Correlation Between Lifestyle Patterns and Cognitive Function Among Community-Dwelling Older Chinese Adults in the Pre-Dementia Stages: A Latent Class Analysis

Lifestyle activity engagement is a modifiable factor for cognitive decline. We aimed to identify lifestyle patterns (LPs) among community-dwelling older adults in the pre-dementia stages and to explore the links between LPs, cognitive function, and individual characteristics. 702 older Chinese adults were recruited. Three LPs were identified by latent class analysis: active aging lifestyle pattern (AALP), leisure lifestyle pattern (LLP), and work-centered lifestyle pattern (WLP). AALP refers to participation in various activities that are meaningful to individuals and benefit their well-being. LLP is the pattern of activities aimed at recreation. WLP refers to the LP where individuals are most likely to engage in work-related activities. However, only AALP is protected against mild cognitive impairment (MCI). Multinomial logistic regression models revealed the differences in individual characteristics among participants with different LPs, indicating the importance of tailored intervention strategies. As a protective factor against MCI, AALP should be highlighted in community-based care.

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

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

Poor sleep quality is an important modifiable risk factor for dementia: Population attributable fraction of poor sleep in a Brazilian population-based study

OBJECTIVES

The populational impact of poor sleep quality and the risk of dementia is unclear. We analyzed the Population Attributable Fraction (PAF) of poor sleep quality for dementia, and its association with other two sleep parameters through self-reported and single questions collected in a large-scale Brazilian cohort (ELSI-Brazil).

METHODS

A subset of the ELSI-Brazil with complete responses to sleep quality was retrieved for this study. This is a large representative sample of the Brazilian elderly population with an extensive assessment of sociodemographic and health risk variables. Prevalence of poor sleep quality was estimated according to the complex sample design, and its PAF was measured using a meta-analytic relative risk. A total of 6024 (56.3% women, mean 62.8 ± 9.5 years of age) individuals had complete responses.

RESULTS

The prevalence of poor sleep quality was 24.9% (95%CI 23%-26%), and the PAF of poor sleep quality including other 10 modifiable risk factors of dementia was 52.5% in Brazil. Secondary analyses identified that sleep quality, restorative sleep and sleep drug usage varied considerably according to age ranges, race, and gender.

CONCLUSIONS

Poor sleep quality is an important populational modifiable risk factor for dementia in Brazil. Targeted interventions may provide an important impact in preventing dementia in low- and middle-income countries.

Sleep patterns and awareness of the consequences of sleep deprivation in Saudi Arabia

PURPOSE

Sleep deprivation is a growing challenge in modern society and places a burden on people's physical and mental well-being. However, only a few studies have investigated sleep patterns and awareness of the associated risks of sleep deprivation in Middle Eastern countries. This study aimed to explore these issues in adults in Saudi Arabia.

METHODS

This was a quantitative cross-sectional study. We collected information on the participants' demographic characteristics, sleep hours, and sense of feeling sleep-deprived over the previous 3 months regardless of sleep duration. Current knowledge of the health consequences associated with chronic sleep deprivation and attitudes toward seeking in-person health care for sleep deprivation symptoms were additionally assessed.

RESULTS

Among 1449 adults, only 41% of the participants slept for the recommended duration for adults of 7 h or more. However, 70% reported feeling sleep-deprived at least some of the time regardless of their sleep duration. Smokers, students, and those on sleep medications were more likely to report feeling sleep-deprived. Most participants (strongly) agreed that chronic sleep deprivation had a negative effect on their health (92%) and social (88%) and professional lives (91%), yet only 10% of our sample had visited a doctor for their sleep deprivation symptoms.

CONCLUSIONS

We found a high level of sleep deprivation among residents of Saudi Arabia and a strong awareness of the association between chronic sleep deprivation and negative consequences, yet a lower awareness of the association with specific medical comorbidities. Our findings also suggested a lack of health care engagement among sleep-deprived participants.

