Impact of sleep on the risk of cognitive decline and dementia

Associations between Japanese calligraphy practice and sleep quality in community-dwelling older adults: A cross-sectional Study

Background

Sleep disturbances, such as insomnia, are common among the elderly population and have been associated with negative health outcomes. Japanese calligraphy is a traditional art practice previously associated with various health benefits, such as stress reduction and improved cognitive function; however, its association with sleep quality has not been fully explored.

Methods

This cross-sectional study included 21,207 subjects with basic attributes, health status, depressive symptoms, artistic practices, and sleep habits. Individuals who satisfied the chronic insomnia criteria were categorized into the following subtypes: sleep onset latency (SOL) insomnia, early morning awakening (EMA) insomnia, and wake after sleep offset (WASF) insomnia. The t-test, chi-square test, and logistic regression analysis were used to determine the association between Japanese calligraphy practice and sleep quality.

Results

In this study, 17,597 elderly Japanese individuals were included, among whom 13.7 % practiced Japanese calligraphy. Regarding sleep characteristics, 32.0 % had chronic insomnia, 13.1 % had SOL insomnia, 9.1 % had EMA insomnia, and 14.2 % had WASF insomnia. Japanese calligraphy practice was associated with lower rates of chronic insomnia (odds ratio [OR] = 0.85, 95 % confidence interval (CI) = 0.76-0.95), including SOL insomnia (OR = 0.84, 95 % CI = 0.71-0.98), and EMA insomnia (OR = 0.80, 95 % CI = 0.66-0.97) but had no significant association with WASF insomnia.

Conclusions

This study suggests that Japanese calligraphy practice is associated with lower odds of insomnia, particularly SOL and EMA insomnia. Calligraphy may be an effective nonpharmacological intervention for insomnia and poor sleep quality among elderly Japanese individuals.

Effects of sleep on the glymphatic functioning and multimodal human brain network affecting memory in older adults

Understanding how sleep affects the glymphatic system and human brain networks is crucial for elucidating the neurophysiological mechanism underpinning aging-related memory declines. We analyzed a multimodal dataset collected through magnetic resonance imaging (MRI) and polysomnographic recording from 72 older adults. A proxy of the glymphatic functioning was obtained from the Diffusion Tensor Image Analysis along the Perivascular Space (DTI-ALPS) index. Structural and functional brain networks were constructed based on MRI data, and coupling between the two networks (SC-FC coupling) was also calculated. Correlation analyses revealed that DTI-ALPS was negatively correlated with sleep quality measures [e.g., Pittsburgh Sleep Quality Index (PSQI) and apnea-hypopnea index]. Regarding human brain networks, DTI-ALPS was associated with the strength of both functional connectivity (FC) and structural connectivity (SC) involving regions such as the middle temporal gyrus and parahippocampal gyrus, as well as with the SC-FC coupling of rich-club connections. Furthermore, we found that DTI-ALPS positively mediated the association between sleep quality and rich-club SC-FC coupling. The rich-club SC-FC coupling further mediated the association between DTI-ALPS and memory function in good sleepers but not in poor sleepers. The results suggest a disrupted glymphatic-brain relationship in poor sleepers, which underlies memory decline. Our findings add important evidence that sleep quality affects cognitive health through the underlying neural relationships and the interplay between the glymphatic system and multimodal brain networks.

Demographic, socioconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India

BACKGROUND

Recent research has revealed that today's older adults report more sleep problems than their predecessors, a trend compounded by expanding social stratification. As such, this study examined the demographic, socioeconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India.

METHODS

The current study sample draws on data from 7118 respondents aged 50 years and over participating in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) wave-2 dataset. Sleep quality (good, moderate, and poor) and sleep duration (in hours and minutes) were self-reported. Adjusted multivariable logistic regression models were employed to examine the associations between sleep quality and sleep duration and several demographic, socioeconomic, and health indicators.

RESULTS

A total of 12.84% and 36.1% of older adults reported long (> 8 h) and short (< 7 h) sleep, respectively. Older adults with primary education had lower odds of poor sleep [aOR: 0.85, CI: 0.73-0.99] than peers with no formal education. The odds of poor sleep were lower among those in higher wealth quintiles than those in the poorest quintile. Older adults with higher education had higher odds of short sleep [aOR: 1.36, CI: 1.06-1.74], and those with primary education had lower odds of long sleep [aOR: 0.70, CI: 0.54-0.91] than those without formal education (base category: age-appropriate sleep, i.e., 7-8 h). Older adults who were widowed had lower odds of both short [aOR: 0.82, CI: 0.68-0.98] and long sleep [aOR:0.74, CI: 0.58-0.95] compared to those who were currently married. Older individuals with adequate nutritional intake reported lower odds of short [aOR:0.59, CI: 0.49-0.72] and higher odds of long sleep [aOR:1.52, CI: 1.20-1.93] relative to their counterparts. Older adults who reported chronic conditions and body pain had higher odds of poor sleep and short sleep than their counterparts.

CONCLUSIONS

We identified significant associations between several unmodifiable factors, including age, education, and marital status, and modifiable factors such as dietary intake, body pain, and pre-existing chronic ailments, and sleep quality and sleep duration. Our findings can assist health care providers and practitioners in developing a more holistic and empathic approach to care. Moreover, that several demographic, socioeconomic, and health-related factors are consequential for older adults' sleep health suggests that early detection through screening programs and community-based interventions is vital to improving sleep among older Indians who are most susceptible to sleep problems.

Sleep-wake behavior and responses to sleep deprivation and immune challenge of protein kinase RNA-activated knockout mice

Protein Kinase RNA-activated (PKR) is an enzyme that plays a role in many systemic processes, including modulation of inflammation, and is implicated in neurodegenerative diseases, such as Alzheimer's disease (AD). PKR phosphorylation results in the production of several cytokines involved in the regulation / modulation of sleep, including interleukin-1β, tumor necrosis factor-α and interferon-γ. We hypothesized targeting PKR would alter spontaneous sleep of mice, attenuate responses to sleep deprivation, and inhibit responses to immune challenge. To test these hypotheses, we determined the sleep-wake phenotype of mice lacking PKR (knockout; PKR-/-) during undisturbed baseline conditions; in responses to six hours of sleep deprivation; and after immune challenge with lipopolysaccharide (LPS). Adult male mice (C57BL/6J, n = 7; PKR-/-, n = 7) were surgically instrumented with EEG recording electrodes and an intraperitoneal microchip to record core body temperature. During undisturbed baseline conditions, PKR -/- mice spent more time in non-rapid eye movement sleep (NREMS) and rapid-eye movement sleep (REMS), and less time awake at the beginning of the dark period of the light:dark cycle. Delta power during NREMS, a measure of sleep depth, was less in PKR-/- mice during the dark period, and core body temperatures were lower during the light period. Both mouse strains responded to sleep deprivation with increased NREMS and REMS, although these changes did not differ substantively between strains. The initial increase in delta power during NREMS after sleep deprivation was greater in PKR-/- mice, suggesting a faster buildup of sleep pressure with prolonged waking. Immune challenge with LPS increased NREMS and inhibited REMS to the same extent in both mouse strains, whereas the initial LPS-induced suppression of delta power during NREMS was greater in PKR-/- mice. Because sleep regulatory and immune responsive systems in brain are redundant and overlapping, other mediators and signaling pathways in addition to PKR are involved in the responses to acute sleep deprivation and LPS immune challenge.

Sex differences in the role of sleep on cognition in older adults

Study Objectives

The study aimed to investigate sex differences in the relationship between sleep quality (self-report and objective) and cognitive function across three domains (executive function, verbal memory, and attention) in older adults.

Methods

We analyzed cross-sectional data from 207 participants with normal cognition (NC) or mild cognitive impairment (89 males and 118 females) aged over 60 years. The relationship between sleep quality and cognitive performance was estimated using generalized additive models. Objective sleep was measured with the GT9X Link ActiGraph, and self-reported sleep was measured with the Pittsburgh Sleep Quality Index.

Results

We found that females exhibited lower executive function with increased objective total sleep time, with a steeper decline in performance after 400 minutes (p = .015). Additionally, longer objective sleep correlated with lower verbal memory linearly (p = .046). In males, a positive linear relationship emerged between objective sleep efficiency and executive function (p = .036). Self-reported sleep was not associated with cognitive performance in females and males with NC. However, in males with cognitive impairment, there was a nonlinear positive relationship between self-reported sleep and executive function (p < .001).

