Decreased sustained attention, processing speed and verbal learning memory in patients with insomnia in Chinese young and middle-aged adults: a cross-sectional study

The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder

STUDY OBJECTIVES

The current study aimed to examine the association of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Thirty-six children with ADHD and insomnia symptoms, 27 children with ADHD without insomnia symptoms, and 21 age-matched healthy controls were recruited in this study (age range: 6-12 years, 70% male). They were assessed by parent-report questionnaires on insomnia symptoms (Children's Sleep Habits Questionnaire) and ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale [SWAN]), and completed a battery of cognitive tests including the Continuous Performance Test (CPT) for sustained attention, Letter-digit test for processing speed, Digit Span forward test and N-back task for working memory, Tower of London (TOL) test for planning skills and Bergs Card Sorting Test (BCST) for set-shifting ability.

RESULTS

Children with ADHD and insomnia symptoms had the highest scores on SWAN total and inattention and hyperactivity subscales, followed by children with ADHD without insomnia and healthy controls (all P < .05). After controlling for potential confounders, children with ADHD and insomnia symptoms showed poorer performance on the CPT and Letter-digit test as compared with children with ADHD without insomnia and healthy controls (all P < .05).

CONCLUSIONS

Insomnia symptoms are associated with more severe ADHD symptoms and cognitive impairments in children with ADHD, especially deficits in sustained attention and processing speed. Future longitudinal studies are needed to explore the long-term impacts of insomnia symptoms and the effects of sleep-focused intervention on cognitive functioning in children with ADHD.

CITATION

Li X, Shea KSC, Chiu WV, et al. The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder. J Clin Sleep Med. 2022;18(8):2029-2039.

Validation of an ecological momentary assessment to measure processing speed and executive function in schizophrenia

Cognitive impairments are a core feature of schizophrenia that have negative impacts on functional outcomes. However, it remains challenging to assess these impairments in clinical settings. Smartphone apps provide the opportunity to measure cognitive impairments in an accessible way; however, more research is needed to validate these cognitive assessments in schizophrenia. We assessed the initial accessibility, validity, and reliability of a smartphone-based cognitive test to measure cognition in schizophrenia. A total of 29 individuals with schizophrenia and 34 controls were included in the analyses. Participants completed the standard pen-and-paper Trail Making Tests (TMT) A and B, and smartphone-based versions, Jewels Trail Tests (JTT) A and B, at the single in-lab visit. Participants were asked to complete the JTT remotely once per week for three months. We also investigated how subjective sleep quality and mood may affect cognitive performance longitudinally. In-lab and remote JTT scores moderately and positively correlated with in-lab TMT scores. Moderate test-retest reliability was observed across the in-lab, first remote, and last remote completion times of the JTT. Additionally, individuals with schizophrenia had significantly lower performance compared to controls on both the in-lab JTT and TMT. Self-reported mood had a significant effect on JTT A performance over time but no other significant relationships were found remotely. Our results support the initial accessibility, validity and reliability of using the JTT to measure cognition in schizophrenia. Future research to develop additional smartphone-based cognitive tests as well as with larger samples and in other psychiatric populations are warranted.

Sex differences in the association between symptom profiles and cognitive functioning in patients with depressive disorder

OBJECTIVE

Depressive disorder (DD) is a heterogeneous disease with sex differences in symptom profiles and cognitive performance. However, sex differences in cognitive dysfunction associated with different symptom profiles have received little systematic study. This study aimed to explore the association between clinical symptoms and cognitive deficits in patients with DD.

METHODS

A cohort of 222 hospitalized patients with DD (males/females = 114/108) and 173 healthy controls (males/females = 80/93) were enrolled. Cognitive function was measured using a comprehensive neuropsychological battery. Depression was assessed using the 17-item Hamilton Rating Scale for Depression (HAMD-17). According to different genders, the relationship between symptom profiles and cognitive deficits was identified using partial correlation analysis and multiple regression analysis.

RESULTS

Patients with DD performed significantly worse than healthy controls in all cognitive domains investigated (all p < 0.05). Remarkably, female patients scored better than male patients on information processing speed (p < 0.05). Multivariate regression analyses showed that the retardation factor score was independently associated with attention and cognitive flexibility, and the sleep disturbance factor score was independently associated with information processing speed in male patients. Furthermore, the anxiety/somatization factor score was independently associated with working memory in female patients.

CONCLUSION

In the present study, we showed that significant sex differences in the association between symptom profiles and cognitive impairment are present in DD patients. Understanding how DD patients' clinical features and cognitive performance are linked from a sex perspective may have clinical implications for predicting and interfering with the outcome of depression.