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Kron JOZJ, Keenan RJ, Hoyer D, Jacobson LH. Orexin Receptor Antagonism: Normalizing Sleep Architecture in Old Age and Disease. Annu Rev Pharmacol Toxicol 2024; 64:359-386. [PMID: 37708433 DOI: 10.1146/annurev-pharmtox-040323-031929] [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] [Indexed: 09/16/2023]
Abstract
Sleep is essential for human well-being, yet the quality and quantity of sleep reduce as age advances. Older persons (>65 years old) are more at risk of disorders accompanied and/or exacerbated by poor sleep. Furthermore, evidence supports a bidirectional relationship between disrupted sleep and Alzheimer's disease (AD) or related dementias. Orexin/hypocretin neuropeptides stabilize wakefulness, and several orexin receptor antagonists (ORAs) are approved for the treatment of insomnia in adults. Dysregulation of the orexin system occurs in aging and AD, positioning ORAs as advantageous for these populations. Indeed, several clinical studies indicate that ORAs are efficacious hypnotics in older persons and dementia patients and, as in adults, are generally well tolerated. ORAs are likely to be more effective when administered early in sleep/wake dysregulation to reestablish good sleep/wake-related behaviors and reduce the accumulation of dementia-associated proteinopathic substrates. Improving sleep in aging and dementia represents a tremendous opportunity to benefit patients, caregivers, and health systems.
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Affiliation(s)
- Jarrah O-Z J Kron
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia;
| | - Ryan J Keenan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia;
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Daniel Hoyer
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia;
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia;
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Laura H Jacobson
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia;
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia;
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2
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Antonsdottir IM, Low DV, Chen D, Rabinowitz JA, Yue Y, Urbanek J, Wu MN, Zeitzer JM, Rosenberg PB, Friedman LF, Sheikh JI, Yesavage JA, Zipunnikov V, Spira AP. 24 h Rest/Activity Rhythms in Older Adults with Memory Impairment: Associations with Cognitive Performance and Depressive Symptomatology. Adv Biol (Weinh) 2023; 7:e2300138. [PMID: 37423973 DOI: 10.1002/adbi.202300138] [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: 04/07/2023] [Revised: 06/16/2023] [Indexed: 07/11/2023]
Abstract
Little is known about links of circadian rhythm alterations with neuropsychiatric symptoms and cognition in memory impaired older adults. Associations of actigraphic rest/activity rhythms (RAR) with depressive symptoms and cognition are examined using function-on-scalar regression (FOSR). Forty-four older adults with memory impairment (mean: 76.84 ± 8.15 years; 40.9% female) completed 6.37 ± 0.93 days of actigraphy, the Beck depression inventory-II (BDI-II), mini-mental state examination (MMSE) and consortium to establish a registry for Alzheimer's disease (CERAD) delayed word recall. FOSR models with BDI-II, MMSE, or CERAD as individual predictors adjusted for demographics (Models A1-A3) and all three predictors and demographics (Model B). In Model B, higher BDI-II scores are associated with greater activity from 12:00-11:50 a.m., 2:10-5:50 p.m., 8:40-9:40 p.m., 11:20-12:00 a.m., higher CERAD scores with greater activity from 9:20-10:00 p.m., and higher MMSE scores with greater activity from 5:50-10:50 a.m. and 12:40-5:00 p.m. Greater depressive symptomatology is associated with greater activity in midafternoon, evening, and overnight into midday; better delayed recall with greater late evening activity; and higher global cognitive performance with greater morning and afternoon activity (Model B). Time-of-day specific RAR alterations may affect mood and cognitive performance in this population.
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Affiliation(s)
- Inga M Antonsdottir
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, 21224, USA
| | - Dominique V Low
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Diefei Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, 21205, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Yiwei Yue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Jacek Urbanek
- Regeneron Pharmaceuticals Inc., Johns Hopkins University, 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Paul B Rosenberg
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, 21224, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Leah F Friedman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Javaid I Sheikh
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, 24144, Qatar
| | - Jerome A Yesavage
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Adam P Spira
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
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3
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Fernandes M, Chiaravalloti A, Nuccetelli M, Placidi F, Izzi F, Camedda R, Bernardini S, Sancesario G, Schillaci O, Mercuri NB, Liguori C. Sleep Dysregulation Is Associated with 18F-FDG PET and Cerebrospinal Fluid Biomarkers in Alzheimer's Disease. J Alzheimers Dis Rep 2023; 7:845-854. [PMID: 37662614 PMCID: PMC10473116 DOI: 10.3233/adr-220111] [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: 12/22/2022] [Accepted: 07/11/2023] [Indexed: 09/05/2023] Open
Abstract
Background Sleep impairment has been commonly reported in Alzheimer's disease (AD) patients. The association between sleep dysregulation and AD biomarkers has been separately explored in mild cognitive impairment (MCI) and AD patients. Objective The present study investigated cerebrospinal-fluid (CSF) and 18F-fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) biomarkers in MCI and AD patients in order to explore their association with sleep parameters measured with polysomnography (PSG). Methods MCI and AD patients underwent PSG, 18F-FDG-PET, and CSF analysis for detecting and correlating these biomarkers with sleep architecture. Results Thirty-five patients were included in the study (9 MCI and 26 AD patients). 18F-FDG uptake in left Brodmann area 31 (owing to the posterior cingulate cortex) correlated negatively with REM sleep latency (p = 0.013) and positively with REM sleep (p = 0.033). 18F-FDG uptake in the hippocampus was negatively associated with sleep onset latency (p = 0.041). Higher CSF orexin levels were associated with higher sleep onset latency (p = 0.042), Non-REM stage 1 of sleep (p = 0.031), wake after sleep onset (p = 0.028), and lower sleep efficiency (p = 0.045). CSF levels of Aβ42 correlated negatively with the wake bouts index (p = 0.002). CSF total-tau and phosphorylated tau levels correlated positively with total sleep time (p = 0.045) and time in bed (p = 0.031), respectively. Conclusion Sleep impairment, namely sleep fragmentation, REM sleep dysregulation, and difficulty in initiating sleep correlates with AD biomarkers, suggesting an effect of sleep on the pathological processes in different AD stages. Targeting sleep for counteracting the AD pathological processes represents a timely need for clinicians and researchers.
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Affiliation(s)
- Mariana Fernandes
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Marzia Nuccetelli
- Department of Clinical Biochemistry and Molecular Biology, University of Rome “Tor Vergata”, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
| | - Francesca Izzi
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
| | - Riccardo Camedda
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Sergio Bernardini
- Department of Clinical Biochemistry and Molecular Biology, University of Rome “Tor Vergata”, Rome, Italy
| | - Giuseppe Sancesario
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
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4
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Kopeć K, Szleszkowski S, Koziorowski D, Szlufik S. Glymphatic System and Mitochondrial Dysfunction as Two Crucial Players in Pathophysiology of Neurodegenerative Disorders. Int J Mol Sci 2023; 24:10366. [PMID: 37373513 DOI: 10.3390/ijms241210366] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Neurodegenerative diseases are a complex problem affecting millions of people around the world. The pathogenesis is not fully understood, but it is known that both insufficiency of the glymphatic system and mitochondrial disorders affect the development of pathology. It appears that these are not just two independent factors that coexist in the processes of neurodegeneration, but that they often interact and drive each other. Bioenergetics disturbances are potentially associated with the accumulation of protein aggregates and impaired glymphatic clearance. Furthermore, sleep disorders characteristic of neurodegeneration may impair the work of both the glymphatic system and the activity of mitochondria. Melatonin may be one of the elements linking sleep disorders with the function of these systems. Moreover, noteworthy in this context is the process of neuroinflammation inextricably linked to mitochondria and its impact not only on neurons, but also on glia cells involved in glymphatic clearance. This review only presents possible direct and indirect connections between the glymphatic system and mitochondria in the process of neurodegeneration. Clarifying the connection between these two areas in relation to neurodegeneration could lead to the development of new multidirectional therapies, which, due to the complexity of pathogenesis, seems to be worth considering.