Conclusions

Our findings suggest that the association between sleep parameters on cognition varies between older males and females, with executive function being most strongly associated with objective sleep for both sexes top of form. Interventions targeting sleep quality to mitigate cognitive decline in older adults may need to be tailored according to sex, with distinct approaches for males and females.

Chronic sleep fragmentation impairs brain interstitial clearance in young wildtype mice

Accumulating evidence shows that most chronic neurological diseases have a link with sleep disturbances, and that patients with chronically poor sleep undergo an accelerated cognitive decline. Indeed, a single-night of sleep deprivation may increase metabolic waste levels in cerebrospinal fluid. However, it remains unknown how chronic sleep disturbances in isolation from an underlying neurological disease may affect the glymphatic system. Clearance of brain interstitial waste by the glymphatic system occurs primarily during sleep, driven by multiple oscillators including arterial pulsatility, and vasomotion. Herein, we induced sleep fragmentation in young wildtype mice and assessed the effects on glymphatic activity and cognitive functions. Chronic sleep fragmentation reduced glymphatic function and impaired cognitive functions in healthy mice. A mechanistic analysis showed that the chronic sleep fragmentation suppressed slow vasomotion, without altering cardiac-driven pulsations. Taken together, results of this study document that chronic sleep fragmentation suppresses brain metabolite clearance and impairs cognition, even in the absence of disease.

Thyroid Hormone and Alzheimer Disease: Bridging Epidemiology to Mechanism

The identification of critical factors that can worsen the mechanisms contributing to the pathophysiology of Alzheimer disease is of paramount importance. Thyroid hormones (TH) fit this criterion. Epidemiological studies have identified an association between altered circulating TH levels and Alzheimer disease. The study of human and animal models indicates that TH can affect all the main cellular, molecular, and genetic mechanisms known as hallmarks of Alzheimer disease. This is true not only for the excessive production in the brain of protein aggregates leading to amyloid plaques and neurofibrillary tangles but also for the clearance of these molecules from the brain parenchyma via the blood-brain barrier and for the escalated process of neuroinflammation-and even for the effects of carrying Alzheimer-associated genetic variants. Suboptimal TH levels result in a greater accumulation of protein aggregates in the brain. The direct TH regulation of critical genes involved in amyloid beta production and clearance is remarkable, affecting the expression of multiple genes, including APP (related to amyloid beta production), APOE, LRP1, TREM2, AQP4, and ABCB1 (related to amyloid beta clearance). TH also affects microglia by increasing their migration and function and directly regulating the immunosuppressor gene CD73, impacting the immune response of these cells. Studies aiming to understand the mechanisms that could explain how changes in TH levels can contribute to the brain alterations seen in patients with Alzheimer disease are ongoing. These studies have potential implications for the management of patients with Alzheimer disease and ultimately can contribute to devising new interventions for these conditions.

Sex- and strain-dependent effects of ageing on sleep and activity patterns in Drosophila

The fruit fly Drosophila is a major discovery platform in the biology of ageing due to its balance of relatively short lifespan and relatively complex physiology and behaviour. Previous studies have suggested that some important phenotypes of ageing, for instance increasingly fragmented sleep, are shared from humans to Drosophila and can be useful measures of behavioural change with age: these phenotypes therefore hold potential as readouts of healthy ageing for genetic or pharmacological interventions aimed at the underpinning biology of ageing. However, some age-related phenotypes in Drosophila show differing results among studies, leading to questions regarding the source of discrepancies among experiments. In this study, I have tested females and males from three common laboratory strains of Drosophila to determine the extent to which sex and background strain influence age-related behavioural changes in sleep and activity patterns. Surprisingly, I find that some phenotypes-including age-related changes in total activity, total sleep, and sleep fragmentation-depend strongly on sex and strain, to the extent that some phenotypes show opposing age-related changes in different sexes or strains. Conversely, I identify other phenotypes, including age-related decreases in morning and evening anticipation, that are more uniform across sexes and strains. These results reinforce the importance of controlling for background strain in both behavioural and ageing experiments, and they imply that caution should be used when drawing conclusions from studies on a single sex or strain of Drosophila. At the same time, these findings also offer suggestions for behavioural measures that merit further investigation as potentially more consistent phenotypes of ageing.

Can stimulants make you smarter, despite stealing your sleep?

Nonmedical use of psychostimulants for cognitive enhancement is widespread and growing in neurotypical individuals, despite mixed scientific evidence of their effectiveness. Sleep benefits cognition, yet the interaction between stimulants, sleep, and cognition in neurotypical adults has received little attention. We propose that one effect of psychostimulants, namely decreased sleep, may play an important and unconsidered role in the effect of stimulants on cognition. We discuss the role of sleep in cognition, the alerting effects of stimulants in the context of sleep loss, and the conflicting findings of stimulants for complex cognitive processes. Finally, we hypothesize that sleep may be one unconsidered factor in the mythology of stimulants as cognitive enhancers and propose a methodological approach to systematically assess this relation.

Sleep Characteristics, Magnetic Resonance Imaging- and Dual-Energy X-Ray Absorptiometry-Based Morphological Parameters, Muscle Strength, and Risk of Falls in Sedentary Older Subjects

BACKGROUND

The aims of this cross-sectional study were to (a) assess actigraphy-based sleep parameters (total sample and gender differences), (b) assess differences in morphological parameters and physical function between short- versus normal-sleepers and poor- versus good-sleepers, and (c) assess the possible correlations between sleep variables and morphological and physical function parameters in older subjects.

METHODS

This study enrolled 42 healthy older participants (60-80 years). Participants completed the following clinical evaluations: (1) whole-body dual-energy X-ray absorptiometry to assess the appendicular skeletal muscle mass index; (2) magnetic resonance imaging acquisition to determine the cross-sectional muscle area of thigh muscles and intermuscular adipose tissue; (3) risk of fall assessment through the mini-Balance Evaluation Systems Test; (4) strength assessment: (a) chair stand test and (b) handgrip strength test; (5) sleep monitoring by actigraphy to assess total sleep time, sleep efficiency, wake after sleep onset, sleep latency, fragmentation index, mobile time, and subjective sleep quality.

RESULTS

31.0% of subjects were short-sleepers (total sleep time < 6 hr), 19.1% were poor-sleepers (sleep efficiency < 85%), and gender differences were detected in mobile time (males: 15.8 ± 6.0 and females: 13.4 ± 6.8; p < .001) and fragmentation index (males: 35.3 ± 14.3 and females: 29.6 ± 14.6; p < .001); no significant differences were observed between groups (short- vs. normal-sleepers and poor- vs. good-sleepers) in morphological and physical function variables; correlation analysis showed that sleep latency negatively correlated with Mini-Balance Evaluation Systems Test (r = -.352; p = .022) and a positive correlation was detected between cross-sectional muscle area and mobile time (r = .349, p = .023).

CONCLUSION

No differences were observed in morphological and function parameters between good- versus poor-sleepers, those subjects with worse sleep onset latency (i.e., longer time to fall asleep) registered higher for risk of fall. The potential role of sleep in the physiological mechanisms of muscular aging must be explored through cross-sectional cohort studies with a larger population.

Cerebrospinal fluid mesencephalic astrocyte-derived neurotrophic factor: A moderating effect on sleep time and cognitive function

BACKGROUND

Sleeping late has been associated with cognitive impairment, and insufficient sleep can affect the secretion of feeding-related cytokines. Feeding-related cytokines may contribute to cognitive deficits resulting from delayed bedtime. Glial cell line-derived neurotrophic factor (GDNF) and mesencephalic astrocyte-derived neurotrophic factor (MANF), which are feeding-related neurotrophic factors, have been associated with improved cognitive function and neuroprotective abilities. Enhanced expression of GDNF and MANF is linked to increased energy expenditure and hyperphagia, respectively.

AIMS

This study aimed to investigate the association between cerebrospinal fluid (CSF) GDNF, MANF, cognition, and sleep time and to explore the moderating effects of GDNF and MANF on cognitive impairment in individuals who sleep late.

METHOD

This cross-sectional study included participants (mean age 31.76 ± 10.22 years) who were categorized as ≤23 o'clock sleepers (n = 66) and >23 o'clock sleepers (n = 125) based on sleep time. Cognition was assessed using Montreal Cognitive Assessment (MoCA), and GDNF and MANF levels in CSF were measured.

RESULTS

MANF may play a moderating role in the relationship between sleep time and cognition (R2 = 0.06, β = 0.59, p = 0.031). Age showed a negative correlation with MoCA scores (R2 = 0.08, β = -0.18), while education exhibited a positive correlation (β = 0.17, both p < 0.05). Only ≤23 o'clock sleepers exhibited a negative correlation between MANF levels and BMI (r = -0.35, p = 0.005).

