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Notland JG, Iversen HK, Jennum P, West AS. Circadian Temperature in Moderate to Severe Acute Stroke Patients. J Circadian Rhythms 2024; 22:3. [PMID: 39100387 PMCID: PMC11295907 DOI: 10.5334/jcr.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/25/2024] [Indexed: 08/06/2024] Open
Abstract
Background Stroke patients often present circadian disruption due to multiple causes e.g., primary disease, comorbidities, medication, immobilization, reduced daylight entrainment and sleep disturbances. Objective To investigate the circadian rhythm of temperature in forehead skin in patients with moderate to severe stroke admitted for rehabilitation. Methods A physiologic study in form of a secondary analysis of a former randomized study. In total 27 patients with moderate to severe stroke were included between May 1st 2014, and June 1st 2015. Circadian temperature was collected approx. seven days after admission at the acute stroke unit by a skin surface temperature probe as part of a Polysomnography (PSG) measurement. Results Temperature variations show no circadian rhythm (Type 3 tests of fixed effects by SAS, p = 0.1610). The median temperature variance did fluctuate, but not significantly, and the small changes in circadian temperature variance did not follow the normal temperature variance. Conclusion Patients with moderate to severe stroke show an abrogated circadian rhythm of temperature. There is an unmet need to understand the mechanisms for this, significance for stroke outcome and treatment.
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Affiliation(s)
- Jakob Ginsbak Notland
- Clinical Stroke Research Unit, Department of Neurology, Copenhagen University Hospital –Rigshospitalet, Copenhagen, Denmark
| | - Helle K. Iversen
- Clinical Stroke Research Unit, Department of Neurology, Copenhagen University Hospital –Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Center for Sleep Medicine, Department of Neurophysiology, Copenhagen University Hospital –Rigshospitalet, Copenhagen, Denmark
| | - Anders S. West
- Clinical Stroke Research Unit, Department of Neurology, Copenhagen University Hospital –Rigshospitalet, Copenhagen, Denmark
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Smagula SF, Zhang G, Krafty RT, Ramos A, Sotres-Alvarez D, Rodakowski J, Gallo LC, Lamar M, Gujral S, Fischer D, Tarraf W, Mossavar-Rahmani Y, Redline S, Stone KL, Gonzalez HM, Patel SR. Sleep-wake behaviors associated with cognitive performance in middle-aged participants of the Hispanic Community Health Study/Study of Latinos. Sleep Health 2024; 10:500-507. [PMID: 38693044 PMCID: PMC11309910 DOI: 10.1016/j.sleh.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Many sleep-wake behaviors have been associated with cognition. We examined a panel of sleep-wake/activity characteristics to determine which are most robustly related to having low cognitive performance in midlife. Secondarily, we evaluate the predictive utility of sleep-wake measures to screen for low cognitive performance. METHODS The outcome was low cognitive performance defined as being >1 standard deviation below average age/sex/education internally normalized composite cognitive performance levels assessed in the Hispanic Community Health Study/Study of Latinos. Analyses included 1006 individuals who had sufficient sleep-wake measurements about 2years later (mean age=54.9, standard deviation= 5.1; 68.82% female). We evaluated associations of 31 sleep-wake variables with low cognitive performance using separate logistic regressions. RESULTS In individual models, the strongest sleep-wake correlates of low cognitive performance were measures of weaker and unstable 24-hour rhythms; greater 24-hour fragmentation; longer time-in-bed; and lower rhythm amplitude. One standard deviation worse on these sleep-wake factors was associated with ∼20%-30% greater odds of having low cognitive performance. In an internally cross-validated prediction model, the independent correlates of low cognitive performance were: lower Sleep Regularity Index scores; lower pseudo-F statistics (modellability of 24-hour rhythms); lower activity rhythm amplitude; and greater time in bed. Area under the curve was low/moderate (64%) indicating poor predictive utility. CONCLUSION The strongest sleep-wake behavioral correlates of low cognitive performance were measures of longer time-in-bed and irregular/weak rhythms. These sleep-wake assessments were not useful to identify previous low cognitive performance. Given their potential modifiability, experimental trials could test if targeting midlife time-in-bed and/or irregular rhythms influences cognition.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Gehui Zhang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Alberto Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Linda C Gallo
- Department of Psychology, University of California San Diego, San Diego, California, USA
| | - Melissa Lamar
- Institute of Minority Health Research, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Swathi Gujral
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dorothee Fischer
- Department of Sleep and Human Factors Research, Institute for Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Hector M Gonzalez
- Department of Neurosciences and the Shiley-Marcos Alzheimer's Disease Research Center, UC San Diego, San Diego, California, USA
| | - Sanjay R Patel
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ishikawa T, Sato T, Okumura M, Kokubu T, Takahashi J, Kitagawa T, Tanabe M, Takatsu H, Onda A, Komatsu T, Sakuta K, Sakai K, Umehara T, Mitsumura H, Iguchi Y. Bathing-Related Ischemic Stroke: Association between Stroke Subtype and Cerebral Small Vessel Disease. J Atheroscler Thromb 2024:64933. [PMID: 38825505 DOI: 10.5551/jat.64933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
AIMS Bathing-related ischemic stroke (BIS) is sometimes fatal. However, its mechanisms and risk factors remain unclear. We aimed to identify the incidence of stroke subtypes in BIS, and clarify the impact of cerebral small vessel disease (CSVD) on BIS. METHODS Consecutive patients with ischemic stroke between October 2012 and February 2022 were retrospectively screened. The inclusion criteria were: 1) onset-to-door time within 7 days; and 2) availability of the results of MRI evaluation of CSVD markers during hospitalization. BIS was defined as an ischemic stroke that occurred while or shortly after bathing. We investigated the incidence of the stroke subtype and the correlation between CSVD markers and BIS. RESULTS 1,753 ischemic stroke patients (1,241 [71%] male, median age 69 years) were included. 57 patients (3%) were included in the BIS group. A higher frequency of large artery atherosclerosis (LAA) (prevalence ratio [PR] 2.069, 95% confidence interval [CI] 1.089 to 3.931, p=0.026) and lower frequency of cardio-embolism (CES) (PR 0.362, 95% CI 0.132 to 0.991, p=0.048) in BIS cases were identified. Moreover, lower periventricular hyperintensity (PVH) Fazekas grade (PR 0.671, 95% CI 0.472 to 0.956, p=0.027) and fewer cerebral microbleeds (CMBs) in deep brain region (PR 0.810, 95%CI 0.657 to 0.999, p=0.049) were associated with BIS cases. CONCLUSIONS The BIS group was more likely to develop LAA and less likely to develop CES. Lower PVH grade and fewer CMBs in deep brain region were associated with the development of BIS.
