Association between sleep quality and subjective cognitive decline: evidence from a community health survey

Relationship between cognitive function and sleep quality in middle-aged and older adults for minimizing disparities and achieving equity in health: Evidence from multiple nationwide cohorts

BACKGROUND

Cognitive decline, a heavy burden on middle-aged and older adults as global aging is aggravated, was found to be associated with sleep quality. However, the country-between heterogeneity of the association prevented us from quantifying underlying relationship and identifying potential effect modifiers for vulnerable populations and targeted interventions.

METHODS

We collected data from 79,922 eligible adults in five nationwide cohorts, examined the respective relationships between cognitive function and sleep quality, synthesized underlying average relationships by meta-analysis, and explored effect modifiers by meta-regressions. Additionally, we conducted subgroup and interaction analyses to identify vulnerable populations and to determine their disparities in vulnerability.

RESULTS

Although country-between disparities exist, cognitive function is robustly associated with sleep quality in middle-aged and older adults worldwide, with an effect (β) of 0.015 [0.003, 0.027]. Executive function is the subdomain most relevant to sleep quality. Disparities in the effects of sleep quality on subdomains exist in populations with different sexes (orientation: βfemale/βmale = 1.615, P = 0.020), marital statuses (orientation: βunmarried/βmarried = 2.074, P < 0.001), education levels (orientation:βuneducated/βeducated = 2.074, P < 0.001) and chronic disease statuses (memory: βunhealthy/βhealthy = 1.560, P = 0.005).

CONCLUSIONS

Cognitive function decreases with worsening sleep quality in middle-aged and older adults. Vulnerability to poor sleep generally persists in singles, females, the uneducated and people with chronic diseases. To minimize disparities and achieve health equity, we advocate for targeted interventions, i.e., encouraging socialization in singles, confirming effectiveness of hormone replacement therapy in females, employing compulsory education in middle-aged and older adults.

Association between Subjective Cognitive Complaints and Sleep Disturbance among Community-Dwelling Elderly Individuals in Japan

Subjective cognitive complaints (SCCs) are a crucial modifiable risk factor for dementia. There is increasing interest in the association between SCC and sleep disturbance; however, the effects of sleep disturbance on SCC development among community-dwelling elderly individuals in Japan remain unclear. We aimed to cross-sectionally investigate the association between SCC and sleep disturbance, with adjustment for multiple factors related to cognitive decline, among 241 community-dwelling elderly persons without cognitive impairment. The measures were SCCs (Kihon Checklist-Cognitive Function, KCL-CF), sleep disturbance (Japanese version of the Athens Insomnia Scale, AIS-J), general cognitive function (Mini-Mental State Examination), and depressive symptoms (five-item version of the Geriatric Depression Scale [GDS-5]). The following data were collected: sex, age, educational history, whether the participants had visited a medical institution for diseases (hypertension, diabetes, hyperlipidemia, heart disease), and the presence/absence of established risk factors (hearing loss, history of head injury, drinking habits, smoking habits, social isolation, and physical inactivity and activity). Based on the KCL-CF, 96 and 145 participants were considered to have and lack SCCs, respectively. On logistic regression analysis, the AIS-J score and smoking history were significantly associated with SCCs. Our findings suggest that sleep disturbance is associated with SCC development among community-dwelling elderly people in Japan. Evaluating and managing sleep disturbances can be important in preventing SCCs and dementia.

Relationship Between Excessive Daytime Sleepiness and Caudate Nucleus Volume in Patients with Subjective Cognitive Decline: A Study from the SILCODE Using the Volbrain

Background

Excessive daytime sleepiness (EDS) and caudate nucleus volume alterations have been linked to Alzheimer's disease (AD), but their relationship remains unclear under the context of subjective cognitive decline (SCD).

Objective

This study aimed to investigate the relationship between EDS and caudate nucleus volume in patients with SCD.