CONCLUSIONS

This study provides hitherto undocumented evidence of the potential protective effect of CSF MANF on cognitive impairment of late sleepers, which suggests that maintaining a regular sleep schedule may contribute to cognition and overall health, with MANF playing a role in this process.

Sleep Capital: Linking Brain Health to Wellbeing and Economic Productivity Across the Lifespan

INTRODUCTION AND FRAMEWORK

Sleep capital contributes to individual and societal wellbeing, productivity, and economic outcomes and involves a novel aspect of brain capital. It encompasses the quality and quantity of sleep as integral components that influence cognitive abilities, mental and brain health, and physical health, affecting workplace productivity, learning, decision-making, and overall economic performance. Here, we bring a framework to understand the complex relationship between sleep quality, health, wellbeing, and economic productivity. Then we outline the multilevel impact of sleep on cognitive abilities, mental/brain health, and economic indicators, providing evidence for the substantial returns on investment in sleep health initiatives. Moreover, sleep capital is a key factor when considering brain health across the lifespan, especially for the aging population.

DISCUSSION

We propose specific elements and main variables to develop specific indexes of sleep capital to address its impacts on health, wellbeing and productivity.

CONCLUSION

Finally, we suggest policy recommendations, workplace interventions, and individual strategies to promote sleep health and brain capital. Investing in sleep capital is essential for fostering a healthier, happier, fairer and more productive society.

Dementia Prevalence and Onchocerca volvulus Infection among Rural Elderly Persons in the Ntui Health District, Cameroon: A Population-Based Study

Recent research suggests that infection with Onchocerca volvulus induces neurocognitive decline. This study sought to compare the cognitive outcomes of elderly persons based on onchocerciasis infection status and report the overall prevalence of dementia in the rural Ntui Health District in Cameroon. A community-based approach was used to recruit 103 participants aged ≥60 years. Dementia screening was done using the Community Screening Interview for Dementia (CSID) tool with a cut-off value of ≤29.5. O. volvulus infection was determined via microscopic examination of skin snips and serological testing of Ov16 antibodies using rapid diagnostic tests. Overall, the prevalence of dementia was 10.7%. Among the tested individuals, 17.9% (15/84) and 62.1% (41/66) were positive for O. volvulus and Ov16 antibodies, respectively. A multivariable linear regression model of CSID scores found a significant positive association with education level (8.654; 95% CI: 2.0870 to 15.222). However, having a positive skin snip for O. volvulus (-3.399; 95% CI: -6.805 to 0.007) and inhaling tobacco (-5.441; 95% CI: -9.137 to -1.744) tended to lower the CSID scores. Ongoing onchocerciasis transmission in the Ntui Health District may constitute a risk factor for dementia. Strengthening onchocerciasis elimination and adopting healthier lifestyles would contribute to dementia prevention among the elderly residing in endemic communities.

Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015

BACKGROUND

Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India.

METHODS

Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses.

RESULTS

Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085).

CONCLUSION

That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

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

Background

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

Methods

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

Results

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

Conclusions

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

Self-Supervised Transformer Model Training for a Sleep-EEG Foundation Model

The American Academy of Sleep Medicine (AASM) recognizes five sleep/wake states (Wake, N1, N2, N3, REM), yet this classification schema provides only a high-level summary of sleep and likely overlooks important neurological or health information. New, data-driven approaches are needed to more deeply probe the information content of sleep signals. Here we present a self-supervised approach that learns the structure embedded in large quantities of neurophysiological sleep data. This masked transformer training procedure is inspired by high performing self-supervised methods developed for speech transcription. We show that self-supervised pre-training matches or outperforms supervised sleep stage classification, especially when labeled data or compute-power is limited. Perhaps more importantly, we also show that our pretrained model is flexible and can be fine-tuned to perform well on new tasks including distinguishing individuals and quantifying "brain age" (a potential health biomarker). This suggests that modern methods can automatically learn information that is potentially overlooked by the 5-class sleep staging schema, laying the groundwork for new schemas and further data-driven exploration of sleep.

Sex Differences in the Role of Sleep on Cognition in Older Adults

Study Objectives

The study aimed to investigate sex differences in the relationship between sleep quality (self-report and objective) and cognitive function across three domains (executive function, verbal memory, and attention) in older adults.

Methods

We analyzed cross-sectional data from 207 participants with normal cognition or mild cognitive impairment (89 males and 118 females) aged over 60. The relationship between sleep quality and cognitive performance was estimated using generalized additive models. Objective sleep was measured with the GT9X Link Actigraph, and self-reported sleep was measured with the Pittsburgh Sleep Quality Index.

Results

We found that females exhibited stable performance of executive function with up to about 400 minutes of total sleep time, with significant declines in performance (p = 0.02) when total sleep time was longer. Additionally, a longer total sleep time contributed to lower verbal memory in a slightly non-linear manner (p = 0.03). Higher self-reported sleep complaints were associated with poorer executive function in females with normal cognition (p = 0.02). In males, a positive linear relationship emerged between sleep efficiency and executive function (p = 0.04), while self-reported sleep was not associated with cognitive performance in males with normal cognition.

Conclusions

Our findings suggest that the relationships between sleep quality and cognition differ between older males and females, with executive function being the most influenced by objective and self-reported sleep. Interventions targeting sleep quality to mitigate cognitive decline in older adults may need to be tailored according to sex, with distinct approaches for males and females.

A comparison of two obesity-related hypoventilation disorders: Impact on sleep, quality of life and neurocognitive outcomes and the effects of positive airway pressure therapy

Study Objectives

Symptom impact and neurocognitive function have not been previously compared between patients with obesity-associated hypoventilation disorders (obesity hypoventilation syndrome [OHS]) and hypoventilation in the setting of obesity and obstructive airways disease (OHAD). The aim of this study is to compare baseline sleep-related symptoms, health-related quality of life, and neurocognitive function between OHS and OHAD and the impact of PAP therapy on these outcomes.

Methods

Epworth Sleepiness Scale (ESS), Pittsburgh Sleepiness Quality Index (PSQI), SF36, and various neurocognitive tests, in addition to anthropometric, polysomnography, lung function, and blood gas data from participants with OHS and participants with OHAD, were included in the analysis. These data were originally collected in their respective randomized clinical trials, comparing the efficacy of different PAP modes (bilevel PAP vs. CPAP) in resolving hypercapnia. Between groups (OHS vs OHAD), pre- and post-treatment (with 3 months of positive airway pressure) comparisons were made using linear mixed modeling.

Results

45 OHS participants (mean age 51 years old, 33% female, BMI 52 kg/m2, FER 0.81, PaCO2 54 mmHg, AHI 87/h) and 32 OHAD participants (mean age 61years old, 31% female, BMI 43kg/m2, FER 0.60, PaCO2 54 mmHg, AHI 59/h) were included in the analysis. Both OHS and OHAD had similar baseline ESS (14(5.6) vs. 12(5.4)), Global PSQI (10(3.2) vs. 11(4.8)), SF36 and neurocognitive test performances (other than OHAD had lower digit symbol substitution test performance). Treatment with PAP therapy resulted in similar ESS, Global PSQI, and SF36 improvements in both groups. Neurocognitive performance did not significantly improve after PAP therapy in either group.

Conclusions

The symptom impact between two separate hypoventilation disorders (OHS and OHAD), in terms of sleepiness, sleep quality, quality of life, and cognitive function, were similar. OHS and OHAD had similar treatment responses in these parameters after 3 months of PAP therapy.Nocturnal ventilatory support in OHS.

Associations Between Repetitive Negative Thinking and Objective and Subjective Sleep Health in Cognitively Healthy Older Adults

Objective

Poor sleep and high levels of repetitive negative thinking (RNT), including future-directed (ie, worry) and past-directed (ie, brooding) negative thoughts, have been associated with markers of dementia risk. The relationship between RNT and sleep health in older adults is unknown. This study aimed to investigate this association and its specificities including multiple dimensions of objective and subjective sleep.

Methods

This study used a cross sectional quantitative design with baseline data from 127 cognitively healthy older adults (mean age 69.4 ± 3.8 years; 63% female) who took part in the Age-Well clinical trial, France. RNT (ie, worry and brooding) levels were measured using the Penn State Worry Questionnaire and the Rumination Response Scale (brooding subscale). Polysomnography was used to assess sleep objectively, and the Pittsburgh Sleep Quality Index and the St. Mary's Hospital Sleep Questionnaire were used to measure sleep subjectively. In primary analyses the associations between RNT and sleep (ie, objective sleep duration, fragmentation and efficiency and subjective sleep disturbance) were assessed via adjusted regressions.