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Affiliation(s)
| | - Takeo Sato
- Department of Neurology, The Jikei University School of Medicine
| | - Motohiro Okumura
- Department of Neurology, The Jikei University School of Medicine
| | - Tatsushi Kokubu
- Department of Neurology, The Jikei University School of Medicine
| | | | | | - Maki Tanabe
- Department of Neurology, The Jikei University School of Medicine
| | - Hiroki Takatsu
- Department of Neurology, The Jikei University School of Medicine
| | - Asako Onda
- Department of Neurology, The Jikei University School of Medicine
| | - Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine
| | - Kenichi Sakuta
- Department of Neurology, The Jikei University School of Medicine
| | - Kenichiro Sakai
- Department of Neurology, The Jikei University School of Medicine
| | - Tadashi Umehara
- Department of Neurology, The Jikei University School of Medicine
| | | | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine
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Bazaz MR, Asthana A, Dandekar MP. Chitosan revokes controlled-cortical impact generated neurological aberrations in circadian disrupted mice via TLR4-NLRP3 axis. Eur J Pharmacol 2024; 969:176436. [PMID: 38423243 DOI: 10.1016/j.ejphar.2024.176436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
The severity of inevitable neurological deficits and long-term psychiatric disorders in the aftermath of traumatic brain injury is influenced by pre-injury biological factors. Herein, we investigated the therapeutic effect of chitosan lactate on neurological and psychiatric aberrations inflicted by circadian disruption (CD) and controlled-cortical impact (CCI) injury in mice. Firstly, CD was developed in mice by altering sporadic day-night cycles for 2 weeks. Then, CCI surgery was performed using a stereotaxic ImpactOne device. Mice subjected to CCI displayed a significant disruption of motor coordination at 1-, 3- and 5-days post-injury (DPI) in the rotarod test. These animals showed anxiety- and depression-like behaviors in the elevated plus maze and forced-swim test at 14 and 15 DPI, respectively. Notably, mice subjected to CD + CCI exhibited severe cognitive impairment in Y-maze and novel object recognition tasks. The compromised neurological, psychiatric, and cognitive functions were mitigated in chitosan-treated mice (1 and 3 mg/mL). Immunohistochemistry and real-time PCR assay results revealed the magnified responses of prima facie biomarkers like glial-fibrillary acidic protein and ionized calcium-binding adaptor molecule 1 in the pericontusional brain region of the CD + CCI group, indicating aggravated inflammation. We also noted the depleted levels of brain-derived neurotrophic factor and augmented expression of toll-like receptor 4 (TLR4)-leucine-rich-containing family pyrin domain-containing 3 (NLRP3) signaling [apoptosis-associated-speck-like protein (ASC), caspase-1, and interleukin 1-β] in the pericontusional area of CD + CCI group. CCI-induced changes in the astrocyte-glia and aggravated immune responses were ameliorated in chitosan-treated mice. These results suggest that the neuroprotective effect of chitosan in CCI-induced brain injury may be mediated by inhibition of the TLR4-NLRP3 axis.
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Affiliation(s)
- Mohd Rabi Bazaz
- Department of Biological Sciences (Pharmacology and Toxicology), National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad, 500037, India
| | - Amit Asthana
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad, 500037, India
| | - Manoj P Dandekar
- Department of Biological Sciences (Pharmacology and Toxicology), National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad, 500037, India.
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Abstract
The brain is a complex organ, fundamentally changing across the day to perform basic functions like sleep, thought, and regulating whole-body physiology. This requires a complex symphony of nutrients, hormones, ions, neurotransmitters and more to be properly distributed across the brain to maintain homeostasis throughout 24 hours. These solutes are distributed both by the blood and by cerebrospinal fluid. Cerebrospinal fluid contents are distinct from the general circulation because of regulation at brain barriers including the choroid plexus, glymphatic system, and blood-brain barrier. In this review, we discuss the overlapping circadian (≈24-hour) rhythms in brain fluid biology and at the brain barriers. Our goal is for the reader to gain both a fundamental understanding of brain barriers alongside an understanding of the interactions between these fluids and the circadian timing system. Ultimately, this review will provide new insight into how alterations in these finely tuned clocks may lead to pathology.
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Affiliation(s)
- Velia S Vizcarra
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Ryann M Fame
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Lauren M Hablitz
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
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Lau SCL, Connor LT, Skidmore ER. Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study. Neurorehabil Neural Repair 2024; 38:197-206. [PMID: 38318642 DOI: 10.1177/15459683241230027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment. OBJECTIVE To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors. METHODS Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition. RESULTS Later onset of rest (B = 0.45; P = .008) and activity (B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = -0.42; P = .017; activity onset: B = -0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity (B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition (B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition (B = 0.39; P = .015). CONCLUSIONS We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.
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Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
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Ang PS, Zhang DM, Azizi SA, Norton de Matos SA, Brorson JR. The glymphatic system and cerebral small vessel disease. J Stroke Cerebrovasc Dis 2024; 33:107557. [PMID: 38198946 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Cerebral small vessel disease is a group of pathologies in which alterations of the brain's blood vessels contribute to stroke and neurocognitive changes. Recently, a neurotoxic waste clearance system composed of perivascular spaces abutting the brain's blood vessels, termed the glymphatic system, has been identified as a key player in brain homeostasis. Given that small vessel disease and the glymphatic system share anatomical structures, this review aims to reexamine small vessel disease in the context of the glymphatic system and highlight novel aspects of small vessel disease physiology. MATERIALS AND METHODS This review was conducted with an emphasis on studies that examined aspects of small vessel disease and on works characterizing the glymphatic system. We searched PubMed for relevant articles using the following keywords: glymphatics, cerebral small vessel disease, arterial pulsatility, hypertension, blood-brain barrier, endothelial dysfunction, stroke, diabetes. RESULTS Cerebral small vessel disease and glymphatic dysfunction are anatomically connected and significant risk factors are shared between the two. These include hypertension, type 2 diabetes, advanced age, poor sleep, obesity, and neuroinflammation. There is clear evidence that CSVD hinders the effective functioning of glymphatic system. CONCLUSION These shared risk factors, as well as the model of cerebral amyloid angiopathy pathogenesis, hint at the possibility that glymphatic dysfunction could independently contribute to the pathogenesis of cerebral small vessel disease. However, the current evidence supports a model of cascading dysfunction, wherein concurrent small vessel and glymphatic injury hinder glymphatic-mediated recovery and promote the progression of subclinical to clinical disease.
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Affiliation(s)
- Phillip S Ang
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Douglas M Zhang
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Saara-Anne Azizi
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | | | - James R Brorson
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States; Department of Neurology, The University of Chicago, Chicago, IL 60637, United States.