Effect of sleep ambient music on sleep quality and mental health in college students: a self-controlled study

To verify the effect of sleep ambient music intervention (SAMI) on sleep quality and mental status of college students, and to further explore the minimum effective duration of SAMI, this study was designed as a pre-and post-intervention self-controlled exploratory study. Participants were subjected to a one-week no-intervention test, then 4 weeks of music intervention followed. Subjective sleep quality data were collected using the Pittsburgh Sleep Quality Index (PSQI); objective sleep quality data were collected with Actigraphy; and mental status data were collected using the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory-II (BDI-II). Data were analyzed and processed using mixed-effects models and repeated measures. The results showed that compared with the no-intervention week, college students' subjective sleep quality, objective sleep onset latency (SOL), trait anxiety, and depression symptom were reduced at week 1; week 2; week 3; week 4 under SAMI; state anxiety of college students at week 3 and week 4 under SAMI were also reduced. And there were differences in sleep quality among college students of different genders too. Compared with females, males had worse sleep efficiency (SE), shorter total sleep time (TST), and more awaking times (AT). In addition, 3 days was the minimum effective length for SAMI to shorten objective SOL, and 2 days was the minimum effective length to shorten the subjective SOL of college students. The findings of this study suggest that SAMI can improve subjective sleep quality, shorten objective SOL, and reduce anxiety and depression in college students. Interventions for more than 3 days had a significant effect on shortening SOL and long-term effects seemed to emerge after 3 weeks.

Sleep Disturbances and Dementia Risk in Older Adults: Findings From 10 Years of National U.S. Prospective Data

INTRODUCTION

Previous research has identified a link between sleep disturbances and cognitive impairment; however, no study has examined this relationship using a national United States sample. This study examines how multiple longitudinal measures of sleep disturbances (sleep-initiation insomnia, sleep-maintenance insomnia, sleep-medication usage) are associated with dementia risk.

METHODS

Ten annual waves (2011-2020) of prospective cohort data from a nationally representative U.S. sample of adults aged ≥65 years were analyzed from the National Health and Aging Trends Study. Sleep disturbances were converted into a longitudinal score and measured as sleep-initiation insomnia (trouble falling asleep in 30 minutes), sleep-maintenance insomnia (trouble falling asleep after waking up early), and sleep-medication usage (taking medication to help sleep). Cox regression models analyzed time to dementia diagnosis for a sample of 6,284 respondents.

RESULTS

In the unadjusted model, sleep-initiation insomnia was significantly associated with a 51% increased dementia risk (hazard ratio=1.51, 95% CI=1.19, 1.90). Adjusted for sociodemographics, sleep-medication usage was significantly associated with a 30% increased dementia risk (adjusted hazard ratio=1.30, 95% CI=1.08-1.56). Adjusted for sociodemographics and health, sleep-maintenance insomnia was significantly associated with a 40% decreased dementia risk (adjusted hazard ratio=0.60, 95% CI=0.46, 0.77).

CONCLUSIONS

These findings suggest that sleep-initiation insomnia and sleep-medication usage may elevate dementia risk. On the basis of the current evidence, sleep disturbances should be considered when assessing the risk profile for dementia. Future research is needed to examine other sleep disturbance measures and to explore the mechanisms for decreased dementia risk among older adults with sleep-maintenance insomnia.

Subjective cognitive decline in patients with Parkinson's disease: an updated review

Cognitive impairment in patients with Parkinson's disease (PD) worsens the prognosis of PD and increases caregivers' burden and economic consequences. Recently, subjective cognitive decline (SCD), which refers to self-reported cognitive decline without detectable objective cognitive dysfunction, has been regarded as an at-risk state of mild cognitive impairment (MCI) and a prodromal stage for dementia in Alzheimer's disease (AD). However, studies on PD-SCD have thus far been scarce, and at present there is no consensus regarding the definition of SCD nor a gold standard as an evaluation tool. The present review aimed to look for an association between PD-SCD and objective cognitive function and found that PD with SCD occurred with brain metabolic changes, which were consistent with early aberrant pathological changes in PD. Moreover, PD patients with SCD were likely to progress to future cognitive impairment. It is necessary to establish a guideline for the definition and evaluation of SCD in PD. A larger sample size and more longitudinal investigations are needed to verify the predictive effectiveness of PD-SCD and to detect earlier subtle cognitive decline before MCI.

Recurrent prescription of sleep medication among primary care patients with type 2 diabetes: an observational study of real-world registry data

BACKGROUND

Little knowledge exists on the prevalence of recurrent sleep medication prescriptions among primary care patients with type 2 diabetes (T2D). Our aims were to examine the prevalence of recurrent sleep medication prescriptions and to elucidate the most often prescribed sleep medications in a Finnish primary care T2D population.

METHODS

The study examined 4,508 T2D patients who consulted a primary health care center between 2011 and 2019 in Rovaniemi, Finland. All the data were retrieved from patient records, and recurrent sleep medication was defined as two or more prescriptions within the study period. We used the Chi-square and Kruskal-Wallis tests to compare patients who did and did not have recurrent sleep medication prescriptions.

