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15
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Guu T, Aarsland D, ffytche D. Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: Revisiting the sundowning syndrome. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5712. [PMID: 35470491 PMCID: PMC9324910 DOI: 10.1002/gps.5712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES It is believed that inadequate environmental light, especially in facilities such as care homes, contribute to the diurnal changes of behavioural and psychological symptoms of dementia (BPSD) historically referred to as "sundowning syndrome". Conceptual models of sundowning phenomena have shifted emphasis from the role of light in vision (image forming) to its role in circadian rhythm modulation. However, the grounds for this change are unclear and the evidence on which it is based has not been examined comprehensively. METHODS We have searched literature on sundowning syndrome and its association with light and studies evaluating BPSD, behavioural rhythm and environmental light in care homes in four databases (PubMed, Web of Science, Embase and Cochrane Library) from inception to 31 January 2021. RESULTS Of the nine studies investigating light, behavioural rhythm and BPSD in care homes identified, we found evidence that insufficient natural light exposure was associated with worsening of BPSD and disrupted activity rhythm but it was not clear whether this related to image forming or disrupted circadian rhythm. There was a paucity of evidence in relation to the role of low levels of light for image forming in the context of a specific BPSD symptom: visual hallucinations. We also found literature on the possible role of light outside the visible spectrum influencing cognition. Based on the evidence, we proposed a new model integrating different components of light in BPSD and sundowning syndrome that combines its image forming and circadian roles. CONCLUSIONS Inadequate light may be a risk factor for BPSD and sundowning syndrome for dementia patients through a range of different mechanisms. It is recommended that multiple neuro-endocrinological and socio-environmental factors relevant to light such as adjusting the environmental setting, increasing light exposure, and scheduling activities should be considered when treating dementia patients with BPSD.
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Affiliation(s)
- Ta‐Wei Guu
- Departments of Internal Medicine, Division of PsychiatryChina Medical University Beigang HospitalYunlinTaiwan,Sleep Medicine Center and Mind‐Body Interface Laboratory (MBI‐Lab)China Medical University HospitalTaichungTaiwan,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation TrustLondonUK,Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
| | - Dominic ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation TrustLondonUK
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16
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de Oliveira P, Cella C, Locker N, Ravindran KKG, Mendis A, Wafford K, Gilmour G, Dijk DJ, Winsky-Sommerer R. Improved Sleep, Memory, and Cellular Pathological Features of Tauopathy, Including the NLRP3 Inflammasome, after Chronic Administration of Trazodone in rTg4510 Mice. J Neurosci 2022; 42:3494-3509. [PMID: 35273086 PMCID: PMC9034788 DOI: 10.1523/jneurosci.2162-21.2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 12/02/2022] Open
Abstract
Several cellular pathways contribute to neurodegenerative tauopathy-related disorders. Microglial activation, a major component of neuroinflammation, is an early pathologic hallmark that correlates with cognitive decline, while the unfolded protein response (UPR) contributes to synaptic pathology. Sleep disturbances are prevalent in tauopathies and may also contribute to disease progression. Few studies have investigated whether manipulations of sleep influence cellular pathologic and behavioral features of tauopathy. We investigated whether trazodone, a licensed antidepressant with hypnotic efficacy in dementia, can reduce disease-related cellular pathways and improve memory and sleep in male rTg4510 mice with a tauopathy-like phenotype. In a 9 week dosing regimen, trazodone decreased microglial NLRP3 inflammasome expression and phosphorylated p38 mitogen-activated protein kinase levels, which correlated with the NLRP3 inflammasome, the UPR effector ATF4, and total tau levels. Trazodone reduced theta oscillations during rapid eye movement (REM) sleep and enhanced REM sleep duration. Olfactory memory transiently improved, and memory performance correlated with REM sleep duration and theta oscillations. These findings on the effects of trazodone on the NLRP3 inflammasome, the unfolded protein response and behavioral hallmarks of dementia warrant further studies on the therapeutic value of sleep-modulating compounds for tauopathies.SIGNIFICANCE STATEMENT Dementia and associated behavioral symptoms such as memory loss and sleep disturbance are debilitating. Identifying treatments that alleviate symptoms and concurrently target cellular pathways contributing to disease progression is paramount for the patients and their caregivers. Here we show that a chronic treatment with trazodone, an antidepressant with positive effects on sleep, has beneficial effects on several cellular pathways contributing to neuroinflammation and tau pathology, in tauopathy-like rTg4510 mice. Trazodone also improved rapid eye movement (REM) sleep, the slowing of brain oscillations, and olfactory memory disturbances, which are all early symptoms observed in Alzheimer's disease. Thus, trazodone and compounds with REM sleep-promoting properties may represent a promising treatment approach to reduce the early symptoms of tauopathy and slow down disease progression.