Results

Higher levels of RNT were associated with poorer objective sleep efficiency (worry: β=-0.32, p<0.001; brooding: β=-0.26, p=0.002), but not objective sleep duration, fragmentation, or subjective sleep disturbance. Additional analyses, however, revealed differences in levels of worry between those with short, compared with typical and long objective sleep durations (p < 0.05).

Conclusion

In cognitively healthy older adults, RNT was associated with sleep characteristics that have been implicated in increased dementia risk. It will take additional research to ascertain the causal link between RNT and sleep characteristics and how they ultimately relate to the risk of developing dementia.

Actigraphy Estimated Sleep Moderates the Relationship between Physical Activity and Cognition in Older Adults

Background and Aims

Physical inactivity and poor sleep are common in older adults and may interact to contribute to age- and disease-related cognitive decline. However, prior work regarding the associations among physical activity, and cognition in older adults is primarily limited to subjective questionnaires that are susceptible to inaccuracies and recall bias. Therefore, this study examined whether objectively measured physical activity and sleep characteristics, each estimated using actigraphy, are independently or interactively associated with cognitive performance.

Methods

The study included 157 older adults free of dementia (136 cognitively unimpaired; 21 MCI; M age = 71.7) from the BIOCARD cohort.

Results

Using multiple linear regression, cognition was regressed on estimated total volume of physical activity (TVPA), sleep efficiency (SE), wake after sleep onset (WASO), and total sleep time (TST) (adjusted for age, sex, education, diagnosis, vascular risk factors, and Apolipoprotein E (APOE)-e4 genetic status). Models were also run for domain-specific cognitive composite scores. TVPA and SE each were positively associated with a global cognitive composite score. TVPA was positively associated with executive function and language composites, and SE was positively related to executive function, visuospatial, and language composites. Importantly, a TVPA by SE interaction (p = 0.015) suggested that adults with the poorest SE experienced the greatest benefit from physical activity in relation to global cognition. The other sleep metrics were unrelated to cognitive performance.

Conclusion

These results suggest that TVPA and SE may synergistically benefit cognition in older adults.

Clinical Phenotypes Supporting the Relationship Between Sleep Disturbance and Impairment of Placebo Effects

Lack of good sleep or insomnia can lead to many health issues, including an elevated risk of cardiovascular disease, obesity, fatigue, low mood, and pain. While chronic pain negatively impacts sleep quality, the relationship between descending pain modulatory systems like placebo effects and sleep quality is not thoroughly known. We addressed this aspect in a cross-sectional study in participants with chronic pain. Placebo effects were elicited in a laboratory setting using thermal heat stimulations delivered with visual cues using classical conditioning and verbal suggestions. We estimated the levels of insomnia severity with the Insomnia Severity Index and the sleep quality with the Pittsburg Sleep Quality Index. The previous night's sleep continuity was assessed as total sleep time, sleep efficiency, and sleep midpoint the night before the experiment. 277 people with chronic pain and 189 pain-free control individuals participated. Participants with chronic pain and insomnia showed smaller placebo effects than those with chronic pain without insomnia. Similarly, poor sleep quality was associated with reduced placebo effects among participants with chronic pain. Clinical anxiety measured by Depression Anxiety Stress Scales partially mediated these effects. In contrast, placebo effects were not influenced by the presence of insomnia or poor sleep quality in pain-free participants. Sleep continuity the night before the experiment did not influence the placebo effects. Our results indicate that participants who experience insomnia and/or poor sleep quality and chronic pain have smaller placebo effects, and that the previous night sleep continuity does not influence the magnitude of placebo effects. PERSPECTIVE: This study examined the relationship between sleep disturbances and experimentally induced placebo effects. We found that individuals with chronic pain who experience insomnia and poor sleep quality demonstrated reduced placebo effects compared to their counterparts with good sleep quality and no insomnia.

A review: effects of neurofeedback on patients with mild cognitive impairment (MCI), and Alzheimer's disease (AD)

Neurofeedback training (NFT) is a non-invasive method and has been shown to be effective for attention deficit/hyperactivity disorder (ADHD) and various psychiatric disorders. The aim of this paper is to evaluate the effectiveness of NFT for patients with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) or Vascular Diseases (VD), so that we searched research articles from four databases, using the keywords neurofeedback, elderly, MCI, AD, VD, and dementia. As a result, 13 articles were identified regarding the effectiveness of NFT in patients with MCI and AD. Although each study differed in study design, training protocol, electroencephalogram (EEG) electrode placement, and reward and inhibition frequency bands, all were shown to enhance memory, attention, and other cognitive abilities. Additional well-designed, randomized studies with sufficient power are needed to further confirm the effectiveness of NFT.

Association of spermidine blood levels with microstructure of sleep-implications from a population-based study

Deteriorations in slow wave sleep (SWS) have been linked to brain aging and Alzheimer's disease (AD), possibly due to its key role in clearance of amyloid-beta and tau (Aß/tau), two pathogenic hallmarks of AD. Spermidine administration has been shown to improve sleep quality in animal models. So far, the association between spermidine levels in humans and parameters of SWS physiology are unknown but may be valuable for therapeutic strategies. Data from 216 participants (age range 50-81 years) of the population-based Study of Health in Pomerania TREND were included in our analysis. We investigated associations between spermidine plasma levels, key parameters of sleep macroarchitecture and microarchitecture that were previously associated with AD pathology, and brain health measured via a marker of structural brain atrophy (AD score). Higher spermidine levels were significantly associated with lower coupling between slow oscillations and spindle activity. No association was evident for SWS, slow oscillatory, and spindle activity throughout non-rapid eye movement sleep. Furthermore, elevated spermidine blood levels were significantly associated with a higher AD score, while sleep markers revealed no association with AD score. The association between higher spermidine levels and brain health was not mediated by coupling between slow oscillations and spindle activity. We report that higher spermidine blood levels are associated not only with deteriorated brain health but also with less advantageous markers of sleep quality in older adults. Future studies need to evaluate whether sleep, spermidine, and Aß/tau deposition are interrelated and whether sleep may play a mediating role.

Lifestyle and behavioural changes in older adults during the Covid-19 pandemic are associated with subjective cognitive complaints

Subjective cognitive complaints (SCC) is a self-reported experience of persistently impaired cognitive functions which could be the earliest red flag of neurocognitive disorders. The COVID-19 pandemic and related restriction measures changed the lifestyle and behaviour of older adults. The aim of this study was to assess the relation of these changes and SCC status in Hungary. This cross-sectional study analysed the data of 359 elderly Hungarians who filled out the WW-FINGERS-SARS-CoV2 survey. A quarter of the respondents (n:88) reported SCC in connection with the pandemic. We compared sociodemographic features, health status, lifestyle, and social life parameters between subjects with reported SCC and without. To eliminate the potential interrelation across group differences, stepwise logistic regression was applied. Participants with SCC showed the following characteristics, compared to individuals without: (1) they were older; (2) they were more likely to be women; (3) they had a higher number of chronic disorders; (4) showed more prominent impairment in physical mobility; (5) had worse sleep quality; (6) spent less time with family; and (7) used internet more frequently during the pandemic (all p's < 0.001). Logistic regression highlighted that only two parameters were related to SCC status independently, the physical mobility (ability to walk 500 m without difficulties; OR = 1.186; p < 0.001; 95%CI = 1.101, 1.270) and changes in time spent with grandchildren (OR = 1.04; p = 0.015; 95%CI = 1.008, 1.073). Our study draws attention to the importance of physical mobility and quality time with family as key factors in the cognitive well-being of elderly people.

Drug therapies for obstructive sleep apnoea: a systematic review and meta-analysis protocol

INTRODUCTION

Obstructive sleep apnoea (OSA) is a common disorder that can affect the quality of life and increase the risk for psychiatric, neurological and cardiometabolic diseases. Despite the significant burden, it poses on health and well-being, there is a lack of evidence regarding the use of drug therapies in these patients. This work aims to evaluate the efficacy and safety of pharmacological treatment alternatives for patients with OSA.

METHODS AND ANALYSIS

Databases, including PubMed, Embase, Web of Science, SciELO, LILACS, Scopus, Cochrane Register of Controlled Trials and ClinicalTrials.gov, will be used for the search. A search strategy was developed to retrieve clinical trials that have evaluated polysomnographic primary outcome (Apnoea-Hypopnoea index) and secondary outcomes (eg, daytime sleepiness, adverse events) of any drug therapy used for OSA. No date or language restrictions will be applied. Two authors will independently select the studies meeting the inclusion criteria by screening the title, abstract and full text. Data will be extracted, and the risk of bias will be evaluated using the Cochrane Risk of Bias Tool. Review Manager V.5.4.1 will be used for data synthesis. The Grading of Recommendation Assessment, Development and Evaluation will be used to assess the strength of the evidence.