Methods

The volume of entire brain was measured in 170 patients with SCD, including 37 patients with EDS and 133 non-EDS, from the Sino Longitudinal Study on Cognitive Decline (SILCODE). Participants underwent a comprehensive assessment battery, including neuropsychological and clinical evaluations, blood tests, genetic analysis for APOE ɛ4, and structural MRI scans analyzed using the fully automated segmentation tool, volBrain.

Results

Patients with EDS had significantly increased volume in the total and left caudate nucleus compared to non-EDS. The most significant cognitive behavioral factor associated with caudate nucleus volume in the EDS was the Auditory Verbal Learning Test-recognition.

Conclusions

These findings suggest that EDS may be associated with alterations in caudate nucleus volume, particularly in the left hemisphere, in the context of SCD. Further research is necessary to understand the underlying mechanisms of this relationship and its implications for clinical management.

Sleep Quality and Subjective Cognitive Decline among Older Adults: The Mediating Role of Anxiety/Depression and Worries

Background

Subjective cognitive decline (SCD) in older individuals has been implicated as a possible precursor to Alzheimer's disease. Poor sleep quality and anxiety/depressive symptoms have been linked to the progression of SCD, but these associations and older adults' worries have yet to be fully established in the Chinese older adult population, which is one of the largest in the world. The aim of this study was to explore the relationship between sleep quality, anxiety/depression symptoms, and worries, and SCD prevalence among Chinese community-dwelling older individuals.

Methods

A total of 707 adults aged between 60 and 99 from Shanghai, China, completed self-report questionnaires that covered their cognitive and mental well-being, as well as demographic information. Subjective cognitive decline (SCD) was evaluated using the memory/cognition syndromes of the old adult self-report (OASR). Sleep quality, anxiety/depression, and worries were measured from their respective sections of the OASR.

Results

The general linear regression models showed that poorer sleep quality was associated with an increased prevalence of anxiety/depression symptoms, worries, and SCD among older adults. As suggested by the mediation analysis, anxiety/depression and worries were significant mediators in the relationship between sleep quality and SCD prevalence, and these two factors also have a serial mediation effect between sleep quality and SCD prevalence.

Conclusions

Poorer sleep quality is associated with a higher rate of SCD among older adults, and a higher prevalence of anxiety/depression and worries mediate this relationship, suggesting possible mechanism pathways that lead to SCD. These factors may provide the basis for early, targeted interventions for older adults' mental health preservation and improved quality of life.

The context of COVID-19 affected the long-term sleep quality of older adults more than SARS-CoV-2 infection

Introduction

Sleep problems are one of the most persistent symptoms of post-COVID syndrome in adults. However, most recent research on sleep quality has relied on the impact of the pandemic, with scarcely any data for older adults on the long-term consequences of COVID infection. This study aims to understand whether older individuals present persistently impaired sleep quality after COVID-19 infection and possible moderators for this outcome.

Methods

This is a cross-sectional analysis of a longitudinal cohort study with 70 elders with 6-month-previous SARS-CoV-2 infection and 153 controls. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality; Geriatric Depression Scale and Geriatric Anxiety Inventory for screening depression and anxiety. Demographics and comorbid conditions were collected.

Results

The mean age of participants was 66,97 ± 4,64 years. There were no statistical differences in depression and anxiety between groups. Poor sleep quality was found in 52,9% and 43,8% of the COVID and control groups (p=.208). After controlling for multiple variables, all the following factors resulted in greater chances of poor sleep quality: female gender (OR, 2.12; p=.027), memory complaints (OR, 2.49; p=.074), insomnia (OR, 3.66; p=.032), anxiety (OR, 5.46; p<.001), depression (OR, 7.26; p=.001), joint disease (OR, 1.80; p=.050), glucose intolerance (OR, 2.20; p=.045), psychoactive drugs (OR, 8.36; p<.001), diuretics (OR, 2.46; p=.034), and polypharmacy (OR, 2.84; p=.016).