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Affiliation(s)
- Paula de Oliveira
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom
- Lilly Research Centre, Eli Lilly and Company, Windlesham GU20 6PH, United Kingdom
| | - Claire Cella
- Lilly Research Centre, Eli Lilly and Company, Windlesham GU20 6PH, United Kingdom
| | - Nicolas Locker
- Department of Microbial and Cellular Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7TE, United Kingdom
| | - Kiran K G Ravindran
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London W12 0BZ and University of Surrey, Guildford GU2 7XP, United Kingdom
| | - Agampodi Mendis
- Surrey Clinical Trials Unit, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom
| | - Keith Wafford
- Lilly Research Centre, Eli Lilly and Company, Windlesham GU20 6PH, United Kingdom
| | - Gary Gilmour
- Lilly Research Centre, Eli Lilly and Company, Windlesham GU20 6PH, United Kingdom
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London W12 0BZ and University of Surrey, Guildford GU2 7XP, United Kingdom
| | - Raphaelle Winsky-Sommerer
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom
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17
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Otsubo H, Kishimoto K, Hirano I, Nakano H, Itaya K, Kumaki R, Osumi H. Relationship between cognitive function affecting motor Functional Independence Measure and hypnotics. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2022; 13:4-11. [PMID: 37859848 PMCID: PMC10545029 DOI: 10.11336/jjcrs.13.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 10/21/2023]
Abstract
Otsubo H, Kishimoto K, Hirano I, Nakano H, Itaya K, Kumaki R, Osumi H. Relationship between cognitive function affecting motor Functional Independence Measure and hypnotics. Jpn J Compr Rehabil Sci 2022; 13: 4-11. Purpose The purpose of this study was to examine the relationship between cognitive dysfunction affecting motor Functional Independence Measure (FIM) and hypnotics. Methods This was a retrospective study involving 509 patients aged ≥ 65 years who were discharged from a convalescent rehabilitation ward. Results Multiple regression analysis was performed with motor FIM efficiency and motor FIM effectiveness (motor FIM-e) as independent variables and the presence or absence of cognitive dysfunction as the dependent variable. The use of hypnotics in patients with cognitive dysfunction showed a positive relationship with motor FIM efficiency (β = 0.147, P = 0.019) and motor FIM-e (β = 0.141, P = 0.026). Multiple regression analyses were performed after further classifying hypnotics by therapeutic class into hypnotics with new mechanisms, non-benzodiazepine (BZ) hypnotics, and BZ hypnotics. Non-BZ hypnotics (β = 0.141, P = 0.021) showed a positive relationship with motor FIM efficiency. Non-BZ hypnotics (β = 0.158, P = 0.009) and BZ hypnotics (β = 0.178, P = 0.003) showed a positive relationship with motor FIM-e, whereas hypnotics with new mechanisms of action did not. In contrast, none of the three combinations of hypnotics showed any significant relationship with either motor FIM efficiency or motor FIM-e in patients without cognitive dysfunction. Conclusion The results suggested that the use of hypnotics in patients with cognitive dysfunction increases motor FIM efficiency and motor FIM-e.