RESULTS

Altogether 28.1% of the T2D patients had been prescribed recurrent sleep medication. Benzodiazepine-like medication, melatonin, and mirtazapine were most often prescribed (to 56.9%, 44.4%, and 35.8%, respectively). Only 22.0% of the patients with recurrent sleep medication prescriptions had been diagnosed with a sleep disorder.

CONCLUSIONS

Recurrent sleep medication prescriptions are frequent among primary care T2D patients. It seems that sleep disorders are underdiagnosed in relation to this. Primary care clinicians should carefully estimate the need for sleep medication when treating T2D patients' sleep problems and emphasize the diagnostic patterns of sleep problems.

The Interplay Among Natural Menopause, Insomnia, and Cognitive Health: A Population-Based Study

PURPOSE

The interrelationships among age at menopause, sleep, and brain health have been insufficiently studied. This study sought to examine the influence of age at natural menopause and insomnia symptoms on long-term cognitive function among US women.

PATIENTS AND METHODS

Our study included a nationally representative cohort of US adults age 50+ from the Health and Retirement Study (2008-2018). We restricted this cohort to 5880 women age 50+, from a diverse racial and ethnic groups. Age at menopause was retrieved from baseline (2008) for women having natural menopause. Five questions were used to identify women with insomnia symptoms (2010 and 2012): trouble falling asleep, nighttime awakenings, early morning awakenings, feelings of nonrestorative sleep, and use of sleep aids. A battery of four neuropsychological tests was conducted biennially (years) to evaluate cognitive function. Longitudinal associations between age at natural menopause and cognitive function were estimated with mixed effects models with a random intercept. Insomnia symptoms were examined as potential mediators or modifiers in the pathway between age at menopause and cognition.

RESULTS

One year earlier in age at menopause was associated with a 0.49 lower mean in composite cognitive score, in any given survey year (adjusted p = 0.002). Earlier age at menopause was associated with higher risk of developing insomnia symptoms (eg, trouble falling asleep OR = 0.97; 95% CI: 0.96, 0.99), and insomnia symptoms were associated with worse cognitive performance (eg, trouble falling asleep, beta = -0.5, p-value = 0.02). Therefore, insomnia symptoms could potentially mediate the association between age at natural menopause and cognition.

CONCLUSION

Earlier age at menopause is associated with a lower score in cognitive performance. This association may be mediated by insomnia symptoms. Our findings spotlight that among women who experience early menopause, there is the need for studies of sleep-based interventions to mitigate cognitive decline.

Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients

In acutely hospitalized older patients (≥65 years), the association between mild cognitive impairment (MCI) and malnutrition is poorly described. We hypothesized that (1) MCI is associated with nutritional status on admission and after discharge; (2) MCI is associated with a change in nutritional status; and (3) a potential association is partly explained by frailty, comorbidity, medication use, and age. We combined data from a randomized controlled trial (control group data) and a prospective cohort study (ClinicalTrials.gov: NCT01964482 and NCT03052192). Nutritional status was assessed on admission and follow-up using the Mini Nutritional Assessment—Short Form. MCI or intact cognition (noMCI) was classified by three cognitive performance tests at follow-up. Data on frailty, comorbidity, medication use, and age were drawn from patient journals. MCI (n = 42) compared to noMCI (n = 47) was associated with poorer nutritional status with an average difference of −1.29 points (CI: −2.30; −0.28) on admission and −1.64 points (CI: −2.57; −0.70) at 4-week follow-up. Only age influenced the estimates of −0.85 (CI: −1.86; 0.17) and −1.29 (CI: −2.25; −0.34), respectively. In acutely hospitalized older patients, there is an association between MCI and poorer nutritional status upon admission and four weeks after discharge. The association is partly explained by higher age.

Association between Blood Glucose Control and Subjective Cognitive Decline in Korean Patients with Diabetes Aged over 50 Years

This study aimed to investigate the association between blood glucose control and subjective cognitive decline in adult patients with diabetes. Using the 2018 data from the community health survey, we included 18,789 patients with diabetes aged ≥50 years who had complete responses recorded. Blood glucose control was the independent variable, and subjective cognitive decline was the dependent variable. Multivariable logistic regression analysis was used to analyze the association between blood glucose control and subjective cognitive decline. Multivariable logistic regression analysis showed that blood glucose control was inversely associated with subjective cognitive decline in patients with diabetes. Patients with uncontrolled blood glucose levels had higher odds of subjective cognitive decline than those with controlled blood glucose levels (odds ratio = 1.22; 95% confidence interval: 1.10, 1.34). Our findings suggest that patients with diabetes may demonstrate subjective cognitive decline if their blood glucose levels are not well-controlled.