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Affiliation(s)
- Kamila Kopeć
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Stanisław Szleszkowski
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Stanislaw Szlufik
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
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5
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Benca R, Herring WJ, Khandker R, Qureshi ZP. Burden of Insomnia and Sleep Disturbances and the Impact of Sleep Treatments in Patients with Probable or Possible Alzheimer's Disease: A Structured Literature Review. J Alzheimers Dis 2022; 86:83-109. [PMID: 35001893 PMCID: PMC9028660 DOI: 10.3233/jad-215324] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Sleep disturbances are frequent in Alzheimer’s disease (AD). Objective: To summarize the impact of sleep disturbances on AD patients and their caregivers and the effects of currently available sleep therapies. Methods: Published studies (January 1985–March 2020) assessing the burden associated with insomnia/sleep disturbances in the AD population and insomnia treatment effects were identified by searching PubMed, Embase, and Cochrane Library and screened against inclusion criteria. Results: 58 studies assessing patient and caregiver burden, institutionalization, and insomnia treatments in AD patients with sleep disturbances were identified. Sleep disturbances were associated with worse cognition, functional ability, and behavioral and neuropsychological functioning. Health status and quality of life of both patients and caregivers were reduced in the presence of sleep disturbances. Sleep disturbances were also associated with institutionalization. Although significant associations between sleep problems and clinical outcomes were apparent, there was generally no control for other influencing factors (e.g., cognitive status). Bright light and behavioral therapies as well as drugs showed some promise in AD patients, but studies were primarily small and limited data were available, particularly in regard to the effect on associated clinical burden. Conclusion: Sleep disturbances are a significant problem for AD patients and caregivers, associated with behavioral and psychological problems and cognitive decline. However, they remain poorly characterized and under-researched. As the global population is aging and AD is on thes rise, data from larger, prospective trials are required to fully understand the clinical correlates of sleep disturbances and the impact insomnia treatments can have.
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Affiliation(s)
- Ruth Benca
- University of California, Irvine, Irvine, CA, USA
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6
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Sleep deficiency as a driver of cellular stress and damage in neurological disorders. Sleep Med Rev 2022; 63:101616. [PMID: 35381445 PMCID: PMC9177816 DOI: 10.1016/j.smrv.2022.101616] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/23/2022]
Abstract
Neurological disorders encompass an extremely broad range of conditions, including those that present early in development and those that progress slowly or manifest with advanced age. Although these disorders have distinct underlying etiologies, the activation of shared pathways, e.g., integrated stress response (ISR) and the development of shared phenotypes (sleep deficits) may offer clues toward understanding some of the mechanistic underpinnings of neurologic dysfunction. While it is incontrovertibly complex, the relationship between sleep and persistent stress in the brain has broad implications in understanding neurological disorders from development to degeneration. The convergent nature of the ISR could be a common thread linking genetically distinct neurological disorders through the dysregulation of a core cellular homeostasis pathway.
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7
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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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8
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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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9
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Hüttenrauch M, Lopez-Noguerola JS, Castro-Obregón S. Connecting Mind-Body Therapy-Mediated Effects to Pathological Features of Alzheimer's Disease. J Alzheimers Dis 2021; 82:S65-S90. [PMID: 33044183 DOI: 10.3233/jad-200743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alzheimer's disease (AD) is a complex, multifactorial neurodegenerative disorder that represents a major and increasing global health challenge. In most cases, the first clinical symptoms of AD are preceded by neuropathological changes in the brain that develop years to decades before their onset. Therefore, research in the last years has focused on this preclinical stage of AD trying to discover intervention strategies that might, if implemented effectively, delay or prevent disease progression. Among those strategies, mind-body therapies such as yoga and meditation have gained increasing interest as complementary alternative interventions. Several studies have reported a positive impact of yoga and meditation on brain health in both healthy older adults and dementia patients. However, the underlying neurobiological mechanisms contributing to these effects are currently not known in detail. More specifically, it is not known whether yogic interventions, directly or indirectly, can modulate risk factors or pathological mechanisms involved in the development of dementia. In this article, we first review the literature on the effects of yogic practices on outcomes such as cognitive functioning and neuropsychiatric symptoms in patients with mild cognitive impairment and dementia. Then, we analyze how yogic interventions affect different risk factors as well as aspects of AD pathophysiology based on observations of studies in healthy individuals or subjects with other conditions than dementia. Finally, we integrate this evidence and propose possible mechanisms that might explain the positive effects of yogic interventions in cognitively impaired individuals.
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Affiliation(s)
- Melanie Hüttenrauch
- División de Neurosciencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Ciudad de México, México
| | - José Sócrates Lopez-Noguerola
- Área Académica de Gerontología, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca de Soto, México
| | - Susana Castro-Obregón
- División de Neurosciencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Ciudad de México, México
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10
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Figueiro MG, Sahin L, Kalsher M, Plitnick B, Rea MS. Long-Term, All-Day Exposure to Circadian-Effective Light Improves Sleep, Mood, and Behavior in Persons with Dementia. J Alzheimers Dis Rep 2020; 4:297-312. [PMID: 33024938 PMCID: PMC7504981 DOI: 10.3233/adr-200212] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Persons with Alzheimer's disease and related dementias (ADRD) frequently experience sleep-wake (circadian) cycle disturbances that lead them to remain awake at night, causing stress and fatigue for families and caregivers. Light therapy shows promise as a nonpharmacological treatment for regulating sleep in this population. OBJECTIVE We investigated the long-term impact of a circadian-effective lighting intervention on sleep, mood, and behavior problems in persons with ADRD. METHODS This 25-week clinical trial administered an all-day lighting intervention to 47 patients with ADRD in 9 senior-care facilities, employing wrist-worn actigraphy measures and standardized measures of sleep quality, mood, and behavior. RESULTS The intervention significantly improved Pittsburgh Sleep Quality Index scores, from an estimated mean±SEM of 11.89±0.53 at baseline to 5.36±0.63 at the end of the intervention. Additional improvements were noted for sleep efficiency data from actigraph measurements. The intervention significantly reduced Cornell Scale for Depression in Dementia scores (mean±SEM of 11.36±0.74 at baseline and 4.18±0.88 at the end of the intervention) and Cohen-Mansfield Agitation Inventory scores (mean±SEM of 47.10±1.98 at baseline and 35.33±2.23 at the end of the intervention). CONCLUSION A regular circadian-effective daytime lighting intervention can improve sleep at night and reduce depression and agitation in patients with dementia living in controlled environments. More importantly, the positive effects of the tailored lighting intervention on these outcomes appear to be cumulative over time.
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Affiliation(s)
| | - Levent Sahin
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Michael Kalsher
- Department of Cognitive Science, School of Humanities, Arts and Social Sciences, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Barbara Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Mark S. Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
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11
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Lee YF, Gerashchenko D, Timofeev I, Bacskai BJ, Kastanenka KV. Slow Wave Sleep Is a Promising Intervention Target for Alzheimer's Disease. Front Neurosci 2020; 14:705. [PMID: 32714142 PMCID: PMC7340158 DOI: 10.3389/fnins.2020.00705] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/11/2020] [Indexed: 12/22/2022] Open
Abstract
Alzheimer's disease (AD) is the major cause of dementia, characterized by the presence of amyloid-beta plaques and neurofibrillary tau tangles. Plaques and tangles are associated with sleep-wake cycle disruptions, including the disruptions in non-rapid eye movement (NREM) slow wave sleep (SWS). Alzheimer's patients spend less time in NREM sleep and exhibit decreased slow wave activity (SWA). Consistent with the critical role of SWS in memory consolidation, reduced SWA is associated with impaired memory consolidation in AD patients. The aberrant SWA can be modeled in transgenic mouse models of amyloidosis and tauopathy. Animal models exhibited slow wave impairments early in the disease progression, prior to the deposition of amyloid-beta plaques, however, in the presence of abundant oligomeric amyloid-beta. Optogenetic rescue of SWA successfully halted the amyloid accumulation and restored intraneuronal calcium levels in mice. On the other hand, optogenetic acceleration of slow wave frequency exacerbated amyloid deposition and disrupted neuronal calcium homeostasis. In this review, we summarize the evidence and the mechanisms underlying the existence of a positive feedback loop between amyloid/tau pathology and SWA disruptions that lead to further accumulations of amyloid and tau in AD. Moreover, since SWA disruptions occur prior to the plaque deposition, SWA disruptions may provide an early biomarker for AD. Finally, we propose that therapeutic targeting of SWA in AD might lead to an effective treatment for Alzheimer's patients.