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Affiliation(s)
- Hiroko Otsubo
- Division of Social Pharmacy and Pharmacy Department of Healthcare and Regulatory Sciences, School of Pharmacy, Showa University, Tokyo, Japan
- Department of Pharmacy, Ichigao Hospital, Yokohama, Japan
| | - Keiko Kishimoto
- Division of Social Pharmacy and Pharmacy Department of Healthcare and Regulatory Sciences, School of Pharmacy, Showa University, Tokyo, Japan
| | - Iyori Hirano
- Department of Rehabilitation, Ichigao Hospital, Yokohama, Japan
| | - Hitoshi Nakano
- Department of Rehabilitation, Ichigao Hospital, Yokohama, Japan
- Department of Neurology, Ichigao Hospital, Yokohama, Japan
| | - Kazuhiro Itaya
- Department of Neurology, Ichigao Hospital, Yokohama, Japan
| | - Ryota Kumaki
- Division of Social Pharmacy and Pharmacy Department of Healthcare and Regulatory Sciences, School of Pharmacy, Showa University, Tokyo, Japan
| | - Hiroyuki Osumi
- Department of Pharmacy, Ichigao Hospital, Yokohama, Japan
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18
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Sidhom E, O’Brien JT, Butcher AJ, Smith HL, Mallucci GR, Underwood BR. Targeting the Unfolded Protein Response as a Disease-Modifying Pathway in Dementia. Int J Mol Sci 2022; 23:2021. [PMID: 35216136 PMCID: PMC8877151 DOI: 10.3390/ijms23042021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
Dementia is a global medical and societal challenge; it has devastating personal, social and economic costs, which will increase rapidly as the world's population ages. Despite this, there are no disease-modifying treatments for dementia; current therapy modestly improves symptoms but does not change the outcome. Therefore, new treatments are urgently needed-particularly any that can slow down the disease's progression. Many of the neurodegenerative diseases that lead to dementia are characterised by common pathological responses to abnormal protein production and misfolding in brain cells, raising the possibility of the broad application of therapeutics that target these common processes. The unfolded protein response (UPR) is one such mechanism. The UPR is a highly conserved cellular stress response to abnormal protein folding and is widely dysregulated in neurodegenerative diseases. In this review, we describe the basic machinery of the UPR, as well as the evidence for its overactivation and pathogenicity in dementia, and for the marked neuroprotective effects of its therapeutic manipulation in murine models of these disorders. We discuss drugs identified as potential UPR-modifying therapeutic agents-in particular the licensed antidepressant trazodone-and we review epidemiological and trial data from their use in human populations. Finally, we explore future directions for investigating the potential benefit of using trazodone or similar UPR-modulating compounds for disease modification in patients with dementia.
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Affiliation(s)
- Emad Sidhom
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0AH, UK; (E.S.); (A.J.B.); (H.L.S.); (G.R.M.)
- Department of Clinical Neurosciences, UK Dementia Research Institute, University of Cambridge, Cambridge CB2 0AH, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Windsor Research Unit, Fulbourn Hospital, Cambridge CB21 5EF, UK
- Gnodde Goldman Sachs Translational Neuroscience Unit, Windsor Research Unit, University of Cambridge, Cambridge CB2 1TN, UK
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge CB2 0SZ, UK;
| | - Adrian J. Butcher
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0AH, UK; (E.S.); (A.J.B.); (H.L.S.); (G.R.M.)
- Department of Clinical Neurosciences, UK Dementia Research Institute, University of Cambridge, Cambridge CB2 0AH, UK
| | - Heather L. Smith
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0AH, UK; (E.S.); (A.J.B.); (H.L.S.); (G.R.M.)
- Department of Clinical Neurosciences, UK Dementia Research Institute, University of Cambridge, Cambridge CB2 0AH, UK
| | - Giovanna R. Mallucci
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0AH, UK; (E.S.); (A.J.B.); (H.L.S.); (G.R.M.)