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Hoepel SJW, Berghout BP, Luik AI, Ikram MK. Sleep and 24-H Activity Rhythms and the Risk of Stroke: A Prospective Cohort Study. Neuroepidemiology 2024; 58:229-236. [PMID: 38295781 PMCID: PMC11302742 DOI: 10.1159/000536526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/15/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Short and long self-reported sleep durations are associated with a higher risk of stroke, but the association between objective estimates of sleep and 24-h activity rhythms is less clear. We studied the association of actigraphy-estimated sleep and 24-h activity rhythms with the risk of stroke in a population-based cohort of middle-aged and elderly. METHODS We included 1,718 stroke-free participants (mean age 62.2 ± 9.3 years, 55.1% women) from the prospective, population-based Rotterdam Study. Actigraphy-estimated sleep (total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset) and 24-h activity rhythms (interdaily stability, intradaily variability, and onset of the least active 5 h) were measured during a median of 7 days (Q1-Q3: 6-7 days). The association of sleep and 24-h activity rhythms with risk of stroke was analyzed using Cox proportional hazards models. RESULTS During a mean follow-up of 12.2 years (SD: 3.2), 105 participants developed a stroke, of whom 81 had an ischemic event. Although there was no clear association between actigraphy-estimated sleep and the risk of stroke, a more fragmented 24-h activity rhythm was associated with a higher risk of stroke (hazard ratio [HR] per SD increase 1.28, 95% confidence interval [CI] 1.07-1.53). A less stable (HR per SD increase in stability 0.78, 95% CI: 0.63-0.97) and more fragmented (HR 1.28, 95% CI: 1.04-1.58) 24-h activity rhythm was also associated with a higher risk of ischemic stroke. CONCLUSIONS Disturbed 24-h activity rhythms, but not sleep, are associated with a higher risk of stroke in middle-aged and elderly persons. This suggests that unstable and fragmented activity rhythms may play a more prominent role in the risk of stroke than sleep per se.
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Affiliation(s)
- Sanne J W Hoepel
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands,
| | - Bernhard P Berghout
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Trimbos Institute - The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Okumura M, Sato T, Ishikawa T, Kokubu T, Takahashi J, Kitagawa T, Nakada R, Takatsu H, Onda A, Komatsu T, Sakuta K, Sakai K, Umehara T, Mitsumura H, Matsushima M, Iguchi Y. Deep and infratentorial cerebral microbleeds are related to wake-up stroke by large-artery atherosclerosis and cardioembolism. J Neurol Sci 2024; 456:122813. [PMID: 38043333 DOI: 10.1016/j.jns.2023.122813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/05/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND AND AIMS Circadian variability of blood pressure (BP) and hypercoagulation in the morning have been proposed as underlying mechanisms of wake-up stroke (WUS). The aim was to determine the impact of cerebral microbleeds (CMBs), showing BP fluctuation and background hypercoagulability, on WUS. METHODS Consecutive patients with acute ischemic stroke onset-to-door time within one week were screened. WUS was defined as an ischemic stroke that occurred during sleep at night. CMBs were categorized into three: "strictly Lobar", "strictly Deep (D) and/or Infratentorial (I)", and "Mixed". Moderate to severe CMBs were defined as having more than three in total. First, whether CMBs are associated with WUS was examined. Second, the same analysis was performed according to the stroke subtype classified as large-artery atherosclerosis (LAA), cardioembolism (CE), and small-vessel occlusion (SVO). RESULTS A total of 1477 patients (1059 [72%] male, median age 69 years) were included, and WUS was observed in 363 (25%) patients. On Poisson regression analysis with a robust variance estimator in the total cohort, moderate to severe strictly D and/or I CMBs (PR 1.505, 95% CI 1.154-1.962, p = 0.003) were associated with WUS. From the perspective of stroke subtype, the same result was confirmed in LAA (PR 2.223, 95% CI 1.036-4.768, p = 0.040) and CE (PR 1.668, 95% CI 1.027-2.709, p = 0.039), not SVO. CONCLUSIONS The presence of moderate to severe strictly D and/or I CMBs might be associated with the development of WUS. By stroke subtype, the same result was confirmed in LAA and CE.
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Affiliation(s)
- Motohiro Okumura
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeo Sato
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Takahiro Ishikawa
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kokubu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Junichiro Takahashi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomomichi Kitagawa
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoji Nakada
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Takatsu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Asako Onda
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Sakuta
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Umehara
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidetaka Mitsumura
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
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10
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Zhao H, Li H, Ding Y, Li Z, Huang Y. The relationship between apathy and nonparametric variables of rest activity rhythm in older adults with cerebral small vessel disease. Chronobiol Int 2023; 40:1574-1581. [PMID: 37990547 DOI: 10.1080/07420528.2023.2282467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
The goal of the current study was to demonstrate if the rest-activity rhythm (RAR) was altered in apathetic older adults with cerebral small vessel disease (CSVD) and find out the relationship between apathy/depression severity and RAR features in CSVD patients. This is a cross-sectional observational investigation including 53 CSVD cases (54.74% men), aged 70.70 ± 6.18 years old. The participants were assessed by neuropsychiatric inventory (NPI) subscale of apathy (NPI-apathy) and depression (NPI-depression) in succession, according to updated diagnostic criteria for apathy (DCA). Each subject wore an actigraph device (ActiGraph GT3X) in their nondominant hand for 7 days to collect raw data. Using a non-parametric methodological analysis, this study determined RAR variables such as interdaily stability (IS), intraday variability (IV) and relative amplitude (RA). Patients in the apathy-positive group had a higher Fazekas score than those in the apathy-negative group. IS, but not IV, RA, or objective sleep variables, differed between elderly patients with varying degrees of CSVD burden. Furthermore, apathy severity was statistically correlated with RA after adjusting for age, gender and education level, whereas depression severity was not associated with RAR variables. Finally, we discovered that the severity of apathy had no significant relationship with the severity of depression. All these findings indicated that the RAR altered in apathetic older adults with CSVD, and apathy was associated with decreased RAR amplitude.
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Affiliation(s)
- Hongyi Zhao
- Department of Neurology, The Seventh-Medical Center of PLA General Hospital, Beijing, China
- Department of Neurology, NO 984 Hospital of PLA, Beijing, China
| | - Hong Li
- Department of Medical prevention and military operatiions, Center for Disease Control and Prevention of Central Theater Command, Beijing, China
| | - Yu Ding
- Department of Neurology, The Seventh-Medical Center of PLA General Hospital, Beijing, China
| | - Zhiyi Li
- Department of Neurology, NO 984 Hospital of PLA, Beijing, China
| | - Yonghua Huang
- Department of Neurology, The Seventh-Medical Center of PLA General Hospital, Beijing, China
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11
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Korostovtseva LS, Kolomeichuk SN. Circadian Factors in Stroke: A Clinician's Perspective. Cardiol Ther 2023; 12:275-295. [PMID: 37191897 DOI: 10.1007/s40119-023-00313-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Stroke remains one of the leading causes of mortality and long-term and permanent disability worldwide despite technological innovations and developments in pharmacotherapy. In the last few decades, the growing data have evidenced the role of the circadian system in brain vulnerability to damage, the development and evolution of stroke, and short-term and long-term recovery. On the other hand, the stroke itself can affect the circadian system via direct injury of specific brain structures involved in circadian regulation (i.e., hypothalamus, retinohypothalamic tracts, etc.) and impairment of endogenous regulatory mechanisms, metabolic derangement, and a neurogenic inflammatory response in acute stroke. Moreover, the disruption of circadian rhythms can occur or exacerbate as a result of exogenous factors related to hospitalization itself, the conditions in the intensive care unit and the ward (light, noise, etc.), medication (sedatives and hypnotics), and loss of external factors entraining the circadian rhythms. In the acute phase of stroke, patients demonstrate abnormal circadian variations in circadian biomarkers (melatonin, cortisol), core body temperature, and rest-activity patterns. The approaches aimed at the restoration of disrupted circadian patterns include pharmacological (melatonin supplementation) and non-medication (bright light therapy, shifting feeding schedules, etc.) interventions; however, their effects on short- and long-term recovery after stroke are not well understood.