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Affiliation(s)
- Yee Fun Lee
- Department of Neurology, MassGeneral Institute of Neurodegenerative Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Dmitry Gerashchenko
- Harvard Medical School/VA Boston Healthcare System, West Roxbury, MA, United States
| | - Igor Timofeev
- Department of Psychiatry and Neuroscience, School of Medicine, Université Laval, Québec, QC, Canada
- CERVO Brain Research Center, Québec, QC, Canada
| | - Brian J. Bacskai
- Department of Neurology, MassGeneral Institute of Neurodegenerative Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Ksenia V. Kastanenka
- Department of Neurology, MassGeneral Institute of Neurodegenerative Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
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12
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Pak VM, Onen SH, Bliwise DL, Kutner NG, Russell KL, Onen F. Sleep Disturbances in MCI and AD: Neuroinflammation as a Possible Mediating Pathway. Front Aging Neurosci 2020; 12:69. [PMID: 32457592 PMCID: PMC7227443 DOI: 10.3389/fnagi.2020.00069] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/26/2020] [Indexed: 12/11/2022] Open
Abstract
Mild cognitive impairment (MCI) and Alzheimer's disease (AD) affect a high proportion of the elderly population with an increasing prevalence. Sleep disturbances are frequent in those with MCI and AD. This review summarizes existing research on sleep disturbances and neuroinflammation in MCI and AD. Although strong evidence supports various pathways linking sleep and AD pathology, the temporal direction of this central relationship is not yet known. Improved understanding of sleep disturbance and neuroinflammation in MCI and AD may aid in the identification of targets for their prevention.
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Affiliation(s)
- Victoria M. Pak
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - S.-Hakki Onen
- Centre de Sommeil, Hôpital de la Croix-Rousse, Lyon, France
- INSERM U128, Université de Lyon, Lyon, France
| | - Donald L. Bliwise
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Nancy G. Kutner
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Katherine L. Russell
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Fannie Onen
- CHU Bichat–Claude-Bernard, AP-HP, Service de Gériatrie, Paris, France
- CESP & INSERM 1178 Université Paris Sud, Paris, France
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13
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Chang YC, Kim JY. Therapeutic implications of circadian clocks in neurodegenerative diseases. J Neurosci Res 2019; 98:1095-1113. [PMID: 31833091 DOI: 10.1002/jnr.24572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Circadian clocks, endogenous oscillators generating daily biological rhythms, have important roles in the nervous system to control diverse cellular processes-not only in the suprachiasmatic nucleus (SCN), where the master clocks reside to synchronize all circadian clocks in the body but also in other non-SCN areas. Accumulating evidence has shown relationships between circadian abnormalities (e.g., sleep disturbances and abnormal rest-activity rhythms) and disease progressions in various neurodegenerative diseases, including Alzheimer's (AD) and Parkinson's (PD) disease. Although circadian abnormalities were frequently considered as consequences of disease onsets, recent studies suggest altered circadian clocks as risk factors to develop neurodegenerative diseases via altered production or clearance rates of toxic metabolites like amyloid β. In this review, we will summarize circadian clock-related pathologies in the most common neurodegenerative diseases in the central nervous system, AD and PD. Then, we will introduce the current clinical trials to rescue circadian abnormalities in AD and PD patients. Finally, a discussion about how to improve targeting circadian clocks to increase treatment efficiencies and specificities will be followed. This discussion will provide insight into circadian clocks as potential therapeutic targets to attenuate onsets and progressions of neurodegenerative diseases.
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Affiliation(s)
- Yu Chen Chang
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Jin Young Kim
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon, Hong Kong
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14
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Chen JH, Lauderdale DS. Cognitive Function, Consent for Participation, and Compliance With Wearable Device Protocols in Older Adults. J Gerontol A Biol Sci Med Sci 2019; 74:269-273. [PMID: 29579176 DOI: 10.1093/gerona/gly032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
Abstract
Background Population-based studies of older adults increasingly use wearable devices to measure activity and sleep. Whether cognitive impairment reduces consent and compliance has not been assessed. Methods In the context of a nationally representative cohort of community-dwelling adults aged 62-90, individuals were invited to participate in a sleep and activity substudy that required wearing a wrist actigraph for 72 consecutive hours. Cognitive function in the parent study was assessed with the survey adaptation of the Montreal Cognitive Assessment, and individuals were categorized as normal, mild cognitive impairment, or dementia. Participants were asked to press an event marker on the actigraph when they started trying to fall asleep and when they awoke each day. Logistic and negative binomial regressions were used to link cognitive status to nonconsent, returning usable data, wearing the actigraph three full days, ever taking the device off-wrist during the 3-day study period, and pushing the event markers, controlling for demographics. Results Cognitive status was not associated with nonconsent, returning usable data, off-wrist, or missing days. However, individuals classified with dementia were more likely to miss bedtime and wake-up event markers. Individuals classified as mild cognitive impairment were more likely to miss wake-up event markers. Conclusions Impaired cognition does not seem to be a barrier to compliance with simply wearing a device but may affect compliance with additional action such as pressing event markers.
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Affiliation(s)
- Jen-Hao Chen
- Department of Sociology and Criminology, Howard University, Washington, District of Columbia
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15
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Alzheimer's disease: Neurotransmitters of the sleep-wake cycle. Neurosci Biobehav Rev 2019; 105:72-80. [PMID: 31377219 DOI: 10.1016/j.neubiorev.2019.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/22/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022]
Abstract
With aging, our sleeping pattern alters. Elderly often wake unrested because their sleep time and sleep efficacy is reduced. In Alzheimer's disease (AD) patients, these alterations are even more pronounced and may further aggravate cognitive decline. Therefore, sleep disturbances greatly impact self-care ability, caregiver exhaustion and institutionalization rate. Reestablishing an effective sleep-wake cycle in these patients still remains an unresolved challenge, partly because sleep physiology is quite complex and multiple neurotransmitter systems contribute to a single process. Gaining a better understanding of sleep physiology will be crucial for further research. Conjointly, animal models, along with a multidisciplinary approach, will be of great value to establish a common ground between AD and sleep disturbances and work towards a potential therapeutic application.
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16
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Sleep architecture changes in the APP23 mouse model manifest at onset of cognitive deficits. Behav Brain Res 2019; 373:112089. [PMID: 31325518 DOI: 10.1016/j.bbr.2019.112089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/26/2019] [Accepted: 07/16/2019] [Indexed: 01/16/2023]
Abstract
Alzheimer's disease (AD), which accounts for most of the dementia cases, is, aside from cognitive deterioration, often characterized by the presence of non-cognitive symptoms such as activity and sleep disturbances. AD patients typically experience increased sleep fragmentation, excessive daytime sleepiness and night-time insomnia. Here, we sought to investigate the link between sleep architecture, cognition and amyloid pathology in the APP23 amyloidosis mouse model for AD. By means of polysomnographic recordings the sleep-wake cycle of freely-moving APP23 and wild-type (WT) littermates of 3, 6 and 12 months of age was examined. In addition, ambulatory cage activity was assessed by interruption of infrared beams surrounding the home cage. To assess visuo-spatial learning and memory a hidden-platform Morris-type Water Maze (MWM) experiment was performed. We found that sleep architecture is only slightly altered at early stages of pathology, but significantly deteriorates from 12 months of age, when amyloid plaques become diffusely present. APP23 mice of 12 months old had quantitative reductions of NREM and REM sleep and were more awake during the dark phase compared to WT littermates. These findings were confirmed by increased ambulatory cage activity during that phase of the light-dark cycle. No quantitative differences in sleep parameters were observed during the light phase. However, during this light phase, the sleep pattern of APP23 mice was more fragmented from 6 months of age, the point at which also cognitive abilities started to be affected in the MWM. Sleep time also positively correlated with MWM performance. We also found that spectral components in the EEG started to alter at the age of 6 months. To conclude, our results indicate that sleep architectural changes arise around the time the first amyloid plaques start to form and cognitive deterioration becomes apparent. These changes start subtle, but gradually worsen with age, adequately mimicking the clinical condition.