- Department of Clinical Neurosciences, UK Dementia Research Institute, University of Cambridge, Cambridge CB2 0AH, UK
| | - Benjamin R. Underwood
- Cambridgeshire and Peterborough NHS Foundation Trust, Windsor Research Unit, Fulbourn Hospital, Cambridge CB21 5EF, UK
- Gnodde Goldman Sachs Translational Neuroscience Unit, Windsor Research Unit, University of Cambridge, Cambridge CB2 1TN, UK
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge CB2 0SZ, UK;
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19
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Rijksen DOC, Zuidema SU, de Haas EC. Use of Benzodiazepines and Z-Drugs in Nursing Home Residents with Dementia: Prevalence and Appropriateness. J Alzheimers Dis Rep 2022; 5:871-879. [PMID: 35088036 PMCID: PMC8764627 DOI: 10.3233/adr-210041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Guidelines worldwide recommend restricted prescription of benzodiazepine receptor agonists (BZRAs), i.e., benzodiazepines and Z-drugs, for the treatment of dementia-associated behavioral and psychological symptoms and insomnia. Objective: To assess the prevalence and appropriateness of BZRA use among nursing home residents with dementia. Methods: This is a post-hoc analysis of BZRA prescriptions from two intervention studies on psychotropic drug use, conducted from 2016 to 2018. It includes 1,111 residents of dementia special care units from 24 Dutch long-term care organizations. We assessed the prevalence of use of continuous and as-needed BZRA prescriptions and their association with registered symptoms. Continuous BZRA prescriptions were evaluated for appropriateness, i.e., whether indication, dosage, duration, and evaluation accorded with guidelines for the treatment of challenging behavior in dementia and sleep disorders. Results: The prevalence of BZRA use is 39.2% (95% CI: 36.3%–42.0%): continuous 22.9%; only as-needed 16.3%. Combinations of preferred BZRAs and appropriate indications occur in 19.0% of continuous anxiolytic prescriptions and 44.8% of hypnotic prescriptions. Frequently registered inappropriate indications are aggression/agitation for anxiolytics (continuous: 75.7%; as-needed: 75.2%) and nighttime agitation for hypnotics (continuous: 40.3%; as-needed: 26.7%). None of the continuous prescriptions with appropriate indications were appropriate for all other items. For most of the prescriptions, duration and time to evaluation exceeded 4 weeks. Conclusion: BZRA use in nursing home residents with dementia is highly frequent. A large proportion of prescriptions do not follow the guidelines with regard to indication, exceed the recommended duration and are not evaluated in a timely manner. The discrepancy between evidence-based guidelines and daily practice calls for an exploration of factors maintaining inappropriate use.
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Affiliation(s)
- Dirk O C Rijksen
- Carintreggeland, Center for Specialized Geriatric Care, Hengelo, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Esther C de Haas
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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20
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Louzada LL, Machado FV, Quintas JL, Ribeiro GA, Silva MV, Mendonça-Silva DL, Gonçalves BSB, Nóbrega OT, Camargos EF. The efficacy and safety of zolpidem and zopiclone to treat insomnia in Alzheimer's disease: a randomized, triple-blind, placebo-controlled trial. Neuropsychopharmacology 2022; 47:570-579. [PMID: 34635802 PMCID: PMC8674235 DOI: 10.1038/s41386-021-01191-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/26/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
No prior studies have evaluated the efficacy and safety of zolpidem and zopiclone to treat insomnia of demented patients. This randomized, triple-blind, placebo-controlled clinical trial used these drugs to treat patients with probable, late onset Alzheimer's dementia (AD) (DSM V and NINCDS-ADRDA criteria) exhibiting insomnia (DSM V criteria and nocturnal NPI scores ≥ 2). Actigraphic records were performed for 7 days at baseline and for 14 days during the treatment period in 62 patients aged 80.5 years in average and randomized at a 1:1:1 ratio for administration of zolpidem 10 mg/day, zopiclone 7.5 mg/day or placebo. Primary endpoint was the main nocturnal sleep duration (MNSD), whereas secondary outcomes were the proportion of the night time slept, awake time after sleep onset (WASO), nocturnal awakenings, total daytime sleep time and daytime naps. Cognitive and functional domains were tested before and after drug/placebo use. Three participants under zopiclone use had intervention interrupted due to intense daytime sedation and worsened agitation with wandering. Zopiclone produced an 81 min increase in MNSD (95% confidence interval (CI): -0.8, 163.2), a 26 min reduction in WASO (95% CI: -56.2, 4.8) and a 2-episode decrease in awakening per night (95% CI: -4.0, 0.4) in average compared to placebo. Zolpidem yielded no significant difference in MNSD despite a significant 22 min reduction in WASO (95% CI: -52.5, 8.3) and a reduction of 1 awakening each night (95% CI: -3.4, 1.2) in relation to placebo. There was a 1-point reduction in mean performance in the symbols search test among zolpidem users (95% CI: -4.1, 1.5) and an almost eight-point reduction in average scores in the digit-symbol coding test among zopiclone users (95% CI: -21.7, 6.2). In summary, short-term use of zolpidem or zopiclone by older insomniacs with AD appears to be clinically helpful, even though safety and tolerance remain issues to be personalized in healthcare settings and further investigated in subsequent trials. This trial was registered in ClinicalTrials.gov Identifier: NCT03075241.