Conclusion

Psychosocial burden in the context of the COVID-19 pandemic and pre-existing conditions seems to influence the sleep quality of older adults more than SARS-CoV-2 infection.

Pilot feasibility and acceptability study evaluating use of group CBT-I in improving sleep and fatigue in older adults

OBJECTIVE

This paper describes a pilot study, in a small sample of older adults, designed to ascertain the feasibility, acceptability and potential effectiveness of group Cognitive Behavioural Therapy For Insomnia (CBT-I).

METHODS

Eleven older adults participated in a 3-week group CBT-I intervention with pre- and post-intervention outcome measures of sleep and fatigue. Acceptability was measured via post-intervention focus groups. Feasibility was measured via recruitment, retention and completion data. Subjective sleep outcomes were measured pre- and post-intervention using the Pittsburgh Sleep Quality Index. Fatigue was measured using the Fatigue Severity Index. Objective sleep outcome measures were obtained via pre- and post-intervention wrist actigraphy.

RESULTS

Feasibility and acceptability were confirmed in the pilot study. Retention and completion levels were high, with participants largely positive in the focus group feedback. Preliminary sleep outcome data supported the potential effectiveness of the intervention in significantly improving several measures of sleep and fatigue including a three-point reduction in the Global PSQI scores, an increase in total sleep time of almost an hour per night and these results were mirrored by a significant reduction of nine points in the overall measure of fatigue severity.

CONCLUSIONS

A group CBT-I intervention is a low-cost, low-risk intervention which improves subjective and objective measures of sleep in older adults. These positive sleep outcomes are translated into significantly decreased levels of fatigue. Future research should focus on a larger sample size with a randomised controlled trial design.

REM sleep deprivation induced by the modified multi-platform method has detrimental effects on memory: A systematic review and meta-analysis

The modified multi-platform method (MMPM) is used to induce animal models of paradoxical sleep deprivation and impairs memory in rodents. However, variations in MMPM protocols have contributed to inconsistent conclusions across studies. This meta-analysis aimed to assess the variations of the MMPM and their effects on memory in rats and mice. A comprehensive search identified 60 studies, and 50 were included in our meta-analysis. Overall, the meta-analysis showed that the MMPM significantly reduced the percentage of time spent in target quadrants (I2 = 54 %, 95 % confidence interval [CI] = [-1.83, -1.18]) and the number of platform-area crossings (I2 = 26 %, 95 % CI = [-1.71, -1.07]) in the Morris water maze (MWM) and shortened the latency to entering the dark compartment in the passive avoidance task (I2 = 68 %, 95 % CI = [-1.36, -0.57]), but it increased the number of errors in the radial arm water maze (RAWM) (I2 = 59 %, 95 % CI = [1.29, 2.07]). Additionally, mice performed worse on the MWM, whereas rats performed worse on the passive avoidance task. More significant memory deficits were found in cross-learning and post-learning MMPM in the MWM and RAWM, respectively. This study provided evidence that the MMPM can be used in preclinical studies of memory deficits induced by paradoxical sleep deprivation.

Correlation among sleep quality, physical frailty and cognitive function of the older adults in China: the mediating role

Objective

To explore the correlation among sleep quality, physical frailty, and cognitive function in the older adults in community, and to explore the mediating role of sleep quality.

Methods

A total of 1,182 community-based older adults were investigated with frailty phenotype (FP), Pittsburgh sleep quality index (PISQI), Montreal cognitive assessment (MoCA) and self-made general information questionnaire.

Results

The incidence of physical frailty among the older adults in the community was 25.8% and the incidence of cognitive decline was 19.5%. Cognitive function was negatively correlated with physical frailty (r = -0.236, p < 0.01) and sleep quality (r = -0.558, p < 0.01). Sleep quality was positively correlated with physical frailty (r = 0.337, p < 0.01).