Paradoxical relationship between subjective and objective cognition: the role of sleep

STUDY OBJECTIVES

Subjective memory complaints and objective cognitive dysfunction are common in aging populations, however research investigating the associations between them is inconclusive. Given the high prevalence of sleep complaints in middle-aged/older adults, this research tested whether objective cognition interacted with sleep parameters in its associations with subjective cognition.

METHODS

Cognitively healthy adults aged 50+ completed the Pittsburgh Sleep Quality Index, Cognitive Failures Questionnaire (CFQ) and cognitive tasks: Stroop, Sternberg, and Posner cueing. Multiple regression and simple slope analyses examined whether objective cognition interacted with sleep parameters in its associations with subjective memory.

RESULTS

Stroop performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, better Stroop performance (faster reaction time, RT-control trials) was associated with more memory complaints at worst and average, but not best sleep efficiency. Additionally, faster RT was associated with more memory complaints only for worst sleep disturbance. Similarly, Sternberg performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, higher proportion correct was associated with more memory complaints only at worst sleep efficiency and sleep disturbance. Finally, Posner performance and sleep disturbance had an interactive association with CFQ-memory. Faster exogenous orienting was associated with more memory complaints only for worst sleep disturbance.

CONCLUSIONS

Objective cognition interacts with sleep efficiency and sleep disturbances in its associations with subjective memory in mid-to-late life. Findings suggest sleep fragmentation plays a role in the discrepant relationship between objective and subjective cognition. Future studies should investigate this relationship in aging populations with sleep disorders and/or cognitive impairments.

Older Adults' Subjective Cognitive Decline Correlated with Subjective but Not Objective Sleep: A Mediator Role of Depression

This study examined the relationship between older adults' subjective versus objective sleep and subjective cognitive decline (SCD), and explored the role of depression on this association. One hundred and four community-dwelling older adults underwent a week of actigraphic sleep monitoring, and completed a series of neuropsychological screeners. Older adults'SCD score was positively correlated with subjective insomnia, but not with objective sleep parameters. Further mediation modeling revealed that older adults'depression mediated the association between subjective insomnia and SCD. Subjective sleep, rather than objective sleep, may be a more sensitive indicator for older adults' SCD, with depression symptoms appearing to account for most of the variance. These findings extend our perspective on the relationship between sleep disruption and cognitive decline, and highlight the necessity of early targeted interventions on sleep to reduce the risk of cognitive impairment in the elderly with SCD.

Hot-water bathing before bedtime and shorter sleep onset latency are accompanied by a higher distal-proximal skin temperature gradient in older adults

STUDY OBJECTIVES

Passive body heating in controlled settings could shorten sleep onset latency (SOL). The hypothesized mechanism is vasodilation-induced heat loss before bedtime. However, this evidence is based on small sample-sized studies in specific populations. Thus, we analyzed the association of hot-water bathing and its before-bedtime timing with SOL and heat loss in a large study population of older adults.

METHODS

We conducted a longitudinal analysis using repeated measurements of hot-water bathing and sleep among 1,094 older adults (mean age, 72.0 years). SOL was recorded using actigraphy and self-reported sleep estimates and was categorized into conditions (intervals of 1-60, 61-120, 121-180, and > 181 minutes between hot bath and bedtime) and compared with the control condition of no bathing. The heat-loss indicator, distal-proximal skin temperature gradient, was examined in the same categorization.

RESULTS

Mixed-effects linear regression models suggested that the bathing conditions of 61-120 minutes and 121-180 minutes showed significantly shorter log-transformed actigraphic SOL by 0.23 log-minutes (95% confidence interval (CI), 0.03-0.42) and 0.32 log-minutes (95% CI, 0.09-0.56), shorter self-reported SOL by 0.16 log-minutes (95% CI, 0.02-0.30) and 0.18 log-minutes (95% CI, 0.01-0.35), and higher distal-proximal skin temperature gradient for 30 minutes before bedtime by 0.49°C (95% CI, 0.22-0.75) and 0.51°C (95% CI, 0.20-0.83), respectively, independent of potential confounders.

CONCLUSIONS

Hot-water bathing before bedtime is significantly associated with shorter SOL and higher distal-proximal skin temperature gradient among the large-scale older population. This finding could enhance the generalizability of hot-water bathing habits for ameliorating sleep initiation difficulty.