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Affiliation(s)
- Lyudmila S Korostovtseva
- Sleep Laboratory, Research Department for Hypertension, Almazov National Medical Research Centre, 2 Akkuratov Str., St Petersburg, 197341, Russia.
| | - Sergey N Kolomeichuk
- Sleep Laboratory, Research Department for Hypertension, Almazov National Medical Research Centre, 2 Akkuratov Str., St Petersburg, 197341, Russia
- Laboratory of Genetics Institute of Biology, Karelian Research Centre, Russian Academy of Sciences, Almazov National Medical Research Centre, St Petersburg, Russia
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12
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Xu J, Su Y, Fu J, Shen Y, Dong Q, Cheng X. Glymphatic pathway in sporadic cerebral small vessel diseases: From bench to bedside. Ageing Res Rev 2023; 86:101885. [PMID: 36801378 DOI: 10.1016/j.arr.2023.101885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Cerebral small vessel diseases (CSVD) consist of a group of diseases with high heterogeneity induced by pathologies of intracranial small blood vessels. Endothelium dysfunction, bloodbrain barrier leakage and the inflammatory response are traditionally considered to participate in the pathogenesis of CSVD. However, these features cannot fully explain the complex syndrome and related neuroimaging characteristics. In recent years, the glymphatic pathway has been discovered to play a pivotal role in clearing perivascular fluid and metabolic solutes, which has provided novel insights into neurological disorders. Researchers have also explored the potential role of perivascular clearance dysfunction in CSVD. In this review, we presented a brief overview of CSVD and the glymphatic pathway. In addition, we elucidated CSVD pathogenesis from the perspective of glymphatic failure, including basic animal models and clinical neuroimaging markers. Finally, we proposed forthcoming clinical applications targeting the glymphatic pathway, hoping to provide novel ideas on promising therapies and preventions of CSVD.
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Affiliation(s)
- Jiajie Xu
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ya Su
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiayu Fu
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong Shen
- Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC and Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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13
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Kitajima T, Kuriyama K. Editorial: Circadian rhythm sleep-wake disorders: Pathophysiology, comorbidity, and management. Front Psychiatry 2023; 14:1134798. [PMID: 36778639 PMCID: PMC9909692 DOI: 10.3389/fpsyt.2023.1134798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Affiliation(s)
- Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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14
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Jeon SY, Byun MS, Yi D, Jung G, Lee JY, Kim YK, Sohn CH, Kang KM, Lee YJ, Lee DY. Circadian rest-activity rhythm and longitudinal brain changes underlying late-life cognitive decline. Psychiatry Clin Neurosci 2022; 77:205-212. [PMID: 36527292 PMCID: PMC10360409 DOI: 10.1111/pcn.13521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
AIM The neurobiological substrates underlying the relationship of circadian rest-activity rhythm (RAR) alteration with accelerated late-life cognitive decline are not clearly understood. In the present study, the longitudinal relationship of objectively measured circadian RAR with in vivo Alzheimer disease (AD) pathologies and cerebrovascular injury was investigated in older adults without dementia. METHODS The present study included 129 participants without dementia who participated in the KBASE (Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer's Disease) cohort. All participants underwent actigraphy at baseline and two consecutive [11 C] Pittsburgh compound-B positron emission tomography (PET), [18 F] fluorodeoxyglucose-PET, magnetic resonance imaging, and Mini-Mental State Examination (MMSE) at baseline and at a 2-year follow-up assessment. The associations of circadian RAR with annualized change in neuroimaging measures including global amyloid-beta retention, AD-signature region cerebral glucose metabolism (AD-CM), and white matter hyperintensity volume were examined. RESULTS Delayed acrophase at baseline was significantly associated with greater annualized decline of AD-CM over a 2-year period, but not with that of other neuroimaging measures. In contrast, other circadian RAR parameters at baseline had no association with annualized change of any neuroimaging measures. Annualized decline of AD-CM was also significantly positively associated with the annual change in MMSE scores. Furthermore, a mediation analysis showed that greater reduction in AD-CM mediated the effect of delayed acrophase at baseline on faster decline of MMSE score. CONCLUSION The findings indicate that delayed acrophase in late life may cause or predict hypometabolism at AD-signature brain regions, which underlies cognitive decline in the near future.
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Affiliation(s)
- So Yeon Jeon
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea.,Department of Psychiatry, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Centre, Seoul National University, Seoul, South Korea
| | - Gijung Jung
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medcine, Seoul, South Korea.,Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Yu Jin Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Medical Research Centre, Seoul National University, Seoul, South Korea
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15
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Pajediene E, Paulekas E, Salteniene V, Skieceviciene J, Arstikyte J, Petrikonis K, Kupcinskas J, Bassetti CL, Daiva R. Diurnal variation of clock genes expression and other sleep-wake rhythm biomarkers among acute ischemic stroke patients. Sleep Med 2022; 99:1-10. [DOI: 10.1016/j.sleep.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 10/31/2022]
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16
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Cai X, Zhào H, Li Z, Ding Y, Huang Y. Detecting apathy in patients with cerebral small vessel disease. Front Aging Neurosci 2022; 14:933958. [PMID: 35992598 PMCID: PMC9381828 DOI: 10.3389/fnagi.2022.933958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Apathy is attracting more and more attention in clinical practice. As one of the most common features of cerebral small vessel disease (CSVD), the assessment of apathy still mainly relies on observers. With the development of Information and Communication Technologies (ICTs), new objective tools take part in the early detection of apathy. Objectives To detect apathy in patients with CSVD and find out the relationship between apathy and actigraphic data sampled from the diurnal and nocturnal periods. Methods A total of 56 patients with CSVD were recruited for a cross-sectional observational study. Apathy was diagnosed by the diagnostic criteria for apathy in neurocognitive disorders. The presence of lacunes, white matter hyperintensities, cerebral microbleeds (CMBs), and perivascular spaces (PVS) in magnetic resonance imaging (MRI) images were rated independently. Actigraph devices were worn in the non-dominant hands of each subject for 7 consecutive days to collect samples of raw data, and diurnal vector magnitude (VM) and a series of sleep quality variables were obtained. Results We found that the frequency of apathy in Chinese patients with CSVD reached 37.50%. Patients in the Apathy+ group showed more lacunes and CMBs, and higher Fazekas scores in comparison to apathy-group individuals. Diurnal VM, instead of other sleep quality variables, was lower in CSVD patients with apathy relative to those without apathy. Lastly, we discovered that diurnal VM and total time in bed (TTB) correlated negatively with apathy severity in patients with CSVD. Conclusion Actigraphy is a promising choice to evaluate apathy in patients with CSVD.