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Affiliation(s)
- Luciana L Louzada
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil.
- Multidisciplinary Geriatric Center, Brasília University Hospital, SGAN 605 Av. L2 Norte, Brasilia, DF, 70840-901, Brazil.
| | - Flávio V Machado
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Juliana L Quintas
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Guilherme A Ribeiro
- Health Sciences Faculty, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Mônica V Silva
- Health Sciences Faculty, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Dayde L Mendonça-Silva
- Health Sciences Faculty, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Bruno S B Gonçalves
- Multidisciplinary Geriatric Center, Brasília University Hospital, SGAN 605 Av. L2 Norte, Brasilia, DF, 70840-901, Brazil
| | - Otávio T Nóbrega
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
- Division of Geriatric Medicine, McGill University Department of Medicine, 1001 boul Décarie, Montreal, QC, H3G 1A4, Canada
| | - Einstein F Camargos
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
- Multidisciplinary Geriatric Center, Brasília University Hospital, SGAN 605 Av. L2 Norte, Brasilia, DF, 70840-901, Brazil
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21
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Roland JP, Bliwise DL. Impact of Pharmacotherapy on Insomnia in Patients with Alzheimer's Disease. Drugs Aging 2021; 38:951-966. [PMID: 34569029 PMCID: PMC8593056 DOI: 10.1007/s40266-021-00891-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 02/03/2023]
Abstract
Insomnia is a pervasive sleep disorder affecting numerous patients across diverse demographical populations and comorbid disease states. Contributing factors are often a complex interaction of biological, psychological, and social components, requiring a multifaceted approach in terms of both diagnosis and management. In the setting of Alzheimer’s disease, insomnia is an even more complicated issue, with a higher overall prevalence than in the general population, greater complexity of contributing etiologies, and differences in diagnosis (at times based on caregiver observation of sleep disruption rather than subjective complaints by the individual with the disorder), and requiring more discretion in terms of treatment, particularly in regard to adverse effect profile concerns. There also is growing evidence of the bidirectional nature of sleep disruption and Alzheimer’s disease, with insomnia potentially contributing to disease progression, making the condition even more paramount to address. The objective of this review was to provide the clinician with an overview of treatment strategies that may have value in the treatment of disturbed sleep in Alzheimer’s disease. Nonpharmacological approaches to treatment should be exhausted foremost; however, pharmacotherapy may be needed in certain clinical scenarios, which can be a challenge for clinicians given the paucity of evidence and guidelines for treatment in the subpopulation of Alzheimer’s disease. Agents such as sedating antidepressants, melatonin, and site-specific γ-aminobutyric acid agonists are often employed based on historical usage but are not necessarily supported by high-quality trials. Newer agents such as dual orexin receptor antagonists have demonstrated some promise but still need further evaluation.
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Affiliation(s)
- Joshua P Roland
- Department of Pulmonology, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, UCLA, 700 W. 7th Street, Suite S270-D, Los Angeles, CA, 90017, USA.