Conclusion

The physical frailty of the older adults has a direct prediction effect on cognitive function, and is regulated by the mediating role of sleep quality. Sleep quality partially mediates the relationship between cognitive dysfunction and physical frailty, which is a new insight into the study of cognition and physical frailty in the older adults. In the future, we can take measures to improve the sleep quality of the older adults, so as to reduce the occurrence of cognitive dysfunction and physical frailty of the older adults.

Relationship between self-reported sleep and cognitive function: a specification curve analysis

The relationship between self-reported sleep and cognitive function is complex; it is unclear whether self-reported sleep is a robust correlate of people's cognitive function. We address this gap by using a comprehensive large-scale dataset (N = 1054) coupled with a novel modeling approach, specification curve analysis (SCA), to test the association between self-reported sleep and cognitive function. The results of the SCA showed robust correlations between self-reported sleep and cognitive function, with poorer sleep associated with worse cognitive function. Furthermore, the correlations between sleep components and cognitive function were heterogeneous, with differences emerging across cognitive measures and domains. Specifically, daytime dysfunction was associated with the strongest effect on subjective cognitive function, whereas sleep duration and sleep efficiency had the strongest effect on objective cognitive function. Therefore, the relationship between self-reported sleep and cognition depends largely on what and how cognitive function is measured. Our findings guide measurement and domain selection for future research on the role of sleep in cognitive function.

Relation of modifiable lifestyle and mood factors to cognitive concerns among participants and their study partners in the A4 screen data

Introduction

Subjective cognitive decline (SCD) has been associated with elevated amyloid levels and increased risk of future cognitive decline, as well as modifiable variables, including depression, anxiety, and physical inactivity. Participants generally endorse greater and earlier concerns than their close family and friends (study partners [SPs]), which may reflect subtle changes at the earliest stages of disease among participants with underlying neurodegenerative processes. However, many individuals with subjective concerns are not at risk of Alzheimer's disease (AD) pathology, suggesting that additional factors, such as lifestyle habits, may be contributory.

Methods

We examined the relation between SCD, amyloid status, lifestyle habits (exercise, sleep), mood/anxiety, and demographic variables among 4481 cognitively unimpaired older adults who are being screened for a multi-site secondary prevention trial (A4 screen data; mean ±SD: age = 71.3 ±4.7, education = 16.6 ±2.8, 59% women, 96% non-Hispanic or Latino, 92% White].

Results

On the Cognitive Function Index (CFI) participants endorsed higher concerns compared to SPs. Participant concerns were associated with older age, positive amyloid status, worse mood/anxiety, lower education, and lower exercise, whereas SP concerns were associated with older participant age, male gender of participant, positive amyloid status of participant, and worse participant-reported mood/anxiety.

Discussion

Findings suggest that modifiable/lifestyle factors (e.g., exercise, education) may be associated with participant concerns among cognitively unimpaired individuals and highlight the importance of further examining how modifiable factors impact participant- and SP-reported concerns, which may inform trial recruitment and clinical interventions.

Sleep Characteristics in Older Adults with Different Levels of Risk for Dementia: A Cross-sectional Study

BACKGROUND

Sleep problems are very prevalent in older adults, especially in those at risk for dementia. But the relationships between sleep parameters and subjective or objective cognitive decline are still inconclusive.

AIM

The study aimed to investigate the self-reported and objectively measured sleep characteristics in older adults with mild cognitive impairment (MCI) and subjective cognitive decline (SCD).

METHODS

This study adopted a cross-sectional design. We included older adults with SCD or MCI. Sleep quality was measured separately by the Pittsburgh sleep quality index (PSQI) and ActiGraph. Participants with SCD were divided into low, moderate, and high levels of SCD groups. Independent samples T-tests, one-way ANOVA, or nonparametric tests were used to compare the sleep parameters across groups. Covariance analyses were also performed to control the covariates.