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Affiliation(s)
- Xiaoping Cai
- Department of Neurology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- 7th Department of Health Cadre, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hóngyi Zhào
- Department of Neurology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Neurology, NO 984 Hospital of PLA, Beijing, China
| | - Zhiyi Li
- Department of Neurology, NO 984 Hospital of PLA, Beijing, China
| | - Yu Ding
- Department of Neurology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yonghua Huang
- Department of Neurology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yonghua Huang,
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17
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Palmer JR, Wang C, Kong D, Cespedes M, Pye J, Hickie IB, Barnett M, Naismith SL. Rest-activity rhythms and tract specific white matter lesions in older adults at risk for cognitive decline. Mol Psychiatry 2022; 27:3410-3416. [PMID: 35764707 PMCID: PMC9708592 DOI: 10.1038/s41380-022-01641-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/04/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022]
Abstract
White matter lesions (WMLs) are common in older adults and represent an important predictor of negative long-term outcomes. Rest-activity rhythm disturbance is also common, however, few studies have investigated associations between these factors. We employed a novel AI-based automatic WML segmentation tool and diffusion-weighted tractography to investigate associations between tract specific WML volumes and non-parametric actigraphy measures in older adults at risk for cognitive decline. The primary non-parametric measures of interest were inter-daily stability (IS), intra-daily variability and relative amplitude, with the anterior thalamic radiation (ATR), superior longitudinal fasciculus (SLF) and inferior longitudinal fasciculus (ILF) selected as tracts of interest. One hundred and eight participants at risk for cognitive decline (classified as experiencing subjective or objective cognitive decline) were included (mean age = 68.85 years, SD = 8.91). Of the primary non-parametric measures of interest, results showed that lower IS was associated with a greater likelihood of higher WML burden in the ATR (OR = 1.82, 95% CI [1.12,3.15]). Analysis of secondary non-parametric measures revealed later onset of the least active period to be associated with greater likelihood of high WML burden in the SLF (OR = 1.55, 95% CI [1.00,2.53]) and increased activity during the least active 5-h period to be associated with a greater likelihood of high whole-brain WML burden (OR = 1.83, 95% CI [1.06,3.47]). This study shows integrity of the ATR and SLF, and overall WML burden is linked to altered rest-activity rhythms in older adults at risk for cognitive decline, with those demonstrating altered rest-activity rhythms showing 50%-80% higher odds of having high WML burden.
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Affiliation(s)
- Jake R. Palmer
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia ,grid.1004.50000 0001 2158 5405Department of Psychology, Macquarie University, Sydney, NSW Australia
| | - Chenyu Wang
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,Sydney Neuroimaging Analysis Centre, Sydney, NSW Australia
| | - Dexiao Kong
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia
| | - Marcela Cespedes
- grid.467740.60000 0004 0466 9684Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD Australia
| | - Jonathon Pye
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XSusan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW Australia
| | - Ian B. Hickie
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia
| | - Michael Barnett
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,Sydney Neuroimaging Analysis Centre, Sydney, NSW Australia
| | - Sharon L. Naismith
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia ,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration, Sydney, NSW Australia
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18
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Zhao J, Kong Q, Wang M, Huang H, Zhou X, Guo Y, Zhang Y, Wu L, Yu Z, Luo X. Association of Excessive Daytime Sleepiness with Cerebral Small Vessel Disease in Community-Dwelling Older Adults. Nat Sci Sleep 2022; 14:765-773. [PMID: 35478722 PMCID: PMC9037722 DOI: 10.2147/nss.s357586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Excessive daytime sleepiness (EDS) and cerebral small vessel disease (CSVD) are common problems among older adults; however, their association is not clear. The present study aimed to investigate the frequency of EDS in CSVD patients and the relationship between EDS and neuroimaging markers of CSVD. PATIENTS AND METHODS We conducted a cross-sectional study among 1076 community-dwelling older adults aged 55-85 years. EDS was measured using the Epworth Sleepiness Scale (ESS), and EDS was defined as an ESS score greater than 10. Binary logistic regression was performed to assess the association between EDS and neuroimaging markers of CSVD. RESULTS Of the 1076 participants (mean age: 65.58 ± 6.46 years, 60.5% female), the prevalence of EDS was 10.0%. EDS was more frequent in participants with CSVD than in the total sample (20.0% vs 10.0%, p <0.001). In fully adjusted models, EDS was significantly correlated with CSVD burden (OR = 1.39, 95% CI 1.16 to 1.68, p <0.001), the severity of white matter hyperintensities (WMH) (OR = 1.33, 95% CI 1.14 to 1.54, p <0.001), and presence of lacunes (OR = 2.47, 95% CI 1.53 to 4.00, p <0.001) but not with the presence of cerebral microbleeds (CMBs) (OR=1.54, 95% CI 0.92 to 2.56, p = 0.099) or severity of enlarged perivascular spaces (EPVS) in basal ganglia (OR = 1.16, 95% CI 0.70 to 1.92, p = 0.564). CONCLUSION We found a high frequency of EDS symptoms in CSVD individuals. Further, EDS was significantly associated with WMH, lacunes, and CSVD burden. Our findings further suggest patients with CSVD may exhibit abnormal sleep-wake patterns.
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Affiliation(s)
- Jing Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Qianqian Kong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xirui Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yinping Guo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yi Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lingshan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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19
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Palmer JR, Duffy SL, Meares S, Pye J, Calamante F, Cespedes M, Hickie IB, Naismith SL. Rest-activity functioning is related to white matter microarchitecture and modifiable risk factors in older adults at-risk for dementia. Sleep 2021; 44:6082819. [PMID: 33428761 DOI: 10.1093/sleep/zsab007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Growing evidence demonstrates pronounced alterations in rest-activity functioning in older adults at-risk for dementia. White matter degeneration, poor cardiometabolic functioning, and depression have also been linked to a greater risk of decline; however, limited studies have examined the white matter in relation to rest-activity functioning in at-risk older adults. METHODS We investigated associations between nonparametric actigraphy measures and white matter microarchitecture using whole-brain fixel-based analysis of diffusion-weighted imaging in older adults (aged 50 years or older) at-risk for cognitive decline and dementia. The fixel-based metrics assessed were fiber density, fiber cross-section, and combined fiber-density, and cross-section. Interactions between rest-activity functioning and known clinical risk factors, specifically body mass index (BMI), vascular risk factors, depressive symptoms and self-reported exercise, and their association with white matter properties were then investigated. RESULTS Sixty-seven older adults were included (mean = 65.78 years, SD = 7.89). Lower relative amplitude, poorer 24-h synchronization and earlier onset of the least active 5-h period were associated with reductions in markers of white matter atrophy in widespread regions, including cortico-subcortical and cortical association pathways. Preliminary evidence was also found indicating more pronounced white matter alterations in those with lower amplitude and higher BMI (β = 0.25, 95% CI [0.05, 0.46]), poorer 24-h synchronization and more vascular risk factors (β = 0.17, 95% CI [-0.02, 0.36]) and earlier onset of inactivity and greater depressive symptoms (β = 0.17, 95% CI [0.03, 0.30]). CONCLUSIONS These findings highlight the complex interplay between rest-activity rhythms, white matter, and clinical risk factors in individuals at-risk for dementia that should be considered in future studies.