ETHICS AND DISSEMINATION

As a review of published data, it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42022362639.

Sleep Quality and Cognitive Abilities in the Greek Cohort of Epirus Health Study

Purpose

Sleep is essential to all human body functions as well as brain functions. Inadequate sleep quantity and poor sleep quality have been shown to directly affect cognitive functioning and especially memory. The primary aim of the present study was to investigate the association of sleep quality with cognitive abilities cross-sectionally in a middle-aged Greek population and secondarily to examine this association prospectively in a smaller group of these participants.

Patients and Methods

A total of 2112 healthy adults aged 25-70 years (mean: 46.7±11.5) from the Epirus Health Study cohort were included in the analysis and 312 of them participated in secondary prospective analysis. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI) scale and cognition was assessed in primary cross-sectional analyses with three neuropsychological tests, namely the Verbal Fluency test, the Logical Memory test and the Trail Making test, and in secondary prospective analyses with online versions of Posner cueing task, an emotional recognition task, the Corsi block-tapping task and the Stroop task. Statistical analysis was performed using multivariable linear regression models adjusted for age, sex, education, body mass index and alcohol consumption.

Results

Attention/processing speed was the only cognitive domain associated cross-sectionally with PSQI score. Specifically, participants with better self-reported sleep quality performed faster on the Trail Making Test - Part A (β= 0.272 seconds, 95% CI 0.052, 0.493).

Conclusion

Further studies are needed to clarify the association of sleep quality with cognition, especially in middle-aged people that are still in productive working years.

Sex as a moderator of the sleep and cognition relationship in middle-aged and older adults: A preliminary investigation

OBJECTIVES

Despite known sex differences in the prevalence of sleep disturbance and cognitive impairment, research investigating sex differences in sleep/cognition associations is limited. We examined sex as a moderator of associations between self-reported sleep and objective cognition in middle-aged/older adults.

METHODS

Adults aged 50+ (32 men/31 women, Mage = 63.6 ± 7.7) completed the Pittsburgh Sleep Quality Index (PSQI) and cognitive tasks: Stroop (processing speed, inhibition), Posner (spatial attentional orienting) and Sternberg (working memory). Multiple regressions examined whether PSQI metrics (global score, sleep quality ratings, sleep duration, sleep efficiency) were independently or interactively (with sex) associated with cognition, controlling for age and education.

RESULTS

Sex interacted with sleep quality ratings in its association with endogenous spatial attentional orienting (∆R2 = .10, p = .01). Worse ratings of sleep quality were associated with worse orienting in women (B = 22.73, SE = 9.53, p = .02), not men (p = .24). Sex interacted with sleep efficiency in its associations with processing speed (∆R2 = .06, p = .04). Lower sleep efficiency was associated with slower Stroop control trial performance in women (B = -15.91, SE = 7.57, p = .04), not men (p = .48).

CONCLUSIONS

Preliminary findings suggest middle-aged/older women are more vulnerable to associations between poor sleep quality and low sleep efficiency on spatial attentional orienting and processing speed, respectively. Future studies in larger samples investigating sex-specific prospective sleep and cognition associations are warranted.

The Effect of Different Types of Exercise on Sleep Quality and Architecture in Parkinson Disease: A Single-Blinded Randomized Clinical Trial Protocol

OBJECTIVES

The purpose of this trial is to (1) determine the best exercise modality to improve sleep quality and sleep architecture in people with Parkinson disease (PD); (2) investigate whether exercise-induced improvements in sleep mediate enhancements in motor and cognitive function as well as other non-motor symptoms of PD; and (3) explore if changes in systemic inflammation after exercise mediate improvements in sleep.

METHODS

This is a multi-site, superiority, single-blinded randomized controlled trial. One hundred fifty persons with PD and sleep problems will be recruited and randomly allocated into 4 intervention arms. Participants will be allocated into 12 weeks of either cardiovascular training, resistance training, multimodal training, or a waiting list control intervention. Assessments will be conducted at baseline, immediately after each intervention, and 8 weeks after each intervention by blinded assessors. Objective sleep quality and sleep architecture will be measured with polysomnography and electroencephalography. Motor and cognitive function will be assessed with the Unified PD Rating Scale and the Scale for Outcomes in PD-Cognition, respectively. Subjective sleep quality, fatigue, psychosocial functioning, and quality of life will be assessed with questionnaires. The concentration of inflammatory biomarkers in blood serum will be assessed with enzyme-linked immunosorbent assays.

IMPACT

This study will investigate the effect of different types of exercise on sleep quality and architecture in PD, exploring interactions between changes in sleep quality and architecture with motor and cognitive function and other non-motor symptoms of the disease as well as mechanistic interactions between systemic inflammation and sleep. The results will provide important practical information to guide physical therapists and other rehabilitation professionals in the selection of exercise and the design of more personalized exercise-based treatments aimed at optimizing sleep, motor, and cognitive function in people with PD.

Enhancing Sleep Quality: Assessing the Efficacy of a Fixed Combination of Linden, Hawthorn, Vitamin B1, and Melatonin

Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF®) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH®) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.

Cancer-Related Neuropathic Pain, Chemotherapy-Induced Peripheral Neuropathy and Cognitive Decline in a 5-Year Prospective Study of Patients with Breast Cancer-NEON-BC

This study aims to estimate the prevalence and to identify the determinants of cancer-related neuropathic pain (CRNP), chemotherapy-induced peripheral neuropathy (CIPN) and cognitive decline among patients with breast cancer over five years after diagnosis. Women with an incident breast cancer (n = 462) and proposed for surgery were recruited at the Portuguese Institute of Oncology-Porto in 2012 and underwent systematic neurological examinations and evaluations with the Montreal Cognitive Assessment (MoCA) before treatment and after one, three, and five years. Multivariate logistic regression was used to assess the determinants of CRNP and CIPN, and multivariate linear regression for the variation in MoCA scores. Prevalence of CRNP and CIPN decreased from the first to the fifth year after diagnosis (CRNP: from 21.1% to 16.2%, p = 0.018; CIPN: from 22.0% to 16.0% among those undergoing chemotherapy, p = 0.007). Cognitive impairment was observed in at least one assessment in 17.7% of the women. Statistically significant associations were observed between: cancer stage III and both CRNP and CIPN; triple negative breast cancer, chemotherapy, axillary node dissection, older age, higher education, and being single and CRNP; taxanes and fruit and vegetable consumption and CIPN. Anxiety, depression and poor sleep quality at baseline were associated with decreases in MoCA values from pre- to post-treatment and with CRNP. Follow-up protocols should consider the persistence of CRNP, CIPN, and cognitive impairment for several years following diagnosis.

Mindfulness-based therapy improves brain functional network reconfiguration efficiency

Mindfulness-based interventions are showing increasing promise as a treatment for psychological disorders, with improvements in cognition and emotion regulation after intervention. Understanding the changes in functional brain activity and neural plasticity that underlie these benefits from mindfulness interventions is thus of interest in current neuroimaging research. Previous studies have found functional brain changes during resting and task states to be associated with mindfulness both cross-sectionally and longitudinally, particularly in the executive control, default mode and salience networks. However, limited research has combined information from rest and task to study mindfulness-related functional changes in the brain, particularly in the context of intervention studies with active controls. Recent work has found that the reconfiguration efficiency of brain activity patterns between rest and task states is behaviorally relevant in healthy young adults. Thus, we applied this measure to investigate how mindfulness intervention changed functional reconfiguration between rest and a breath-counting task in elderly participants with self-reported sleep difficulties. Improving on previous longitudinal designs, we compared the intervention effects of a mindfulness-based therapy to an active control (sleep hygiene) intervention. We found that mindfulness intervention improved self-reported mindfulness measures and brain functional reconfiguration efficiency in the executive control, default mode and salience networks, though the brain and behavioral changes were not associated with each other. Our findings suggest that neuroplasticity may be induced through regular mindfulness practice, thus bringing the intrinsic functional configuration in participants' brains closer to a state required for mindful awareness.

Impact of lifestyle risk factors on admission to nursing home care: a cohort study of 127 108 people aged 60 years and over

BACKGROUND

Little is known on how lifestyle factors, individually or in combination, may relate to nursing home admission, an outcome of great societal and economic importance with increased population ageing. The aim of this study was to determine the association of lifestyle risk factors with nursing home admission.