RESULTS

Around half of the participants (45.9%) reported poor sleep quality (PSQI＜7), and 71.3% of participants slept less than 7 hours per night, as measured by ActiGraph. Participants with MCI showed shorter time in bed (TIB) (p＜0.05), a tendency of shorter total sleep time (TST) at night (p = 0.074) and for each 24-hour cycle (p = 0.069), compared to those with SCD. The high SCD group reported the highest PSQI total score and longest sleep latency than all the other three groups (p＜0.05). Both the MCI and high SCD groups had shorter TIB and TST for each 24-hour cycle than the low or moderate SCD groups. Besides, participants with multiple-domain SCD reported poorer sleep quality than those with single-domain SCD (p＜0.05).

CONCLUSION

Sleep dysregulation is prevalent in older adults with a risk for dementia. Our findings revealed that objectively measured sleep duration might be an early sign of MCI. Individuals with high levels of SCD demonstrated poorerself-perceived sleep quality and deserved more attention. Improving sleep quality might be a potential target to prevent cognitive decline for people with a risk for dementia.

Metabotropic glutamate receptor function and regulation of sleep-wake cycles

Metabotropic glutamate (mGlu) receptors are the most abundant family of G-protein coupled receptors and are widely expressed throughout the central nervous system (CNS). Alterations in glutamate homeostasis, including dysregulations in mGlu receptor function, have been indicated as key contributors to multiple CNS disorders. Fluctuations in mGlu receptor expression and function also occur across diurnal sleep-wake cycles. Sleep disturbances including insomnia are frequently comorbid with neuropsychiatric, neurodevelopmental, and neurodegenerative conditions. These often precede behavioral symptoms and/or correlate with symptom severity and relapse. Chronic sleep disturbances may also be a consequence of primary symptom progression and can exacerbate neurodegeneration in disorders including Alzheimer's disease (AD). Thus, there is a bidirectional relationship between sleep disturbances and CNS disorders; disrupted sleep may serve as both a cause and a consequence of the disorder. Importantly, comorbid sleep disturbances are rarely a direct target of primary pharmacological treatments for neuropsychiatric disorders even though improving sleep can positively impact other symptom clusters. This chapter details known roles of mGlu receptor subtypes in both sleep-wake regulation and CNS disorders focusing on schizophrenia, major depressive disorder, post-traumatic stress disorder, AD, and substance use disorder (cocaine and opioid). In this chapter, preclinical electrophysiological, genetic, and pharmacological studies are described, and, when possible, human genetic, imaging, and post-mortem studies are also discussed. In addition to reviewing the important relationships between sleep, mGlu receptors, and CNS disorders, this chapter highlights the development of selective mGlu receptor ligands that hold promise for improving both primary symptoms and sleep disturbances.

Subjective cognitive decline in Brazil: Prevalence and association with dementia modifiable risk factors in a population-based study

Introduction

Subjective cognitive decline (SCD) may be an early symptom of Alzheimer's disease. We aimed to estimate the prevalence of SCD in Brazil and its association with dementia modifiable risk factors.

Methods

We used data of 8138 participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based study that included clinical and demographic variables of individuals across the country. We calculated the prevalence of SCD and its association with dementia modifiable risk factors.

Results

We found that the prevalence of SCD in Brazil was 29.21% (28.22%-30.21%), varying according to region, sex, and age. SCD was strongly associated with hearing loss, low education, psychological distress, Brown/Pardo and Black races.

Discussion

The prevalence of SCD in Brazil is higher than in high-income countries. Brown/Black races and dementia modifiable risk factors were associated with SCD. Public strategies that target SCD may help mitigate the incidence of dementia.