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Affiliation(s)
- Jake R Palmer
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.,School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Shantel L Duffy
- Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration, Sydney, NSW, Australia
| | - Susanne Meares
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jonathon Pye
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Fernando Calamante
- Sydney Imaging and School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, NSW, Australia
| | - Marcela Cespedes
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD, Australia
| | - Ian B Hickie
- Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration, Sydney, NSW, Australia
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20
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Sommer R, Yu L, Schneider JA, Bennett DA, Buchman AS, Lim ASP. Disrupted Rest-Activity Rhythms and Cerebral Small Vessel Disease Pathology in Older Adults. Stroke 2021; 52:2427-2431. [PMID: 33902300 PMCID: PMC8790726 DOI: 10.1161/strokeaha.120.030870] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The pathogenesis of cerebral small vessel disease remains incompletely understood. The relationship between circadian rhythm disturbances and histopathologic measures of cerebral small vessel disease has not been studied. We hypothesized that disrupted circadian rest-activity rhythms would be associated with a higher burden of cerebral small vessel disease pathology. METHODS We studied 561 community-dwelling older adults (mean age at death, 91.2, 27.4% male) from the Rush Memory and Aging Project. We used actigraphy to quantify several measures of 24-hour rest-activity rhythmicity, including interdaily stability, intradaily variability, and amplitude, and used ordinal logistic regression models to relate these measures to the severity of cerebral arteriolosclerosis, atherosclerosis, macroinfarcts, and microinfarcts, assessed at autopsy. RESULTS Lower interdaily stability was associated with a higher burden of arteriolosclerosis, higher intradaily variability was associated with a higher burden of atherosclerosis and subcortical infarcts, and lower amplitude was associated with a higher burden of arteriosclerosis, atherosclerosis and subcortical macroinfarcts. Moreover, the associations between interdaily stability and arteriolosclerosis and intradaily variability and subcortical infarcts were independent of cardiovascular risk factors, sleep fragmentation, and medical comorbidities. CONCLUSIONS Disrupted rest-activity rhythms are associated with a greater burden of cerebral small vessel disease in older adults.
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Affiliation(s)
- Rosa Sommer
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.S., A.S.P.L.)
| | - Lei Yu
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
| | - Julie A Schneider
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
- Department of Pathology (J.A.S.), Rush University, Chicago, IL
| | - David A Bennett
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
| | - Aron S Buchman
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
| | - Andrew S P Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.S., A.S.P.L.)
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21
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McMahon M, Malneedi Y, Worthy DA, Schnyer DM. Rest-activity rhythms and white matter microstructure across the lifespan. Sleep 2021; 44:6017487. [PMID: 33269397 DOI: 10.1093/sleep/zsaa266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/09/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES The purpose of this study was to examine how rest-activity (RA) rhythm stability may be associated with white matter microstructure across the lifespan in healthy adults free of significant cardiovascular risk. METHODS We analyzed multi-shell diffusion tensor images from 103 healthy young and older adults using tract-based spatial statistics (TBSS) to examine relationships between white matter microstructure and RA rhythm stability. RA measures were computed using both cosinor and non-parametric methods derived from 7 days of actigraphy data. Fractional anisotropy (FA) and mean diffusivity (MD) were examined in this analysis. Because prior studies have suggested that the corpus callosum (CC) is sensitive to sleep physiology and RA rhythms, we also conducted a focused region of interest analysis on the CC. RESULTS Greater rest-activity rhythm stability was associated with greater FA across both young and older adults, primarily in the CC and anterior corona radiata. This effect was not moderated by age group. While RA measures were associated with sleep metrics, RA rhythm measures uniquely accounted for the variance in white matter integrity. CONCLUSIONS This study strengthens existing evidence for a relationship between brain white matter structure and RA rhythm stability in the absence of health risk factors. While there are differences in RA stability between age groups, the relationship with brain white matter was present across both young and older adults. RA rhythms may be a useful biomarker of brain health across both periods of adult development.
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Affiliation(s)
- Megan McMahon
- Department of Psychology, University of Texas at Austin, Austin, TX
| | - Yoshita Malneedi
- Department of Psychology, University of Texas at Austin, Austin, TX
| | - Darrell A Worthy
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX
| | - David M Schnyer
- Department of Psychology, University of Texas at Austin, Austin, TX
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Evans CRD, Kovach CR. The Association Between Physiological Sources of Pain and Sleep Quality in Older Adults With and Without Dementia. Res Gerontol Nurs 2020; 13:297-308. [PMID: 33034650 DOI: 10.3928/19404921-20201002-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/21/2020] [Indexed: 11/20/2022]
Abstract
The association of musculoskeletal pain, respiratory distress, gastrointestinal discomfort, and genitourinary pain to sleep quality in 89 persons with and without dementia was examined in the current exploratory, cross-sectional, observational quantitative design. Sources of pain were recorded, with 37.1% of the sample reporting urinary retention, 30.3% reporting genitourinary discomfort, and 53.9% reporting gastrointestinal discomfort. Mild scores of musculoskeletal pain and respiratory discomfort were elicited in >75% of the sample. An actigraph was used to measure sleep variables. Findings from this research illustrated dementia, gender, pillow use, respiratory distress, and urinary retention were statistically significantly associated with nighttime sleep quality. Results suggest comprehensive assessments of pain and sleep for older adults with and without dementia are needed. Developing and testing interventions that address factors contributing to sleep quality may improve outcomes. [Research in Gerontological Nursing, 13(6), 297-308.].
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Suibkitwanchai K, Sykulski AM, Perez Algorta G, Waller D, Walshe C. Nonparametric time series summary statistics for high-frequency accelerometry data from individuals with advanced dementia. PLoS One 2020; 15:e0239368. [PMID: 32976498 PMCID: PMC7518630 DOI: 10.1371/journal.pone.0239368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022] Open
Abstract
Accelerometry data has been widely used to measure activity and the circadian rhythm of individuals across the health sciences, in particular with people with advanced dementia. Modern accelerometers can record continuous observations on a single individual for several days at a sampling frequency of the order of one hertz. Such rich and lengthy data sets provide new opportunities for statistical insight, but also pose challenges in selecting from a wide range of possible summary statistics, and how the calculation of such statistics should be optimally tuned and implemented. In this paper, we build on existing approaches, as well as propose new summary statistics, and detail how these should be implemented with high frequency accelerometry data. We test and validate our methods on an observed data set from 26 recordings from individuals with advanced dementia and 14 recordings from individuals without dementia. We study four metrics: Interdaily stability (IS), intradaily variability (IV), the scaling exponent from detrended fluctuation analysis (DFA), and a novel nonparametric estimator which we call the proportion of variance (PoV), which calculates the strength of the circadian rhythm using spectral density estimation. We perform a detailed analysis indicating how the time series should be optimally subsampled to calculate IV, and recommend a subsampling rate of approximately 5 minutes for the dataset that has been studied. In addition, we propose the use of the DFA scaling exponent separately for daytime and nighttime, to further separate effects between individuals. We compare the relationships between all these methods and show that they effectively capture different features of the time series.