Perceived environmental pollution and subjective cognitive decline (SCD) or SCD-related functional difficulties among the general population

This study aimed to determine whether perceived environmental pollution is associated with subjective cognitive decline (SCD) or SCD-related functional difficulties. We conducted a cross-sectional study using data from a nationwide sample of 191,054 individuals aged ≥19 years from the 2018 Korea Community Health Survey. Perceived air, water, soil, noise, and green space pollution was assessed. To investigate the dose-response effect of the amount of perceived environmental pollution, we determined whether an increasing number of types of perceived environmental pollution also increased the odds of having SCD or SCD-related functional difficulties. Among the 191,054 individuals, the prevalence of SCD and SCD-related functional difficulties was 17.7% (N = 33,853) and 2.2% (N = 4139), respectively. Perception of air, soil, or noise pollution was significantly associated with SCD. However, the perception of any type of environmental pollution was not significantly associated with SCD-related functional difficulties. With regard to a dose-response effect, individuals perceiving a greater number of types of environmental pollution had significantly higher odds of SCD or SCD-related functional difficulties. This association was notably more evident in the younger age group.

Prevalence and factors associated with use of sleeping pills among older adults in Brazil

OBJECTIVES

Little is known about sleeping pills consumption among older adults in low- and middle-income countries. This study investigated the prevalence and factors associated with sleeping pills use among Brazilians aged 50 and over.

METHODS

A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9412). Univariate and bivariate analyses were used to describe the sample. Robust Poisson regression was employed to estimate prevalence ratios and predict probabilities.

KEY FINDINGS

Prevalence of sleeping pills use among older Brazilians was estimated at 16.8%, with considerable disparities related to gender (22.3% among women and 10.3% among men), race/skin colour (19.7% among whites and 11.9% among blacks) and geographic region (ranging from 5.9% in the North to 20.5% in the South). The multivariate analysis showed associations between sleeping pills consumption and sociodemographic factors (age, gender, race/skin colour, geographic region and income), health status/behaviour characteristics (poor self-rated health status, number of chronic conditions and alcohol consumption) and variables related to healthcare utilisation (number of visits, usual source of care, care coordination, doctor's awareness of all medication, difficulty in managing own medication and number of medicines).

CONCLUSIONS

Our work found that sleeping pills consumption is disproportionately prevalent among women, is associated with worse health status and increases with more medical office visits and use of additional medicines. Moreover, the large inexplicable variations in care deserve special attention from policy-makers and clinicians.

Effect of magnetic stimulation of Shenmen point on cognitive function of chronic insomnia: A randomized controlled clinical trial

BACKGROUND

Chronic insomnia (CI) can lead to cognitive dysfunction and bring great pain to patients' life. There is no effective intervention for cognitive dysfunction caused by CI. Shenmen (HT7) is the first choice for insomnia treatment. However, the effect and mechanism of this acupoint on cognitive function after insomnia is not clear. Therefore, the purpose of this study is to explore whether magnetic stimulation of HT7 can improve cognitive impairment of CI by regulating prefrontal lobe and its mechanism.

METHODS/DESIGN

This is a randomized controlled clinical trial. Seventy-two subjects aged 18 to 65 years old with primary insomnia and more than 3 months were randomly divided into 2 groups according to the ratio of 1:1, and 36 healthy controls were included. The control group was given sleep hygiene and cognitive therapy in behavioral cognitive therapy technology, while the experimental group was given the behavioral cognitive therapy technology intervention and magnetic stimulation of HT7 acupoint for 30 times (2 times / d, 5 times / wk for 20 days), while the healthy control group had no intervention measures. Before treatment and 20 days after treatment, we evaluated the working memory (1-back test), episodic memory (Complex Figure Test), and problem-solving ability (Hanoi tower test) processed by prefrontal lobe to explore the effect of magnetic stimulation on cognitive function of CI and its possible mechanism. At the same time, insomnia severity index was used to evaluate sleep state, Becker depression scale was used to evaluate depression, and Beck anxiety scale was used to evaluate anxiety. Chi-squared test or rank sum test was used to collect the data of patients. If P value is less than or equal to .05, the difference will be considered statistically significant.

CONCLUSION

This study explored the effect and mechanism of magnetic stimulation of Shenmen (HT7) on cognitive function of CI, and confirmed that magnetic stimulation of HT7 can be used as an alternative therapy to improve cognitive impairment of CI.

TRIAL REGISTRATION NUMBER

ChiCTR2000034280.