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17
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Shi Y, Fang YY, Wei YP, Jiang Q, Zeng P, Tang N, Lu Y, Tian Q. Melatonin in Synaptic Impairments of Alzheimer's Disease. J Alzheimers Dis 2019; 63:911-926. [PMID: 29710712 DOI: 10.3233/jad-171178] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease (AD) underlies dementia for millions of people worldwide with no effective treatment. The dementia of AD is thought stem from the impairments of the synapses because of their critical roles in cognition. Melatonin is a neurohormone mainly released by the pineal gland in a circadian manner and it regulates brain functions in various manners. It is reported that both the melatonin deficit and synaptic impairments are present in the very early stage of AD and strongly contribute to the progress of AD. In the mammalian brains, the effects of melatonin are mainly relayed by two of its receptors, melatonin receptor type 1a (MT1) and 1b (MT2). To have a clear idea on the roles of melatonin in synaptic impairments of AD, this review discussed the actions of melatonin and its receptors in the stabilization of synapses, modulation of long-term potentiation, as well as their contributions in the transmissions of glutamatergic, GABAergic and dopaminergic synapses, which are the three main types of synapses relevant to the synaptic strength. The synaptic protective roles of melatonin in AD treatment were also summarized. Regarding its protective roles against amyloid-β neurotoxicity, tau hyperphosphorylation, oxygenation, inflammation as well as synaptic dysfunctions, melatonin may be an ideal therapeutic agent against AD at early stage.
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Affiliation(s)
- Yan Shi
- Department of Pathology and Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Disease of National Education Ministry and Hubei Province, Institute for Brain Research, Huazhong University of Science and Technology, Wuhan, China
| | - Ying-Yan Fang
- Department of Pathology and Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Disease of National Education Ministry and Hubei Province, Institute for Brain Research, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Ping Wei
- Department of Pathology and Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Disease of National Education Ministry and Hubei Province, Institute for Brain Research, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Jiang
- Integrated TCM and Western Medicine Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zeng
- Department of Pathology and Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Disease of National Education Ministry and Hubei Province, Institute for Brain Research, Huazhong University of Science and Technology, Wuhan, China
| | - Na Tang
- Department of Pathology and Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Disease of National Education Ministry and Hubei Province, Institute for Brain Research, Huazhong University of Science and Technology, Wuhan, China
| | - Youming Lu
- Department of Pathology and Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Disease of National Education Ministry and Hubei Province, Institute for Brain Research, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Tian
- Department of Pathology and Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Disease of National Education Ministry and Hubei Province, Institute for Brain Research, Huazhong University of Science and Technology, Wuhan, China
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18
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Wilfling D, Dichter MN, Trutschel D, Köpke S. Prevalence of Sleep Disturbances in German Nursing Home Residents with Dementia: A Multicenter Cross-Sectional Study. J Alzheimers Dis 2019; 69:227-236. [DOI: 10.3233/jad-180784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
| | - Martin N. Dichter
- German Center of Neurodegenerative Diseases, Witten, Germany and School of Nursing Science, Witten/Herdecke University, Germany
| | - Diana Trutschel
- German Center of Neurodegenerative Diseases, Witten, Germany
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
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19
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Duncan MJ. Interacting influences of aging and Alzheimer's disease on circadian rhythms. Eur J Neurosci 2019; 51:310-325. [DOI: 10.1111/ejn.14358] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Marilyn J. Duncan
- Department of NeuroscienceUniversity of Kentucky Medical School Lexington Kentucky
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20
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Brzecka A, Leszek J, Ashraf GM, Ejma M, Ávila-Rodriguez MF, Yarla NS, Tarasov VV, Chubarev VN, Samsonova AN, Barreto GE, Aliev G. Sleep Disorders Associated With Alzheimer's Disease: A Perspective. Front Neurosci 2018; 12:330. [PMID: 29904334 PMCID: PMC5990625 DOI: 10.3389/fnins.2018.00330] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/30/2018] [Indexed: 12/12/2022] Open
Abstract
Sleep disturbances, as well as sleep-wake rhythm disturbances, are typical symptoms of Alzheimer's disease (AD) that may precede the other clinical signs of this neurodegenerative disease. Here, we describe clinical features of sleep disorders in AD and the relation between sleep disorders and both cognitive impairment and poor prognosis of the disease. There are difficulties of the diagnosis of sleep disorders based on sleep questionnaires, polysomnography or actigraphy in the AD patients. Typical disturbances of the neurophysiological sleep architecture in the course of the AD include deep sleep and paradoxical sleep deprivation. Among sleep disorders occurring in patients with AD, the most frequent disorders are sleep breathing disorders and restless legs syndrome. Sleep disorders may influence circadian fluctuations of the concentrations of amyloid-β in the interstitial brain fluid and in the cerebrovascular fluid related to the glymphatic brain system and production of the amyloid-β. There is accumulating evidence suggesting that disordered sleep contributes to cognitive decline and the development of AD pathology. In this mini-review, we highlight and discuss the association between sleep disorders and AD.
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Affiliation(s)
- Anna Brzecka
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Leszek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Nagendra S. Yarla
- Department of Biochemistry and Bioinformatics, School of Life Sciences, Institute of Science, Gandhi Institute of Technology and Management University, Visakhapatnam, India
| | - Vadim V. Tarasov
- Institute for Pharmaceutical Science and Translational Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vladimir N. Chubarev
- Institute for Pharmaceutical Science and Translational Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anna N. Samsonova
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Chernogolovka, Russia
| | - George E. Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Chernogolovka, Russia
- GALLY International Biomedical Research and Consulting LLC, San Antonio, TX, United States
- School of Health Science and Healthcare Administration, University of Atlanta, Johns Creek, GA, United States
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21
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Harding A, Robinson S, Crean S, Singhrao SK. Can Better Management of Periodontal Disease Delay the Onset and Progression of Alzheimer's Disease? J Alzheimers Dis 2018; 58:337-348. [PMID: 28453484 DOI: 10.3233/jad-170046] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A risk factor relationship exists between periodontal disease and Alzheimer's disease (AD) via tooth loss, and improved memory following dental intervention. This links the microbial contribution from indigenous oral periodontal pathogens to the manifestation of chronic conditions, such as AD. Here, we use Porphyromonas gingivalis infection to illustrate its effect on mental health. P. gingivalis infection, in its primary sub-gingival niche, can cause polymicrobial synergy and dysbiosis. Dysbiosis describes the residency of select commensals from the oral cavity following co-aggregation around the dominant keystone pathogen, such as P. gingivalis, to gain greater virulence. The initial process involves P. gingivalis disturbing neutrophil mediated innate immune responses in the healthy gingivae and then downregulating adaptive immune cell differentiation and development to invade, and subsequently, establish new dysbiotic bacterial communities. Immune responses affect the host in general and functionally via dietary adjustments caused by tooth loss. Studies from animals orally infected with P. gingivalis confirm this bacterium can transmigrate to distant organ sites (the brain) and contribute toward peripheral and intracerebral inflammation, and compromise vascular and microvascular integrity. In another study, P. gingivalis infection caused sleep pattern disturbances by altering glial cell light/dark molecular clock activity, and this, in turn, can affect the clearance of danger associated molecular patterns, such as amyloid-β, via the glymphatic system. Since P. gingivalis can transmigrate to the brain and modulate organ-specific inflammatory innate and adaptive immune responses, this paper explores whether better management of indigenous periodontal bacteria could delay/prevent the onset and/or progression of dementia.
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22
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Van Erum J, Van Dam D, De Deyn PP. Sleep and Alzheimer's disease: A pivotal role for the suprachiasmatic nucleus. Sleep Med Rev 2017; 40:17-27. [PMID: 29102282 DOI: 10.1016/j.smrv.2017.07.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Alzheimer's disease (AD), which accounts for most of the dementia cases, is, aside from cognitive deterioration, often characterized by the presence of non-cognitive symptoms. Society is desperately in need for interventions that alleviate the economic and social burden related to AD. Circadian dysrhythmia, one of these symptoms in particular, immensely decreases the self-care ability of AD patients and is one of the main reasons of caregiver exhaustion. Studies suggest that these circadian disturbances form the root of sleep-wake problems, diagnosed in more than half of AD patients. Sleep abnormalities have generally been considered merely a consequence of AD pathology. Recent evidence suggests that a bidirectional relationship exists between sleep and AD, and that poor sleep might negatively impact amyloid burden, as well as cognition. The suprachiasmatic nucleus (SCN), the main circadian pacemaker, is subjected to several alterations during the course of the disease. Its functional deterioration might fulfill a crucial role in the relation between AD pathophysiology and the development of sleep abnormalities. This review aims to give a concise overview of the anatomy and physiology of the SCN, address how AD pathology precisely impacts the SCN and to what degree these alterations can contribute to the progression of the disease.