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Affiliation(s)
- Keerati Suibkitwanchai
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
- * E-mail:
| | - Adam M. Sykulski
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Daniel Waller
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
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24
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Sleep, rest-activity fragmentation and structural brain changes related to the ageing process. Curr Opin Behav Sci 2020. [DOI: 10.1016/j.cobeha.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Smagula SF, Chahine L, Metti A, Rangarajan A, Aizenstein HJ, Tian Q, Rosano C. Regional Gray Matter Volume Links Rest-Activity Rhythm Fragmentation With Past Cognitive Decline. Am J Geriatr Psychiatry 2020; 28:248-251. [PMID: 31377045 PMCID: PMC6980463 DOI: 10.1016/j.jagp.2019.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/19/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We examined the extent to which measures of neurodegeneration and cerebrovascular disease explain the rest-activity rhythm (RAR)-cognition link. METHODS Seventy participants (mean age at MRI = 86, standard deviation (SD) = 2.6; 53% female) had cognitive, MRI, and accelerometer data. The slope of cognitive decline was defined applying a mixed model to 10 repeated Modified Mini Mental Status Test (3MS) measures over 14 years. Regional gray matter volume (GMV), white matter hyperintensities, and RARs were measured around year 12. RESULTS Past 3MS decline was related to RAR fragmentation (per SD β = -0.43, 95% confidence interval: -0.73, -0.14) and lower posterior parietal GMV (per standard deviation β = 0.47, 95% confidence interval: 0.14, 0.79). Higher RAR fragmentation was related to lower posterior parietal GMV (Pearson r = -0.39, n = 70, p = 0.0007), which attenuated the association of RAR fragmentation and past cognitive decline by 17%. CONCLUSIONS Longitudinal studies are warranted to understand the temporal relations and mechanisms linking RAR fragmentation and neurodegeneration.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry (SFS, AR, and HJA), School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Lana Chahine
- Department of Neurology (LC), School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Andrea Metti
- Department of Epidemiology (AM and CR), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Anusha Rangarajan
- Department of Psychiatry (SFS, AR, and HJA), School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Howard J Aizenstein
- Department of Psychiatry (SFS, AR, and HJA), School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Qu Tian
- Intramural Research Program (QT), National Institute on Aging, Baltimore, MD
| | - Caterina Rosano
- Department of Epidemiology (AM and CR), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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26
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Li K, Luo X, Zeng Q, Jiaerken Y, Wang S, Xu X, Xu X, Xu J, Wang C, Zhou J, Huang P, Zhang M. Interactions between sleep disturbances and Alzheimer's disease on brain function: a preliminary study combining the static and dynamic functional MRI. Sci Rep 2019; 9:19064. [PMID: 31836777 PMCID: PMC6911090 DOI: 10.1038/s41598-019-55452-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
Though sleep disturbance constitutes the risk factor for Alzheimer's disease (AD), the underlying mechanism is still unclear. This study aims to explore the interaction between sleep disturbances and AD on brain function. We included 192 normal controls, 111 mild cognitive impairment (MCI), and 30 AD patients, with either poor or normal sleep (PS, NS, respectively). To explore the strength and stability of brain activity, we used static amplitude of low-frequency fluctuation (sALFF) and dynamic ALFF (dALFF) variance. Further, we examined white matter hyperintensities (WMH) and amyloid PET deposition, representing the vascular risk factor and AD-related hallmark, respectively. We observed that sleep disturbance significantly interacted with disease severity, exposing distinct effects on sALFF and dALFF variance. Interestingly, PS groups showed the dALFF variance trajectory of initially increased, then decreased and finally increased along the AD spectrum, while showing the opposite trajectory of sALFF. Further correlation analysis showed that the WMH burden correlates with dALFF variance in PS groups. Conclusively, our study suggested that sleep disturbance interacts with AD severity, expressing as effects of compensatory in MCI and de-compensatory in AD, respectively. Further, vascular impairment might act as important pathogenesis underlying the interaction effect between sleep and AD.
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Affiliation(s)
- Kaicheng Li
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Xiao Luo
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Qingze Zeng
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Yerfan Jiaerken
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Shuyue Wang
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaopei Xu
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaojun Xu
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Jingjing Xu
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Chao Wang
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Jiong Zhou
- Department of Neurology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Peiyu Huang
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China.
| | - Minming Zhang
- Department of Radiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China.
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27
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Kim WH, Yoo YH, Lim JY, Kang SG, Jung HY, Bae JN, Joa KL. Objective and subjective sleep problems and quality of life of rehabilitation in patients with mild to moderate stroke. Top Stroke Rehabil 2019; 27:199-207. [DOI: 10.1080/10749357.2019.1673591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, South Korea
| | - Young-Hwan Yoo
- Department of Physical Medicine and Rehabilitation, Inha University Hospital, Incheon, South Korea
| | - Ju-Young Lim
- Department of Physical Medicine and Rehabilitation, Inha University Hospital, Incheon, South Korea
| | - Sang-Gu Kang
- Department of Psychiatry, Inha University Hospital, Incheon, South Korea
| | - Han-Young Jung
- Department of Physical Medicine and Rehabilitation, Inha University Hospital, Incheon, South Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, South Korea
| | - Kyung-Lim Joa
- Department of Physical Medicine and Rehabilitation, Inha University Hospital, Incheon, South Korea
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28
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Aribisala BS, Riha RL, Valdes Hernandez M, Muñoz Maniega S, Cox S, Radakovic R, Taylor A, Pattie A, Corley J, Redmond P, Bastin ME, Starr J, Deary I, Wardlaw JM. Sleep and brain morphological changes in the eighth decade of life. Sleep Med 2019; 65:152-158. [PMID: 31706897 DOI: 10.1016/j.sleep.2019.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sleep is important for brain health. We analysed associations between usual sleep habits and magnetic resonance imaging (MRI) markers of neurodegeneration (brain atrophy), vascular damage (white matter hyperintensities, WMH) and waste clearance (perivascular spaces, PVS) in older community-dwelling adults. METHOD We collected self-reported usual sleep duration, quality and medical histories from the Lothian Birth Cohort 1936 (LBC1936) age 76 years and performed brain MRI. We calculated sleep efficiency, measured WMH and brain volumes, quantified PVS, and assessed associations between sleep measures and brain markers in multivariate models adjusted for demographic and medical history variables. RESULTS In 457 subjects (53% males, mean age 76 ± 0.65 years), we found: brain and white matter loss with increased weekend daytime sleep (β = -0.114, P = 0.03; β = -0.122, P = 0.007 respectively), white matter loss with less efficient sleep (β = 0.132, P = 0.011) and PVS increased with interrupted sleep (OR 1.84 95% CI, P = 0.025). CONCLUSION Cross-sectional associations of sleep parameters with brain atrophy and more PVS suggest adverse relationships between usual sleep habits and brain health in older people that should be evaluated longitudinally.