METHODS

This prospective cohort study linked data from the 45 and Up Study, Australia, to health records. 127 108 men and women, aged ≥60 years, were recruited between 2006 and 2009. A healthy lifestyle score categorised participants into three risk groups based on five equally contributing risk factors: smoking status, physical activity, sedentary behaviour, sleep duration and diet quality. HRs for incident nursing home admission were estimated using multivariable Cox proportional hazards model.

RESULTS

One-quarter of participants were in the low-risk lifestyle group, 62% were in the medium-risk group and 14% in the high-risk (least healthy) group. During a median (IQR) follow-up of 11.3 years, 23 094 (18%) participants were admitted to a nursing home. Compared with those in the low-risk group, risk of nursing home admission was 43% higher among participants in the high-risk group (multivariable adjusted HR (aHR) 1.43; 95% CI 1.36 to 1.50); and participants in the medium-risk group had an intermediate 12% greater risk (aHR 1.12; 95% CI 1.08 to 1.16). Participants aged 60-64 years in the high-risk (aHR 2.15; 95% CI 1.82 to 2.54) lifestyle group had the greatest risk of nursing home admission.

CONCLUSION

An unhealthy lifestyle was associated with a marked increased risk of admission to a nursing home in adults aged 60+ years. Interventions focused on lifestyle modifications may prevent or delay nursing home admission.

Daytime dysfunction may be associated with postoperative delirium in patients undergoing total hip/knee replacement: The PNDABLE study

PURPOSE

Postoperative delirium (POD) is a usual complication after total hip/knee replacement, which may be affected by sleep characteristics. However, up to now, preoperative sleep characteristics have not been evaluated as risk factors of POD. The relationship between self-reported sleep characteristics and POD in patients has been investigated in this study.

PATIENTS AND METHODS

We recruited 495 cognitively intact individuals in the final analysis from the Perioperative Neurocognitive Disorder and Biomarker Lifestyle study. Sleep characteristics were tested by the Pittsburgh Sleep Quality Index (PSQI). Mini-mental state examination was applied to assess preoperative mental status of patients. Postoperatively, we used confusion assessment method and memorial delirium assessment scale to evaluate the incidence of POD and POD severity, respectively. The cerebrospinal fluid (CSF) levels of T-tau, P-tau, Aβ40, and Aβ42 were detected by enzyme-linked immune-sorbent assay before the operation. Logistic regression, multiple linear regression, and mediation effects were performed to analyze the relationship between self-reported sleep characteristics and POD.

RESULTS

POD was detected in 11.31% (56/495) of the patients, with logistic regression analysis showing that daytime dysfunction, P-tau, and T-tau were risk factors of POD, and Aβ42 was a protective factor of POD. Multiple linear regression analysis confirmed that daytime dysfunction was positively correlated with P-tau in patients with POD. Meanwhile, compared to the patients with no postoperative delirium, the CSF levels of P- and T-tau were higher in patients with POD. Furthermore, mediation analysis showed that it was probable that daytime dysfunction mediated POD through P-tau (proportion: 12.90%) partially.

CONCLUSION

Daytime dysfunction is a risk factor of POD preoperatively. To sum up, CSF P-tau protein might partially mediate the influence of daytime dysfunction on POD.

CLINICAL TRIAL REGISTRATION

This study was registered at Chinese Clinical Trial Registry (ChiCTR2000033439).

Brief Change in Dopamine Activity during Consolidation Impairs Long-Term Memory via Sleep Disruption

Sleep disturbances are associated with poor long-term memory (LTM) formation, yet the underlying cell types and neural circuits involved have not been fully decoded. Dopamine neurons (DANs) are involved in memory processing at multiple stages. Here, we show that brief activation of protocerebral anterior medial DANs (PAM-DANs) or inhibition of a pair of dorsal posterior medial (DPM) neurons during the first few hours of memory consolidation impairs 24 h LTM. Interestingly, sleep deprivation elevates the neural activity of PAM-DANs and DPM neurons, and brief thermos-activation of PAM-DANs or inactivation of DPM neurons results in sleep loss and fragmentation. Pharmacological rescue of sleep after this manipulation restores LTM. A specific subset of PAM-DANs, PAM-α1 that synapse onto DPM neurons specify the microcircuit that links sleep and memory. PAM-DANs, including PAM-α1, form functional synapses with DPM neurons mainly via Dop1R1 receptor to inhibit DPM. Our data suggest that the post-training activity of PAM(-α1)-DPM microcircuit, especially during memory consolidation, plays an essential role in maintaining the sleep necessary for LTM consolidation, providing a new cellular and circuit basis for the complex relationship between sleep and memory.

Deep learning-based sleep stage classification with cardiorespiratory and body movement activities in individuals with suspected sleep disorders

Deep learning methods have gained significant attention in sleep science. This study aimed to assess the performance of a deep learning-based sleep stage classification model constructed using fewer physiological parameters derived from cardiorespiratory and body movement data. Overnight polysomnography (PSG) data from 123 participants (age: 19-82 years) with suspected sleep disorders were analyzed. Multivariate time series data, including heart rate, respiratory rate, cardiorespiratory coupling, and body movement frequency, were input into a bidirectional long short-term memory (biLSTM) network model to train and predict five-class sleep stages. The trained model's performance was evaluated using balanced accuracy, Cohen's κ coefficient, and F1 scores on an epoch-per-epoch basis and compared with the ground truth using the leave-one-out cross-validation scheme. The model achieved an accuracy of 71.2 ± 5.8%, Cohen's κ of 0.425 ± 0.115, and an F1 score of 0.650 ± 0.083 across all sleep stages, and all metrics were negatively correlated with the apnea-hypopnea index, as well as age, but positively correlated with sleep efficiency. Moreover, the model performance varied for each sleep stage, with the highest F1 score observed for N2 and the lowest for N3. Regression and Bland-Altman analyses between sleep parameters of interest derived from deep learning and PSG showed substantial correlations (r = 0.33-0.60) with low bias. The findings demonstrate the efficacy of the biLSTM deep learning model in accurately classifying sleep stages and in estimating sleep parameters for sleep structure analysis using a reduced set of physiological parameters. The current model without using EEG information may expand the application of unobtrusive in-home monitoring to clinically assess the prevalence of sleep disorders outside of a sleep laboratory.

Designing and Developing a Vision-Based System to Investigate the Emotional Effects of News on Short Sleep at Noon: An Experimental Case Study

Background: Sleep is a critical factor in maintaining good health, and its impact on various diseases has been recognized by scientists. Understanding sleep patterns and quality is crucial for investigating sleep-related disorders and their potential links to health conditions. The development of non-intrusive and contactless methods for analyzing sleep data is essential for accurate diagnosis and treatment. Methods: A novel system called the sleep visual analyzer (VSleep) was designed to analyze sleep movements and generate reports based on changes in body position angles. The system utilized camera data without requiring any physical contact with the body. A Python graphical user interface (GUI) section was developed to analyze body movements during sleep and present the data in an Excel format. To evaluate the effectiveness of the VSleep system, a case study was conducted. The participants' movements during daytime naps were recorded. The study also examined the impact of different types of news (positive, neutral, and negative) on sleep patterns. Results: The system successfully detected and recorded various angles formed by participants' bodies, providing detailed information about their sleep patterns. The results revealed distinct effects based on the news category, highlighting the potential impact of external factors on sleep quality and behaviors. Conclusions: The sleep visual analyzer (VSleep) demonstrated its efficacy in analyzing sleep-related data without the need for accessories. The VSleep system holds great potential for diagnosing and investigating sleep-related disorders. The proposed system is affordable, easy to use, portable, and a mobile application can be developed to perform the experiment and prepare the results.

Adverse Childhood Experiences and Poor Sleep Quality in Older Adults: The Influence of Emotion Regulation

BACKGROUND

Adverse childhood experiences (ACEs) are associated with sleep impairment across the life span, but little is known about modifiable factors that may ameliorate this relationship, such as adaptive emotion regulation (ER) skills.

METHODS

Data were obtained from an online questionnaire completed by a community sample of older adults (N = 278). The questionnaire included the Pittsburgh Sleep Quality Index, an Adverse Childhood Experiences questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), and measures of health conditions, and other sample demographics. Moderation analyses were used to examine the interaction between ACEs and 5 adaptive ER skills of CERQ on sleep quality in older adults, while accounting for the effects of age, sex, income, body mass index, and health.