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Affiliation(s)
- Jan Van Erum
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Peter Paul De Deyn
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen (UMCG), Groningen, The Netherlands; Department of Neurology, Memory Clinic of Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.
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23
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Sleep in older adults and in subjects with dementia. Z Gerontol Geriatr 2017; 50:603-608. [PMID: 28721544 DOI: 10.1007/s00391-017-1289-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
The neuronal structures for the regulation of sleep and wakefulness are located in the brain. This complex network is vulnerable to numerous factors, most importantly neurodegenerative diseases and drugs. The macrostructure and microstructure of sleep change with age. These changes are more pronounced in subjects with dementia. Sleep disorders in subjects with dementia may be independent of dementia or caused by dementia. Furthermore, epidemiological studies reveal that sleep disorders per se may induce dementia by reduction of cerebral clearance of beta-amyloids. The population attributable risk (PAR) of sleep disturbances to the incidence of dementia is estimated to be about 15%; therefore, management of sleep disturbances in older adults and subjects with dementia gives the opportunity of an impact on incidence and course of dementia. Sleep history should be taken from each individual and obvious sleep disturbances, especially sleep apnea, should be managed according to current guidelines. Future studies that concern the incidence and the management of dementia must take into account sleep and sleep disturbances.
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24
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Kabeshita Y, Adachi H, Matsushita M, Kanemoto H, Sato S, Suzuki Y, Yoshiyama K, Shimomura T, Yoshida T, Shimizu H, Matsumoto T, Mori T, Kashibayashi T, Tanaka H, Hatada Y, Hashimoto M, Nishio Y, Komori K, Tanaka T, Yokoyama K, Tanimukai S, Ikeda M, Takeda M, Mori E, Kudo T, Kazui H. Sleep disturbances are key symptoms of very early stage Alzheimer disease with behavioral and psychological symptoms: a Japan multi-center cross-sectional study (J-BIRD). Int J Geriatr Psychiatry 2017; 32:222-230. [PMID: 27001907 DOI: 10.1002/gps.4470] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Sleep disturbances in Alzheimer disease (AD) may affect behavioral and psychological symptoms of dementia (BPSD). Our aim was to elucidate the associations between sleep disturbances and other BPSD at different stages of AD. METHODS This investigation was part of a multicenter-retrospective study in Japan (J-BIRD). Eligible for final analyses were 684 AD patients. Global severity of dementia was estimated using the Clinical Dementia Rating (CDR) scale. BPSD were assessed using the Neuropsychiatric Inventory (NPI). We analyzed the relationships between sleep disturbances and BPSD at different stages of AD according to the CDR score. RESULTS Among the 684 AD patients, 146 (21.3%) had sleep disturbances. Patients with very early AD (CDR 0.5) and sleep disturbances had significantly more BPSD than those without sleep disturbances, as indicated by the higher prevalence of the following four NPI items: anxiety, euphoria, disinhibition, and aberrant motor behavior. In AD at CDR 2, (moderate AD) only one NPI item (irritability) was affected, while none was affected at CDR 1 (mild AD) and 3 (severe AD). Multiple regression analyses were performed in those with AD having various CDR scores. At CDR 0.5, the presence of sleep disturbances was associated with a high total NPI score (β = 0.32, p < 0.001). However, other factors, including cognitive decline, age, gender, and years of education, were not significantly associated with the NPI score. At CDR 1 and 2, no factor was significantly related to BPSD. CONCLUSION Sleep disturbances were strongly associated with other BPSD in the very early stage of AD. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yasunobu Kabeshita
- Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.,Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,The Sleep Medical Center of Osaka University Hospital, Suita, Japan
| | - Hiroyoshi Adachi
- Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.,Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,The Sleep Medical Center of Osaka University Hospital, Suita, Japan
| | - Masateru Matsushita
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.,Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideki Kanemoto
- Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunsuke Sato
- Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukiko Suzuki
- Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Yoshiyama
- Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuo Shimomura
- Department of Rehabilitation Medicine, Akita Prefectural Centre of Rehabilitation and Psychiatric Medicine, Daisen, Japan
| | - Taku Yoshida
- Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Hideaki Shimizu
- Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Teruhisa Matsumoto
- Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Takaaki Mori
- Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Tetsuo Kashibayashi
- Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yutaka Hatada
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshiyuki Nishio
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenjiro Komori
- Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan.,Zaidan-Niihama Hospital, Niihama, Japan
| | - Toshihisa Tanaka
- Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazumasa Yokoyama
- Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
| | - Satoshi Tanimukai
- Department of Community and Geriatric Nursing, Ehime University Graduate School of Medicine, Toon, Japan
| | - Manabu Ikeda
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masatoshi Takeda
- Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.,Aino University, Ibaraki, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kudo
- Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.,Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroaki Kazui
- Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Tanev KS, Winokur A, Pitman RK. Sleep Patterns and Neuropsychiatric Symptoms in Hospitalized Patients With Dementia. J Neuropsychiatry Clin Neurosci 2017; 29:248-253. [PMID: 28294708 PMCID: PMC5578477 DOI: 10.1176/appi.neuropsych.16090166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The authors examined 28 dementia inpatients receiving treatment as usual. Beginning-to-end differences in neuropsychiatric symptoms and actigraphic sleep patterns were measured. Using a mixed-model, the authors regressed neuropsychiatric symptoms on average sleep minutes (between-subjects effect) and each night's deviation from average (within-subject effect). Sleep did not significantly differ from beginning to end of participation, whereas neuropsychiatric symptoms did. Average sleep minutes predicted average neuropsychiatric symptoms (p=0.002), but each night's deviation from the average did not predict next day's symptoms (p=0.90). These findings raise questions about the immediate benefits of treating sleep-wake disturbances on neuropsychiatric symptoms in hospitalized inpatients with dementias.
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Affiliation(s)
- Kaloyan S. Tanev
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andrew Winokur
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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26
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Kayser-Jones J, Schell ES. Staffing and the mealtime experience of nursing home residents on a Special Care Unit. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759701200204] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As part of a study that examined the social, cultural, clinical, and environmental factors that influence eating behavior in nursing homes, the effect of staffing on the mealtime experience of residents in a Special Care Unit (SCU) for dementia patients was investigated. An adequate staff to resident ratio, the presence of a knowledgeable and skillful nursing assistant who was an excellent role model, and sufficient supervision positively affected the experience of residents, making lunchtime a pleasant and nourishing event. In the evening, however; overtaxed and poorly supervised aides resorted to strategies that made dinnertime a hurried, unpleasant experience and put residents under duress. A discussion of how to provide extra help at mealtime, improve the education and training of staff, and enhance supervision at mealtime is presented.
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Affiliation(s)
- Jeanie Kayser-Jones
- University of California, San Francisco; Department of Physiological Nursing & Medical Anthropology Program, San Francisco, California
| | - Ellen S. Schell
- Department of Physiological Nursing, University of California, San Francisco, California
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Capezuti E, Strumpf N, Evans L, Maislin G. Outcomes of nighttime physical restraint removal for severely impaired nursing home residents. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759901400302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is ample evidence that physical restraint reduction does not lead to increased falls or injuries. This study tests the effect of removing nighttime restraints by comparing two groups: Restrained in bed at pre- but not postintervention (n = 51), or restrained in bed at both pre- and post-intervention (n = 11). No differences in nighttime fall rates between the two groups were detected. Nighttime physical restraint removal does not lead to increases in falls from bed in older nursing home residents. Although markedly reduced in nursing homes, restraint use remains a common practice among hospitalized older adults. We should continue to focus efforts on developing new, individualized approaches to reduce risk of falling from bed among frail elders.
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Affiliation(s)
| | | | | | - Greg Maislin
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Kutner NG, Brown PJ, Stavisky RC, Clark WS, Green RC. “Friendship” Interactions and Expression of Agitation among Residents of a Dementia Care Unit. Res Aging 2016. [DOI: 10.1177/0164027500222005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
“Friendships” (ongoing interpersonal interactions) and agitated behavior were studied among 59 residents of a dementia special care unit; most residents had mild to moderate cognitive impairment. Behavior scan data were recorded by trained observers over six months. Three scans per hour were conducted, seven days a week, between 9 a.m. and 9 p.m., producing more than 17,000 observations. A marginal model for binary longitudinal data was developed to associate covariates with repeated observations of agitation, the dependent variable; generalized estimating equations were used to estimate regression parameters. Friendship behavior was significantly associated with (less) observed agitation in this group of dementia residents, controlling for additional variables expected to predict agitation. Opportunity for self-initiated interpersonal engagement may contribute significantly to the well-being of moderately impaired dementia residents. Repeated over-time assessments are important in understanding factors related to expression of problem behaviors in this population.