The Application of Color Psychology in Community Health Environment Design

The topic of health has gained importance in today's society in the context of a healthy China. The success of community environmental design is intimately correlated with everyone's physical and mental health since it is the setting for people's daily lives. At present, although the facilities and equipment of the community environment in our country are improving day by day, the important role of color psychology in the community environment has been neglected. Color has always been a part of human life and a very important component of the community environment. When it comes to the design of communal environments, the color design of various areas will have variable degrees of influence on the psychological space and perspective of individuals. Therefore, the purpose of this paper is to investigate the application value of color psychology in the design of community health environments using color psychology as a scientific foundation. Additionally, the paper attempts to use color psychology as a scientific basis to study the thinking of health issues in the community environment. In addition, the results of the questionnaire survey are used to perform analysis and discussion in order to investigate the regular characteristics of the various research objects, as well as their preferences and psychological needs for color. This is done with the goal of providing empirical support for the improvement of the community environment and the health of the people living in it. In the end, the results of the questionnaire survey are compiled with four different design concepts. These design principles include functionality, naturalness, beauty, and safety. And the design intention and optimization strategy from the three directions the overall building, planting, and paving in the community healthy environment are then presented. This is done in order to create a colorful and comfortable healthy environment for the community life of people and to support the development of people's physical and mental health.

The association between sleep and suicidality in the presence and absence of depressive symptoms: A cross-sectional study in rural China

This study aimed to explore the association between sleep and suicidality in the presence and absence of depressive symptoms in the rural Chinese population. The research involved a cross-sectional survey conducted in Liuyang, China, between November 2010 and August 2011. A total of 2052 participants were surveyed (987 males and 1065 females). To investigate the mediating effect of depressive symptoms in the correlation between sleep quality and suicidality. The association between sleep quality and suicidality in the absence of depressive symptoms was also explored. Suicide risk was measured using the Mini-International Neuropsychiatric Interview subscale. The visual analog scale was used to assess sleep quality. Patient Health Questionnaire-9 and Patient Health Questionnaire-2, avoiding the overlap in sleep and suicidality assessments, were used for detecting depressive symptoms in participants. Depressive symptoms partially mediated the association between sleep quality and suicidality among rural adults. Furthermore, some participants did not exhibit depressive symptoms in this study yet still exhibited a risk for suicidality, with poor sleep quality contributing significantly to their suicidality even after adjusting for cofounders. Poor sleep quality significantly increases the likelihood of suicidality in the presence and absence of depressive symptoms in the rural Chinese population. Poor sleep quality could correlate with increased suicide risk independently of depressive symptoms.

Brain Photobiomodulation Improves Sleep Quality in Subjective Cognitive Decline: A Randomized, Sham-Controlled Study

Background: Sleep appears to be a sensitive biomarker that facilitates early detection and effective intervention for Alzheimer’s disease, while subjective cognitive decline (SCD) is a risk factor for Alzheimer’s disease. Prefrontal cortex atrophy is associated with both sleep disruption and cognitive decline. Transcranial brain photobiomodulation (PBM) therapy can enhance frontal cortex oxygen consumption, increasing frontal cortex mediated memory function. Objective: This study aimed to test whether PBM therapy targeting the frontal cortex could improve sleep and cognitive function in SCD. Methods: Fifty-eight SCDs were divided into the PBM group (N = 32) in which real light therapy was administered and a sham light therapy group (N = 26). All the participants received either real light or sham light therapy for 6 days consecutively, while the sleep data were recorded. The n-back task was employed to measure each participant’s working memory. Results: We found no differences in sleep efficiency change (F = 211, p = 0.279), REM stage percent change (F = 420, p = 0.91), and wake-up time (F = 212, p = 0.277) between the two groups. The sleep efficiency and REM were improved within the true light group on the fifth day. The true light group perform better than the control group in the n-back test, the accuracy was higher in the 2-back test (88.6% versus 79.6%, p = 0.001), and the reaction time in 1-back was shorter (544.80±202.00 versus 592.87±222.05, p = 0.003). Conclusion: After five days of PBM therapy targeting the prefrontal cortex, sleep efficiency and N-back cognitive performance were improved on the fifth day.

Assessment of the difference in depressive symptoms of the Korean adult population before and during the COVID-19 pandemic using a community health survey

BACKGROUND

The aim of this study was to evaluate the rate of depression during the COVID-19 pandemic compared to that during the prepandemic period.