RESULTS

ACEs were significantly associated with worse sleep quality in older adults, and this effect was moderated by positive reappraisal and refocusing on planning (all ps < .05). For individuals reporting greater use of these ER skills, ACEs had no effect on sleep quality, whereas for individuals reporting less frequent use of these ER skills, ACEs were associated with substantially worse sleep quality. This relationship remained significant after accounting for age, sex, income, body mass index, and health conditions in the model.

CONCLUSIONS

The effects of ACEs on sleep quality persist into older age; however, greater use of ER skills that focus on positively reframing negative events and identifying strategies for coping protect against sleep impairment in individuals with higher ACEs.

The state of brain activity modulates cerebrospinal fluid transport

Earlier studies based on 2-photon imaging have shown that glymphatic cerebrospinal fluid (CSF) transport is regulated by the sleep-wake cycle. To examine this association, we used 3DISCO whole-body tissue clearing to map CSF tracer distribution in awake, sleeping and ketamine-xylazine anesthetized mice. The results of our analysis showed that CSF tracers entered the brain to a significantly larger extent in natural sleep or ketamine-xylazine anesthesia than in wakefulness. Furthermore, awake mice showed preferential transport of CSF tracers in the rostro-caudal direction towards the cervical and spinal cord lymphatic vessels, and hence to venous circulation and excretion by the kidneys. The study extends the current literature by showing that CSF dynamics on the whole-body scale is controlled by the state of brain activity.

Daytime Sleepiness Predicts Mortality in Nursing Home Residents: Findings from the Frailty in Residential Aged Care Sector Over Time (FIRST) Study

OBJECTIVES

Excessive daytime sleepiness is an increasingly frequent condition among older adults with comorbidities and living in nursing homes (NHs). This study investigated associations between participants' characteristics and excessive daytime sleepiness (EDS); the ability of the Epworth Sleepiness Scale (ESS) scores, EDS, and EDS severity levels to predict mortality at 12 months of follow-up; and the optimal cut-off for ESS to predict mortality among NH residents.

DESIGN

Prospective and cross-sectional analysis in a prospective study.

SETTING AND PARTICIPANTS

Older adults permanently residing in 12 NHs from South Australia.

METHODS

Baseline characteristics including the ESS were collected and mortality at 12 months was assessed. Logistic regression analyzed associations between participants' characteristics and EDS (ESS >10). Kaplan-Meier cumulative survival estimates followed by log-rank and adjusted Cox proportional hazards models explored associations of ESS scores, EDS, and EDS severity levels with time-to-incident death. Receiver operator curve analysis assessed the best cut-off for ESS to predict mortality risk.

RESULTS

A total of 550 participants [mean (SD) age, 87.7 (7.2) years; 968 (50.9%) female]. Malnutrition [adjusted odds ratio (aOR) 2.02, 95% confidence interval (CI) 1.13‒3.61], myocardial infarction (aOR 1.91, 95% CI 1.20‒3.03), heart failure (aOR 2.85, 95% CI 1.68‒4.83), Parkinson's disease (aOR 2.16, 95% CI 1.04‒4.47) and severe dementia (aOR 8.57, 95% CI 5.25‒14.0) were associated with EDS. Kaplan-Meier analyses showed reduced survival among participants with EDS (log-rank test: χ2 = 25.25, P < .001). EDS predicted increased mortality risk (HR 1.63, 95% CI 1.07-2.51, P = .023). ESS score of 10.5 (>10) was the best cut point predicting mortality risk (area under the curve = 0.62).

CONCLUSIONS AND IMPLICATIONS

EDS predicts mortality risk and is associated with age-related comorbidities in NH residents. Screening for EDS is a simple strategy to identify NH residents at higher risk of adverse outcomes, triggering an assessment for reversibility or conversations about end-of-life care.

Gaming in Pandemic Times: An International Survey Assessing the Effects of COVID-19 Lockdowns on Young Video Gamers' Health

The onset of COVID-19 coincided with the peak growth of video game usage, with 2.7 billion gamers in 2020. During the pandemic, gaming and streaming platforms offered an entertaining, social, and safe alternative to recreation during severe lockdowns and social isolations. This study aimed to examine the impact of the COVID-19 pandemic on health-related outcomes in self-proclaimed video gamers based on the type of lockdown experienced and to discuss the potential role of video games during times of preventive lockdown measures. This was a cross-sectional international survey constructed by two academic institutions, NYIT (NY, USA) and McGill University (Montreal, Canada), and Adamas Esports (BC, Canada). The survey consisted of questions including demographics, multiple choice, ratings, and Likert scales relating to the periods prior to and during the COVID-19 lockdowns. There were 897 respondents from North America (72.7%), Europe (10.9%), Asia (4.9%), and other countries (11.5%), with a mean age of 22 years. Significant increases in game time were reported in casual and competitive gamers during the first months of the pandemic. The level of gaming, type of lockdown, and physical activity level prior to the pandemic were examined as potential moderating factors. Significant increases in sedentary behaviors (video game time and sitting time) were observed, while physical activity levels remained unchanged in most participants, regardless of the type of lockdown. Sleep time, but not sleep quality, increased, while mental health exhibited opposing effects, influenced by the type of lockdown and gaming competition levels. Video games, when played moderately, could offer a cost-effective, safe strategy to promote socialization and mental health and improve the overall well-being of the non-gaming and gaming population during pandemic times when strict lockdowns are in place.

The Combination of Quantitative Proteomics and Systems Genetics Analysis Reveals that PTN Is Associated with Sleep-Loss-Induced Cognitive Impairment

Sleep loss is associated with cognitive dysfunction. However, the detailed mechanisms remain unclear. In this study, we established a para-chlorophenylalanine (PCPA)-induced insomniac mouse model with impaired cognitive function. Mass-spectrometry-based proteomics showed that the expression of 164 proteins was significantly altered in the hippocampus of the PCPA mice. To identify critical regulators among the potential markers, a transcriptome-wide association screening was performed in the BXD mice panel. Among the candidates, the expression of pleiotrophin (Ptn) was significantly associated with cognitive functions, indicating that Ptn-mediates sleep-loss-induced cognitive impairment. Gene co-expression analysis further revealed the potential mechanism by which Ptn mediates insomnia-induced cognitive impairment via the MAPK signaling pathway; that is, the decreased secretion of Ptn induced by insomnia leads to reduced binding to Ptprz1 on the postsynaptic membrane with the activation of the MAPK pathway via Fos and Nr4a1, further leading to the apoptosis of neurons. In addition, Ptn is genetically trans-regulated in the mouse hippocampus and implicated in neurodegenerative diseases in human genome-wide association studies. Our study provides a novel biomarker for insomnia-induced cognitive impairment and a new strategy for seeking neurological biomarkers by the integration of proteomics and systems genetics.

Heat of the night: sleep disturbance activates inflammatory mechanisms and induces pain in rheumatoid arthritis

Sleep has a homeostatic role in the regulation of the immune system and serves to constrain activation of inflammatory signalling and expression of cellular inflammation. In patients with rheumatoid arthritis (RA), a misaligned inflammatory profile induces a dysregulation of sleep-wake activity, which leads to excessive inflammation and the induction of increased sensitivity to pain. Given that multiple biological mechanisms contribute to sleep disturbances (such as insomnia), and that the central nervous system communicates with the innate immune system via neuroendocrine and neural effector pathways, potential exists to develop prevention opportunities to mitigate the risk of insomnia in RA. Furthermore, understanding these risk mechanisms might inform additional insomnia treatment strategies directed towards steering and reducing the magnitude of the inflammatory response, which together could influence outcomes of pain and disease activity in RA.

How emotions induced by reading influence sleep quality in young and older adults

OBJECTIVES

This study examined whether emotions induced by reading before sleep influence sleep quality in young and older adults.

METHOD

Sixty older adults (64-75 years) and 60 young adults (18-35 years) were randomly assigned to three conditions: positive reading, neutral reading, and control. The reading groups read a short story at bedtime, whereas the control group kept its routine. Participants completed measures of affective states, subjective sleep parameters, and self-reported sleep quality related to emotions over 7 consecutive days.

RESULTS

Older adults reported much longer sleep latency and lower sleep efficiency than young adults. In both reading conditions, older adults reported reduced sleep latencies compared to the control group. In the positive reading condition, older adults reported an increased sleep duration compared to younger adults and the other conditions. Young and older adults in the positive condition showed better self-reported sleep quality than those in the neutral conditions, regardless of age.

CONCLUSIONS

Reading at bedtime appears to reduce older adults' time to fall asleep and increase their sleep duration. Positive emotions induced by reading short stories at bedtime seem to be a sleep-promoting factor that improves bedtime and wake time in young and older adults.