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29
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Gnanasekaran G. "Sundowning" as a biological phenomenon: current understandings and future directions: an update. Aging Clin Exp Res 2016; 28:383-92. [PMID: 26243434 DOI: 10.1007/s40520-015-0431-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/23/2015] [Indexed: 02/07/2023]
Abstract
The clinical phenomenon of early evening disruptive behavior also called "Sundowning" in elderly patients has been largely reported in the medical literature without a consistent diagnosis and criteria to define this phenomenon. The current understandings of sundowning are incomplete and current treatment strategies have relied heavily on use of antipsychotic medications, despite side effects and limited evidence to justify their use. A comprehensive understanding of the biogenesis of this phenomenon and mechanistic changes from oxidative pathways may provide novel information on completing the sundowning puzzle. Future studies could examine the utility of natural factors in reviving neuronal energy loss and altering the oxidative pathways might be safe and additional options in development of treatment models for this behavioral disorder.
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Figueiro MG, Hunter CM, Higgins P, Hornick T, Jones GE, Plitnick B, Brons J, Rea MS. Tailored Lighting Intervention for Persons with Dementia and Caregivers Living at Home. Sleep Health 2015; 1:322-330. [PMID: 27066526 PMCID: PMC4822719 DOI: 10.1016/j.sleh.2015.09.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Light therapy has shown promise as a nonpharmacological treatment to help regulate abnormal sleep-wake patterns and associated behavioral issues prevalent among individuals diagnosed with Alzheimer's disease and related dementia (ADRD). The present study investigated the effectiveness of a lighting intervention designed to increase circadian stimulation during the day using light sources that have high short-wavelength content and high light output. METHODS Thirty-five persons with ADRD and 34 caregivers completed the 11-week study. During week 1, subjective questionnaires were administered to the study participants. During week 2, baseline data were collected using Daysimeters and actigraphs. Researchers installed the lighting during week 3, followed by 4 weeks of the tailored lighting intervention. During the last week of the lighting intervention, Daysimeter, actigraph and questionnaire data were again collected. Three weeks after the lighting intervention was removed, a third data collection (post-intervention assessment) was performed. RESULTS The lighting intervention significantly increased circadian entrainment, as measured by phasor magnitude and sleep efficiency, as measured by actigraphy data, and significantly reduced symptoms of depression in the participants with ADRD. The caregivers also exhibited an increase in circadian entrainment during the lighting intervention; a seasonal effect of greater sleep efficiency and longer sleep duration was also found for caregivers. CONCLUSIONS An ambient lighting intervention designed to increase daytime circadian stimulation can be used to increase sleep efficiency in persons with ADRD and their caregivers, and may also be effective for other populations such as healthy older adults with sleep problems, adolescents, and veterans with traumatic brain injury.
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Affiliation(s)
| | - Claudia M. Hunter
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Patricia Higgins
- School of Nursing, Case Western Reserve University, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas Hornick
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Geoffrey E. Jones
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Barbara Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Jennifer Brons
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Mark S. Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
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31
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Kang D, Lim HK, Jung WS, Jeong JH, Kim TW, Han JH, Lee CU, Hong SC. Sleep and Alzheimer’s Disease. SLEEP MEDICINE RESEARCH 2015. [DOI: 10.17241/smr.2015.6.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Sloane PD, Figueiro M, Garg S, Cohen LW, Reed D, Williams CS, Preisser J, Zimmerman S. Effect of home-based light treatment on persons with dementia and their caregivers. LIGHTING RESEARCH & TECHNOLOGY (LONDON, ENGLAND : 2001) 2015; 47:161-176. [PMID: 26273229 PMCID: PMC4530796 DOI: 10.1177/1477153513517255] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Sleep disorders are problematic for persons with dementia and their family caregivers. This randomized controlled trial with crossover evaluated the effects of an innovative blue-white light therapy on 17 pairs of home-dwelling persons with dementia and their caregivers. Subjects with dementia received blue-white light and control ('red-yellow' light) for six weeks separated by a four-week washout. Neither actigraphic nor most self-reported sleep measures significantly differed for subjects with dementia. For caregivers, both sleep and role strain improved. No evidence of retinal light toxicity was observed. Six weeks of modest doses of blue-white light appear to improve sleep in caregivers but not in persons with dementia. Greater or prolonged circadian stimulation may be needed to determine if light is an effective treatment for persons with dementia.
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Affiliation(s)
- PD Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - S Garg
- Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - LW Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - CS Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Preisser
- Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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33
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Sleep and Alzheimer's disease. Sleep Med Rev 2015; 19:29-38. [DOI: 10.1016/j.smrv.2014.03.007] [Citation(s) in RCA: 234] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 03/03/2014] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
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34
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Sundowning syndrome in aging and dementia: Research in mouse models. Exp Neurol 2013; 243:67-73. [DOI: 10.1016/j.expneurol.2012.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/30/2012] [Accepted: 05/08/2012] [Indexed: 11/22/2022]
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35
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Zhou QP, Jung L, Richards KC. The management of sleep and circadian disturbance in patients with dementia. Curr Neurol Neurosci Rep 2012; 12:193-204. [PMID: 22314860 DOI: 10.1007/s11910-012-0249-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep and circadian disturbances are common among patients with dementia. Symptomatic manifestations vary according to dementia subtype, with one commonly shared pattern--the irregular sleep-wake rhythm (ISWR), a circadian disorder characterized by an absence of the sleepwake cycle’s circadian synchronization. Hypothesized mechanisms of circadian rhythm disturbance include suprachiasmatic nucleus (SCN) circadian pacemaker damage, pineal gland and melatonin secretion alterations, and reduced zeitbeigers and decreased input to the SCN. Management options include prescribed sleep/wake scheduling, light therapy, melatonin, physical and social activity, and mixed modality. The mixed-modality approach is the most effective method in treating ISWR. Pharmacologic interventions are controversial, with no evidence supporting their effectiveness while associated with multiple side effects. They should be used with caution and only be considered as short-term therapy. All treatment strategies should be individualized to achieve the best outcomes.
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Affiliation(s)
- Qiuping Pearl Zhou
- School of Nursing, College of Health and Human Services, George Mason University, 4400 University Drive, MS: 3C4, Fairfax, VA 22030-4400, USA.
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36
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Bliwise DL, Mercaldo ND, Avidan AY, Boeve BF, Greer SA, Kukull WA. Sleep disturbance in dementia with Lewy bodies and Alzheimer's disease: a multicenter analysis. Dement Geriatr Cogn Disord 2011; 31:239-46. [PMID: 21474933 PMCID: PMC3085031 DOI: 10.1159/000326238] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Evidence suggests that patients with dementia with Lewy bodies (DLB) may have more nocturnal sleep disturbance than patients with Alzheimer's disease (AD). We sought to confirm such observations using a large, prospectively collected, standardized, multicenter-derived database, i.e. the National Alzheimer's Coordinating Center Uniform Data Set. METHODS Nocturnal sleep disturbance (NSD) data, as characterized by the Neuropsychiatric Inventory Questionnaire (NPI-Q), were derived from 4,531 patients collected between September 2005 and November 2008 from 32 National Institute on Aging participating AD centers. Patient and informant characteristics were compared between those with and without NSD by dementia diagnosis (DLB and probable AD). Finally, a logistic regression model was created to quantify the association between NSD status and diagnosis while adjusting for these patient/informant characteristics, as well as center. RESULTS NSD was more frequent in clinically diagnosed DLB relative to clinically diagnosed AD (odds ratio = 2.93, 95% confidence interval = 2.22-3.86). These results were independent from the gender of the patient or informant, whether the informant lived with the patient, and other patient characteristics, such as dementia severity, depressive symptoms, and NPI-Q-derived measures of hallucinations, delusions, agitation and apathy. In AD, but not DLB, patients, NSD was associated with more advanced disease. Comorbidity of NSD with hallucinations, agitation and apathy was higher in DLB than in AD. There was also evidence that the percentage of DLB cases with NSD showed wide variation across centers. CONCLUSION As defined by the NPI-Q, endorsement of the nocturnal behavior item by informants is more likely in patients with DLB when compared to AD, even after the adjustment of key patient/informant characteristics.