METHODS

Data from participants in the Korean Community Health Survey in 2019 and 2020 aged ≥ 19 years old were analyzed. In total, the data of 223,306 participants from the 2020 group were compared with the data of 217,133 participants from the 2019 group regarding the experience and severity of depression. The experience of depression was surveyed in terms of a history of sadness or despair for ≥2 weeks in the last year. In addition, the PHQ-9 scores were used, and participants with PHQ-9 scores ≥10 were recategorized as having moderate to severe depression. The odds for depression of the 2020 group compared to the 2019 group based on the survey and PHQ-9 scores were calculated using simple or multiple logistic regression with complex sampling with weighted values.

RESULTS

The rate of depression experience was lower in the 2020 group than in the 2019 group. The odds of experiencing depression were lower in the 2020 group than in the 2019 group (adjusted odds ratio [aOR] = 0.95, 95% confidence intervals [95% CI] = 0.91-0.98, P = 0.004). The odds of moderate to severe depression were also lower in the 2020 group than in the 2019 group (aOR=0.92, 95% CI=0.88-0.97, P = 0.001).

CONCLUSION

The rate of depression experience was not higher during the COVID-19 pandemic than during the prepandemic period in Korea.

Gender and Racial/Ethnic Disparities in Social Determinants of Health and Subjective Cognitive Decline: The Mediating Role of Depression

Social determinants of health (SDOH) may be associated with subjective cognitive decline (SCD), which is a precursor for Alzheimer's disease. The main aims of the current study were to examine the association between SDOH and SCD; to determine if there is an indirect pathway among SDOH, depression, and SCD; and to examine the related gender and racial/ethnic disparities. Cross-sectional data were obtained from the 2017 Behavioral Risk Factor Surveillance System Survey (N = 6,509; 2,530 men and 3,978 women aged ≥45 years). Path analyses (stratified by gender and race) were used to determine the relationship between a SDOH index, depression, and SCD. After controlling for gender, age, income, education, employment, and other health-related behaviors, SDOH were positively associated with SCD among the overall population, men, and White populations. SDOH were associated with depression, and depression was associated with SCD among men, women, and White and Black populations. After adjustment for confounders, the indirect pathway among SDOH, depression, and SCD was statistically significant for men (β = 0.035, p < 0.001), women (β = 0.040, p < 0.001), White populations (β = 0.034, p < 0.001), and Black populations (β = 0.036, p = 0.026). Gender and racial/ethnic disparities existed in the relationship among SDOH, depression, and SCD. Future research should assess alternative mediational pathways between SDOH and SCD. [Journal of Gerontological Nursing, 48(2), 13-22.].

Association between quality and duration of sleep and subjective cognitive decline: a cross-sectional study in South Korea

Sleep is being emphasized as a factor that improves mental health and quality of life. Here, we aimed to investigate the association between the quality and duration of sleep and subjective cognitive decline in the Korean population. We used the 2018 Korean Community Health Survey data that are nationwide representative data collected by the Korea Centers for Disease Control and Prevention. Sleep quality was measured using the Korean version of Pittsburgh Sleep Quality Index. The study population comprised 206,719 individuals aged 19 years and over. We used multiple logistic regression for the analysis. Individuals of both sexes with poor sleep quality were more likely to experience subjective cognitive decline compared with the reference group (good sleep quality) (men, odds ratio (OR) = 1.97 [95% confidence interval (CI) 1.86-2.09]; women, OR = 1.75 [95% CI 1.67-1.84]). U-shape associations were found between sleep duration and subjective cognitive decline. Additionally, the presence of depressive symptom or stress and health-related behaviors, including smoking, drinking, and not walking, were high-risk factors for subjective cognitive decline. Our results indicate that poor sleep quality might contribute to subjective cognitive decline in the Korean population. We suggest the implementation of intervention measures for poor sleep behaviors to prevent cognitive decline.