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Emory University, Atlanta, GA, USA
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22
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Palagini L, Manni R, Aguglia E, Amore M, Brugnoli R, Bioulac S, Bourgin P, Micoulaud Franchi JA, Girardi P, Grassi L, Lopez R, Mencacci C, Plazzi G, Maruani J, Minervino A, Philip P, Royant Parola S, Poirot I, Nobili L, Biggio G, Schroder CM, Geoffroy PA. International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders. Front Psychiatry 2021; 12:688890. [PMID: 34177671 PMCID: PMC8222620 DOI: 10.3389/fpsyt.2021.688890] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders. Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method. Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders. Conclusion: The administration of prolonged release melatonin at 2-10 mg, 1-2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders.
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Affiliation(s)
- Laura Palagini
- Psychiatry Division, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Eugenio Aguglia
- Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital “Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Stéphanie Bioulac
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France
| | - Patrice Bourgin
- Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France
- Centre des troubles du sommeil - CIRCSom, Strasbourg University Hospitals, Strasbourg, France
| | - Jean-Arthur Micoulaud Franchi
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Régis Lopez
- Service de Neurologie, Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - Claudio Mencacci
- Department of Neuroscience, Aziende Socio Sanitarie Territoriali Fatebenefratelli Sacco, Milan, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Julia Maruani
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
| | - Antonino Minervino
- Department of Psychiatry, Italian Society of Psychosomatic Medicine (SIMP), Parma, Italy
| | - Pierre Philip
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France
| | | | - Isabelle Poirot
- Service de psychiatrie adulte, Hôpital Fontan, CHU de Lille, Lille, France
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Child Neuropsychiatry Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, Cagliari, Italy
| | - Carmen M. Schroder
- Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
| | - Pierre A. Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
- GHU Paris - Psychiatry & Neurosciences, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
- Université de Paris, NeuroDiderot, Inserm, Paris, France
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Muñiz R, López-Alvarez J, Agüera-Ortiz L, Perea L, Olazarán J. Syndrome-Based Prescription to Optimize Psychotropics: Are CHROME Criteria a Game Changer? Front Psychiatry 2021; 12:662228. [PMID: 33967863 PMCID: PMC8101684 DOI: 10.3389/fpsyt.2021.662228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
A variety of medical and social factors have contributed over the last decades to the overuse of psychotropic drugs in people with dementia. One social factor is probably the frequent failure to provide adequate person-centered care, be it in the community or in institutional settings. This unfortunate reality has been reacted upon with numerous guidelines to reduce prescriptions of the most dangerous drugs (e.g., neuroleptics). Each psychotropic drug prescription can in principle be assessed around three dimensions: (a) adequate, (b) inadequate, and (c) chemical restraint. The CHemical Restraints avOidance MEthodology (CHROME) defined chemical restraint as any prescription based on organizational convenience, rather than justified with medical diagnosis. Two validation studies revealed that one of the main medical reasons of over- and miss-prescriptions was symptom-based prescription. By switching to syndrome-based prescription, a large proportion of drugs could be de-prescribed and some re-adjusted or kept. Paucity of research and weakness of data are not conclusive about the adequacy of specific drugs for the myriad of cases presented by patients with dementia and comorbid conditions. Clinical practice, however, leads us to believe that even under optimal care conditions, psychotropics might still contribute to quality of life if based on an adequate diagnosis. This article explains the rationale that underlies a syndromic approach aimed at optimizing psychotropic treatment in people with dementia whose significant suffering derives from their thought, affective, or behavioral problems. The results of previous validation studies of this new methodology will be discussed and conclusions for future results will be drawn.
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Affiliation(s)
| | - Jorge López-Alvarez
- Maria Wolff Foundation, Madrid, Spain
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERSAM, Madrid, Spain
| | - Luis Perea
- Albertia Servicios Sociosanitarios, Madrid, Spain
| | - Javier Olazarán
- Maria Wolff Foundation, Madrid, Spain
- Memory Disorders Clinic, HM Hospitals, Madrid, Spain
- Neurology Service, University Hospital Gregorio Marañón, Madrid, Spain
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