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Affiliation(s)
- Donald L. Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA,*Donald L. Bliwise, PhD, Department of Neurology, Emory University School of Medicine, Wesley Woods Health Center, 1841 Clifton Road, Room 509, Atlanta, GA 30329 (USA), Tel. +1 404 728 4751, E-Mail
| | - Nathaniel D. Mercaldo
- National Alzheimer's Coordinating Center, University of Washington, Seattle, Wash., USA,Department of Biostatistics, Vanderbilt University Nashville, Tenn., USA
| | - Alon Y. Avidan
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, Calif., USA
| | - Bradley F. Boeve
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minn., USA
| | - Sophia A. Greer
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA
| | - Walter A. Kukull
- National Alzheimer's Coordinating Center, University of Washington, Seattle, Wash., USA
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Cole CS, Richards KC, Smith-Olinde L, Roberson PK, Sullivan DH. Tone-induced sleep fragmentation in persons with Alzheimer's disease: a feasibility study. Biol Res Nurs 2010; 11:229-35. [PMID: 19617235 PMCID: PMC2848358 DOI: 10.1177/1099800409339206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sleep fragmentation increases as Alzheimer's disease (AD) progresses. Its effects on cognition, specifically vigilant attention, are profoundly important because vigilant attention is thought to be the first step in memory acquisition. To our knowledge, no one has experimentally studied the effect of sleep fragmentation on vigilant attention in persons with AD. Therefore, this study piloted an experimental method using sound (tones produced by an audiometer) to induce sleep fragmentation. Participants enrolled in the University of Arkansas for Medical Sciences Memory Research Center ([MRC] n = 4) underwent one night of undisturbed and one of fragmented sleep. All participants tolerated the earphone needed for the tone-induced sleep fragmentation (TISF) method, and we were able to score awakenings in real time. However, only 50% of tones produced awakenings. The findings suggest that this experimental method is feasible for use in persons with mild AD. Based on the results, we will increase the duration, intensity, and frequency of tones delivered for optimal result.
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Affiliation(s)
- Catherine S Cole
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Harper DG, Stopa EG, Kuo-Leblanc V, McKee AC, Asayama K, Volicer L, Kowall N, Satlin A. Dorsomedial SCN neuronal subpopulations subserve different functions in human dementia. Brain 2008; 131:1609-17. [PMID: 18372313 DOI: 10.1093/brain/awn049] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The suprachiasmatic nuclei (SCN) are necessary and sufficient for the maintenance of circadian rhythms in primate and other mammalian species. The human dorsomedial SCN contains populations of non-species-specific vasopressin and species-specific neurotensin neurons. We made time-series recordings of core body temperature and locomotor activity in 19 elderly, male, end-stage dementia patients and 8 normal elderly controls. Following the death of the dementia patients, neuropathological diagnostic information and tissue samples from the hypothalamus were obtained. Hypothalamic tissue was also obtained from eight normal control cases that had not had activity or core temperature recordings previously. Core temperature was analysed for parametric, circadian features, and activity was analysed for non-parametric and parametric circadian features. These indices were then correlated with the degree of degeneration seen in the SCN (glia/neuron ratio) and neuronal counts from the dorsomedial SCN (vasopressin, neurotensin). Specific loss of SCN neurotensin neurons was associated with loss of activity and temperature amplitude without increase in activity fragmentation. Loss of SCN vasopressin neurons was associated with increased activity fragmentation but not loss of amplitude. Evidence for a circadian rhythm of vasopressinergic activity was seen in the dementia cases but no evidence was seen for a circadian rhythm in neurotensinergic activity. These results provide evidence that the SCN is necessary for the maintenance of the circadian rhythm in humans, information on the role of neuronal subpopulations in subserving this function and the utility of dementia in elaborating brain-behaviour relationships in the human.
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Affiliation(s)
- David G Harper
- Geriatric Psychiatry Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
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Sack RL, Auckley D, Auger RR, Carskadon MA, Wright KP, Vitiello MV, Zhdanova IV. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review. Sleep 2008; 30:1484-501. [PMID: 18041481 DOI: 10.1093/sleep/30.11.1484] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Disorder (DSPD), Free-Running Disorder (FRD) and Irregular Sleep-Wake Rhythm ISWR). METHODS A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. RESULTS A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of CRSDs. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications. CONCLUSION Circadian rhythm science has also pointed the way to rational interventions for CRSDs and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.
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Affiliation(s)
- Robert L Sack
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR, USA
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Wu YH, Swaab DF. Disturbance and strategies for reactivation of the circadian rhythm system in aging and Alzheimer's disease. Sleep Med 2007; 8:623-36. [PMID: 17383938 DOI: 10.1016/j.sleep.2006.11.010] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 11/09/2006] [Accepted: 11/11/2006] [Indexed: 12/15/2022]
Abstract
Circadian rhythm disturbances, such as sleep disorders, are frequently seen in aging and are even more pronounced in Alzheimer's disease (AD). Alterations in the biological clock, the suprachiasmatic nucleus (SCN), and the pineal gland during aging and AD are considered to be the biological basis for these circadian rhythm disturbances. Recently, our group found that pineal melatonin secretion and pineal clock gene oscillation were disrupted in AD patients, and surprisingly even in non-demented controls with the earliest signs of AD neuropathology (neuropathological Braak stages I-II), in contrast to non-demented controls without AD neuropathology. Furthermore, a functional disruption of the SCN was observed from the earliest AD stages onwards, as shown by decreased vasopressin mRNA, a clock-controlled major output of the SCN. The observed functional disconnection between the SCN and the pineal from the earliest AD stage onwards seems to account for the pineal clock gene and melatonin changes and underlies circadian rhythm disturbances in AD. This paper further discusses potential therapeutic strategies for reactivation of the circadian timing system, including melatonin and bright light therapy. As the presence of melatonin MT1 receptor in the SCN is extremely decreased in late AD patients, supplementary melatonin in the late AD stages may not lead to clear effects on circadian rhythm disorders.
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Affiliation(s)
- Ying-Hui Wu
- Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
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Abstract
It is important that we identify factors that could lead to interventions to slow cognitive decline in people with Alzheimer's disease. One potentially modifiable factor in Alzheimer's disease is disturbed sleep. The effect of disturbed sleep on cognition is of profound importance in people with Alzheimer's disease because disturbed sleep may worsen memory complaints. Therefore, the purpose of this article is to provide an updated review of literature that describes the impact of disturbed sleep on cognition in healthy populations and discuss the implications that this relationship has for people with Alzheimer's disease and their formal and informal caregivers.
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Affiliation(s)
- Catherine S Cole
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Dowling GA, Mastick J, Hubbard EM, Luxenberg JS, Burr RL. Effect of timed bright light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. Int J Geriatr Psychiatry 2005; 20:738-43. [PMID: 16035127 PMCID: PMC2387133 DOI: 10.1002/gps.1352] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Disturbances in rest-activity rhythm are prominent and disabling symptoms in Alzheimer's disease (AD). Nighttime sleep is severely fragmented and daytime activity is disrupted by multiple napping episodes. In most institutional environments, light levels are very low and may not be sufficient to entrain the circadian clock to the 24-hour day. METHOD The purpose of this randomized clinical trial was to test the effectiveness of timed bright light therapy in reducing rest-activity (circadian) disruption in institutionalized patients with AD. The experimental groups received either morning (9.30-10.30 am) or afternoon (3.30-4.30 pm) bright light exposure ( > or = 2500 lux in gaze direction) Monday through Friday for 10 weeks. The control group received usual indoor light (150-200 lux). Nighttime sleep, daytime wake, and rest-activity parameters were determined by actigraphy. Repeated measures analysis of variance was employed to test the primary study hypotheses. RESULTS Seventy institutionalized subjects with AD (mean age 84) completed the study. No significant differences in actigraphy-based measures of nighttime sleep or daytime wake were found between groups. Subjects in either experimental light condition evidenced a significantly (p < 0.01) more stable rest-activity rhythm acrophase over the 10-week treatment period compared to the control subjects whose rhythm phase delayed by over two hours. CONCLUSIONS One hour of bright light, administered to subjects with AD either in the morning or afternoon, did not improve nighttime sleep or daytime wake compared to a control group of similar subjects. However, exposure to one-hour of bright light in either the morning or afternoon may provide sufficient additional input to the circadian pacemaker to facilitate entrainment to the 24-hour day.