Barriers to brain health behaviours: results from the Five Lives Brain Health Ireland Survey

Modifiable risk factors for dementia remain prevalent in Ireland. A detailed examination of barriers to risk reduction behaviours in an Irish context has heretofore been lacking. Many existing studies examining barriers to brain health behaviours fail to examine how they might vary across different modifiable risk factors. This study undertook a detailed assessment of barriers to individual risk reduction behaviours. As existing research suggests that barriers may vary across sociodemographic factors, we sought to investigate the distribution of barriers across age, gender, educational status, and household income. The Five Lives Brain Health Ireland Survey is a cross-sectional survey that was distributed online amongst a non-patient population. The survey captured the following: (1) Sociodemographic factors; (2) Barriers to brain health behaviours; (3) Exposure to, and knowledge of, modifiable risk factors for dementia, namely diet, social interaction, exercise, hypertension, sleep, current low mood/depression, current smoking, alcohol consumption, cognitive stimulation, hearing impairment, diabetes, air pollution, and head injury; (4) Participants' perceptions regarding potential for dementia prevention, and risk reduction. Lack of motivation was the most prevalent barrier to consuming a healthy diet (64%, n = 213), physical activity (77.7%, n = 167), smoking cessation (68%, n = 85), and moderation of alcohol intake (56.3%, n = 67). Practical factors were the most prevalent barriers to addressing low mood (56.5%, n = 87), air pollution (30.1%, n = 58), hearing impairment (63.8%, n = 44), diabetes (11.1%, n = 5), and head injury (80%, n = 8). Emotional factors were the most prevalent barriers to engaging in mentally stimulating activity (56.9%, n = 66), social activity (54.9%, n = 302), and good sleep (70.1%, n = 129). Lack of knowledge was the most prevalent barrier to hypertension control (14.4%, n = 29). Distribution of barriers varied across age, gender, educational status, and household income. This study investigated barriers to lifestyle change to improve brain health in an Irish sample of adults aged 50 and above. Detailed subtyping of barriers, as well as examination of differences according to age, gender, education, and income were undertaken. The heterogeneity of barriers to brain health behaviours revealed in this study highlights the necessity to tailor public health interventions to their target population, taking into account the gender, age, educational status, and income of recipients.

Sleep Traits Causally Affect the Brain Cortical Structure: A Mendelian Randomization Study

Background: Brain imaging results in sleep deprived patients showed structural changes in the cerebral cortex; however, the reasons for this phenomenon need to be further explored. Methods: This MR study evaluated causal associations between morningness, ease of getting up, insomnia, long sleep, short sleep, and the cortex structure. Results: At the functional level, morningness increased the surface area (SA) of cuneus with global weighted (beta(b) (95% CI): 32.63 (10.35, 54.90), p = 0.004). Short sleep increased SA of the lateral occipital with global weighted (b (95% CI): 394.37(107.89, 680.85), p = 0.007. Short sleep reduced cortical thickness (TH) of paracentral with global weighted (OR (95% CI): -0.11 (-0.19, -0.03), p = 0.006). Short sleep reduced TH of parahippocampal with global weighted (b (95% CI): -0.25 (-0.42, -0.07), p = 0.006). No pleiotropy was detected. However, none of the Bonferroni-corrected p values of the causal relationship between cortical structure and the five types of sleep traits met the threshold. Conclusions: Our results potentially show evidence of a higher risk association between neuropsychiatric disorders and not only paracentral and parahippocampal brain areas atrophy, but also an increase in the middle temporal zone. Our findings shed light on the associations of cortical structure with the occurrence of five types of sleep traits.

Association of sleep disorders with clinical symptoms and age in Chinese older adult patients with and without cognitive decline

Objective

To investigate correlation between cognitive function, age, and sleep disturbances.

Methods

This retrospective clinical study enrolled 78 patients with sleep disorders who were divided into three groups: a group of 24 patients with sleep disorders accompanied by cognitive decline (SD-CD); 54 patients with sleep disorders and no cognitive decline (SD-nCD) was divided into two groups, one of 30 patients aged between 60 and 70 years and another of 24 patients aged >70 years. Polysomnography was used to record patients' sleep indicators throughout night; these included total sleep duration, sleep efficiency (SE), sleep latency, sleep structure and percentage of N1, N2, and N3 stages, rapid eye movement (REM) stage, as well as apnea hypopnea index (AHI), and oxygen saturation (OS). Analysis of variance (ANOVA) for continuous variables and chi-square test for categorical variables were used to analyze variables between different groups. Pearson's correlation was used to analyze correlation between sleep parameters and mini-mental state examination (MMSE). Blood samples were used to determine their Aβ, Aβ40, Aβ42, total tau, phosphorylated tau protein (ptau), ptau181, ptau217, the inflammatory factor IL-1β, vitamin B12 (VB12), and melatonin levels.

Results

In the SD-CD group, there was a significant decrease in SE and an increase in N1 stage sleep in older patients and a significant increase in AHI, REM stage AHI, and non-REM stage AHI. In patients with SD-nCD, the minimum OS, minimum OS in the REM period, and minimum OS in the non-REM period were significantly reduced. OS was significantly correlated with cognitive level, as evaluated by the MMSE. The addition of sleep parameters can significantly improve the accuracy of dementia diagnosis. Dementia biomarkers of Aβ and tau proteins in blood showed cognition-related differences, while ptau181 was associated with both cognition and age-related differences. Regression models revealed that age was related to higher levels of cognitive decline before (β = -0.43, P < 0.001) and after (β = -0.38, P < 0.001) adjustment of gender, BMI, and education level. There was a significant mediation effect of relationship between aging and cognitive function by sleep efficiency and N1 stage sleep.

Conclusion

Sleep disorders and low OS are associated with a higher incidence of cognitive decline and dementia.

Association of Sociodemographic Factors with Physical Activity and Sleep Quality in Arab and Non-Arab Individuals of Both Sexes during the COVID-19 Pandemic

We explored the association of sociodemographic and anthropometric factors with self-reported physical activity (PA) and sleep quality in Arab and non-Arab individuals of both sexes during the COVID-19 pandemic. In this cross-sectional study, 638 participants (those recovered from COVID-19 = 149, and non-infected = 489) of both sexes aged 18-55 years were recruited. Their sociodemographic and anthropometric information, PA (self-reported using the International Physical Activity Questionnaire Short-form [IPAQ-SF)]) and sleep quality (self-reported using the Pittsburgh Sleep Quality Index [PSQI]) were documented. The association between participants' characteristics, PA levels, and sleep quality were determined using the chi-squared test. Variables significantly associated with IPAQ and PSQI in bivariate analyses were included in a multivariate binary logistic regression model. Men were more active than women (odds ratio [OR] = 1.66, p = 0.010), and non-Arab participants were more active than Arab ones (OR = 1.49, p = 0.037). Participants ≥40 years, men, non-Arab participants, and those who were working were more likely to have a good sleep quality than those ≤40 years (OR 1.70, p = 0.048), women (OR 1.10, p = 0.725), Arab individuals (OR 1.95, p = 0.002), and unemployed people (OR 2.76, p = 0.007). Male and non-Arab participants seemed to have a better self-reported PA and sleep quality compared to female and Arab participants, during the pandemic.

Sleep and memory: The impact of sleep deprivation on transcription, translational control, and protein synthesis in the brain

In countries around the world, sleep deprivation represents a widespread problem affecting school-age children, teenagers, and adults. Acute sleep deprivation and more chronic sleep restriction adversely affect individual health, impairing memory and cognitive performance as well as increasing the risk and progression of numerous diseases. In mammals, the hippocampus and hippocampus-dependent memory are vulnerable to the effects of acute sleep deprivation. Sleep deprivation induces changes in molecular signaling, gene expression and may cause changes in dendritic structure in neurons. Genome wide studies have shown that acute sleep deprivation alters gene transcription, although the pool of genes affected varies between brain regions. More recently, advances in research have drawn attention to differences in gene regulation between the level of the transcriptome compared with the pool of mRNA associated with ribosomes for protein translation following sleep deprivation. Thus, in addition to transcriptional changes, sleep deprivation also affects downstream processes to alter protein translation. In this review, we focus on the multiple levels through which acute sleep deprivation impacts gene regulation, highlighting potential post-transcriptional and translational processes that may be affected by sleep deprivation. Understanding the multiple levels of gene regulation impacted by sleep deprivation is essential for future development of therapeutics that may mitigate the effects of sleep loss.

Global synergistic actions to improve brain health for human development

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.