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Staedt J, Stoppe G. Treatment of rest-activity disorders in dementia and special focus on sundowning. Int J Geriatr Psychiatry 2005; 20:507-11. [PMID: 15920710 DOI: 10.1002/gps.1307] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Dowling GA, Hubbard EM, Mastick J, Luxenberg JS, Burr RL, Van Someren EJW. Effect of morning bright light treatment for rest-activity disruption in institutionalized patients with severe Alzheimer's disease. Int Psychogeriatr 2005; 17:221-36. [PMID: 16050432 PMCID: PMC2387132 DOI: 10.1017/s1041610205001584] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Disturbances in rest-activity rhythm are prominent and disabling symptoms in Alzheimer's disease (AD). Nighttime sleep is severely fragmented and daytime activity is disrupted by multiple napping episodes. In most institutional environments, light levels are very low and may not be sufficient to enable the circadian clock to entrain to the 24-hour day. The purpose of this randomized, placebo-controlled, clinical trial was to test the effectiveness of morning bright light therapy in reducing rest-activity (circadian) disruption in institutionalized patients with severe AD. METHOD Subjects (n = 46, mean age 84 years) meeting the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke--the Alzheimer's Disease and Related Disorders Association) AD diagnostic criteria were recruited from two large, skilled nursing facilities in San Francisco, California. The experimental group received one hour (09:30-10:30) of bright light exposure (> or = 2500 lux in gaze direction) Monday through Friday for 10 weeks. The control group received usual indoor light (150-200 lux). Nighttime sleep efficiency, sleep time, wake time and number of awakenings and daytime wake time were assessed using actigraphy. Circadian rhythm parameters were also determined from the actigraphic data using cosinor analysis and nonparametric techniques. Repeated measures analysis of variance (ANOVA) was used to test the primary study hypotheses. RESULTS AND CONCLUSION Although significant improvements were found in subjects with aberrant timing of their rest-activity rhythm, morning bright light exposure did not induce an overall improvement in measures of sleep or the rest-activity in all treated as compared to control subjects. The results indicate that only subjects with the most impaired rest-activity rhythm respond significantly and positively to a brief (one hour) light intervention.
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Affiliation(s)
- Glenna A Dowling
- University of California, San Francisco, Department of Physiological Nursing, 2 Koret Way, Room N631, San Francisco, CA 94143-0610, USA.
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Haesler EJ. Effectiveness of strategies to manage sleep in residents of aged care facilities. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1479-6988.2004.00010.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Singer C, Tractenberg RE, Kaye J, Schafer K, Gamst A, Grundman M, Thomas R, Thal LJ. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease. Sleep 2004; 26:893-901. [PMID: 14655926 PMCID: PMC4418658 DOI: 10.1093/sleep/26.7.893] [Citation(s) in RCA: 228] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the safety and efficacy of 2 dose formulations of melatonin for the treatment of insomnia in patients with Alzheimer's disease. DESIGN A multicenter, randomized, placebo-controlled clinical trial of 2 dose formulations of oral melatonin coordinated by the National Institute of Aging-funded Alzheimer's Disease Cooperative Study. Subjects with Alzheimer's disease and nighttime sleep disturbance were randomly assigned to 1 of 3 treatment groups: placebo, 2.5-mg slow-release melatonin, or 10-mg melatonin. SETTING Private homes and long-term care facilities. PARTICIPANTS 157 individuals were recruited by 36 Alzheimer's disease research centers. Subjects with a diagnosis of Alzheimer's disease were eligible if they averaged less than 7 hours of sleep per night (as documented by wrist actigraphy) and had 2 or more episodes per week of nighttime awakenings reported by the caregiver. MEASUREMENTS Nocturnal total sleep time, sleep efficiency, wake-time after sleep onset, and day-night sleep ratio during 2- to 3-week baseline and 2-month treatment periods. Sleep was defined by an automated algorithmic analysis of wrist actigraph data. RESULTS No statistically significant differences in objective sleep measures were seen between baseline and treatment periods for the any of the 3 groups. Nonsignificant trends for increased nocturnal total sleep time and decreased wake after sleep onset were observed in the melatonin groups relative to placebo. Trends for a greater percentage of subjects having more than a 30-minute increase in nocturnal total sleep time in the 10-mg melatonin group and for a decline in the day-night sleep ratio in the 2.5-mg sustained-release melatonin group, compared to placebo, were also seen. On subjective measures, caregiver ratings of sleep quality showed improvement in the 2.5-mg sustained-release melatonin group relative to placebo. There were no significant differences in the number or seriousness of adverse events between the placebo and melatonin groups. CONCLUSIONS Based on actigraphy as an objective measure of sleep time, melatonin is not an effective soporific agent in people with Alzheimer's disease.
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Affiliation(s)
- Clifford Singer
- Department of Psychiatry, Oregon Health & Science University, Portland, USA.
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Haesler EJ. Effectiveness of strategies to manage sleep in residents of aged care facilities. ACTA ACUST UNITED AC 2004; 2:1-107. [PMID: 27820000 DOI: 10.11124/01938924-200402040-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The promotion of sleep in older adults is a significant issue in high-level residential aged care facilities, with as many as 67% of residents experiencing disruptions to their sleep patterns. Not only do health concerns such as cognitive impairment, pain and incontinence impact upon this population's sleep quality and quantity, but environmental factors including noise, light and night-time nursing care also affect sleep of those residing in institutions. In order to address the issue of sleep disruption, assessment and diagnosis of sleep problems and implementation of interventions that are effective in promoting sleep are essential. OBJECTIVES The objective of this review was to determine the most effective tools for the assessment and diagnosis of sleep in older adults in high-level aged care. The review also sought to determine the most effective strategies for the promotion of sleep in this population. Outcome measures for this review were: indicators of improved sleep quality and quantity, including an improvement in daytime functioning and improved night-time sleep; reduction in use of hypnotics and sedatives; and increased satisfaction with sleep. SEARCH STRATEGY A literature search was performed using the following databases for the years 1993-2003: AgeLine, APAIS Health, CINAHL, Cochrane Library, Current Contents, Dissertation Abstracts International, Embase, Medline, Proquest, PsycInfo, Science Citations Index. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. SELECTION CRITERIA The review was limited to papers addressing sleep diagnosis, assessment and/or management in adults aged 65 or over who were residing in high-level aged care. The review included randomised controlled trials (RCTs) and, due to the limited number of RCTs available, non-RCTs, cohort and case control studies and qualitative research were also considered for inclusion. Research was included if it addressed the assessment, diagnosis or management of sleep using outcome measure of improved night-time sleep or daytime function, improvements in resident satisfaction with sleep or reduction in medication use associated with sleep. The types of interventions considered by this review were alternative therapies including massage, aromatherapy and medicinal herbs; behavioural or cognitive interventions; biochemical interventions; environmental interventions; pharmacological interventions and related nocturnal interventions such as continence care. Instruments and strategies to diagnose and assess the sleep of older high-level care residents, including objective and subjective assessment tools, were considered by this review. DATA COLLECTION AND ANALYSIS All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Papers were grouped according to the type of intervention or type of assessment tool used and findings were presented in a narrative summary. FINDINGS Wrist actigraphy was found to be the most accurate objective sleep assessment tool for use in the population of interest, and issues surrounding its use are presented. Although no subjective sleep assessment tools were identified in this review, the evidence suggested that subjective reports of sleep quality are an important consideration in sleep assessment. Evidence suggested that behavioural observations may be an effective assessment strategy when conducted on a frequent basis. The review found no evidence on the effectiveness of any assessment tools for the diagnosis of specific sleep problems in older adults. The use of multidisciplinary strategies including reduction of environmental noise, reduction of night-time nursing care that disrupts sleep and daytime activity is likely to be the most effective strategy for the promotion of sleep in older high-level care residents. The use of sedating medications did not appear to have a substantial effect in promoting sleep, and health practitioners in high-level aged care should consider their use cautiously.
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Affiliation(s)
- Emily J Haesler
- Australian Centre for Evidence Based Aged Care (a collaborating centre of the Joanna Briggs Institute), La Trobe University, Melbourne, Victoria, Australia
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