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Affiliation(s)
- Benjamin S Aribisala
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK; Department of Computer Science, Lagos State University, Lagos, Nigeria
| | - Renata L Riha
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Sleep Medicine, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Maria Valdes Hernandez
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK
| | - Susana Muñoz Maniega
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK
| | - Simon Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ratko Radakovic
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK; Faculty of Health and Medical Sciences, University of East Anglia, Norwich, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Adele Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Alison Pattie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Janie Corley
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Paul Redmond
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK
| | - John Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Ian Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK; UK Dementia Research Institute, University of Edinburgh, UK.
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Lau HL, Rundek T, Ramos AR. Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment. CURRENT SLEEP MEDICINE REPORTS 2019; 5:71-82. [PMID: 31850157 PMCID: PMC6916645 DOI: 10.1007/s40675-019-00142-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss the most recent data on sleep disorders and stroke, highlighting relevant findings for the practicing neurologist or health providers who encounter patients with sleep disorders and stroke. RECENT FINDINGS Sleep apnea and abnormal sleep duration have the strongest association with stroke risk. Possible mechanisms include non-dipping of blood pressure during sleep, hypoxemia or reoxygenation leading to sympathetic activation, hypertension, atrial fibrillation and impaired cerebral hemodynamics. Treatment studies suggest that continuous positive airway pressure (CPAP) for sleep apnea could improve primary prevention of stroke, but data is equivocal for secondary prevention. However, CPAP could improve functional outcomes after stroke. SUMMARY Sleep disorders present an opportunity to improve stroke risk and functional outcomes. However, new strategies are needed to determine the patients at high-risk who would most likely benefit from targeted care. Novel methods for phenotyping sleep disorders could provide personalized stroke care to improve clinical outcomes and public health strategies.
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Affiliation(s)
- H Lee Lau
- Departments of Neurology, Miller School of Medicine University of Miami, Miami, Florida, USA
| | - Tanja Rundek
- Departments of Neurology, Miller School of Medicine University of Miami, Miami, Florida, USA
| | - Alberto R Ramos
- Departments of Neurology, Miller School of Medicine University of Miami, Miami, Florida, USA
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West AS, Sennels HP, Simonsen SA, Schønsted M, Zielinski AH, Hansen NC, Jennum PJ, Sander B, Wolfram F, Iversen HK. The Effects of Naturalistic Light on Diurnal Plasma Melatonin and Serum Cortisol Levels in Stroke Patients during Admission for Rehabilitation: A Randomized Controlled Trial. Int J Med Sci 2019; 16:125-134. [PMID: 30662336 PMCID: PMC6332482 DOI: 10.7150/ijms.28863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Stroke patients admitted for rehabilitation often lack sufficient daytime blue light exposure due to the absence of natural light and are often exposed to light at unnatural time points. We hypothesized that artificial light imitating daylight, termed naturalistic light, would stabilize the circadian rhythm of plasma melatonin and serum cortisol levels among long-term hospitalized stroke patients. Methods: A quasi-randomized controlled trial. Stroke patients in need of rehabilitation were randomized between May 1, 2014, and June 1, 2015 to either a rehabilitation unit equipped entirely with always on naturalistic lighting (IU), or to a rehabilitation unit with standard indoor lighting (CU). At both inclusion and discharge after a hospital stay of at least 2 weeks, plasma melatonin and serum cortisol levels were measured every 4 hours over a 24-hour period. Circadian rhythm was estimated using cosinor analysis, and variance between time-points. Results: A total of 43 were able to participate in the blood collection. Normal diurnal rhythm of melatonin was disrupted at both inclusion and discharge. In the IU group, melatonin plasma levels were increased at discharge compared to inclusion (n = 23; median diff, 2.9; IQR: -1.0 to 9.9, p = 0.030) and rhythmicity evolved (n = 23; p = 0.007). In the CU group, melatonin plasma levels were similar between discharge and inclusion and no rhythmicity evolved. Overall, both patient groups showed normal cortisol diurnal rhythms at both inclusion and discharge. Conclusions: This study is the first to demonstrate elevated melatonin plasma levels and evolved rhythmicity due to stimulation with naturalistic light.
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Affiliation(s)
- Anders S West
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Henriette P Sennels
- Department of Clinical Biochemistry, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen
| | - Sofie A Simonsen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Marie Schønsted
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Alexander H Zielinski
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Niklas C Hansen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Neurophysiology Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Birgit Sander
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital
| | - Frauke Wolfram
- Department of diagnostic, Radiologic clinic, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen
| | - Helle K Iversen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
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Smagula SF, Gujral S, Capps CS, Krafty RT. A Systematic Review of Evidence for a Role of Rest-Activity Rhythms in Dementia. Front Psychiatry 2019; 10:778. [PMID: 31736798 PMCID: PMC6832024 DOI: 10.3389/fpsyt.2019.00778] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Rest-activity rhythm (RAR) disruption may be a risk factor for dementia that can be objectively measured with wearable accelerometers. It is possible that risk monitoring and preventive interventions could be developed targeting RARs. To evaluate whether current evidence supports these applications, we systematically reviewed published studies linking RARs with dementia, its course, and mechanisms. Methods: Entering pre-defined search terms in PsycINFO, MEDLINE, and PubMed databases returned 192 unique titles. We identified 32 articles that met our primary inclusion criteria, namely, that they examined objective RAR measures in the context of dementia, cognition, or brain biomarkers. Results: Cross-sectional studies consistently found that people with dementia had less stable (5/6 studies), more fragmented (4/6 studies), lower amplitude rhythms (5/5 studies), that had a worse fit to 24-h models (3/3 studies). Findings from studies relating RARs to cognitive test performance (rather than diagnostic status) were more nuanced. RAR fragmentation was associated with neurodegeneration biomarkers in 2/2 studies; and 1/1 study found 24-h model fit related to hippocampal hyperactivation. Although 2/2 studies found RARs related to markers of cerebrovascular disease, the specific RARs and cerebrovascular disease measures were not consistent. Longitudinal studies (3/3 articles) reported that lower amplitude and worse 24-h rhythm fit predicted future cognitive impairment and executive function. However, interventions aimed at modifying RARs had mixed effects (e.g., 0/4 studies demonstrated effects of morning light on 24-h model fit; evening light was associated with improved 24-h fit in 2/2 studies reporting); these effects may be more evident in subgroups. Conclusions: Consistent evidence shows that dementia is associated with disrupted RARs. Importantly, recent studies have shown that RAR disruption is associated with dementia biomarkers and, prospectively, with the risk of cognitive impairment. Interventions mostly tried using bright light to modify RARs in people who already have dementia; these studies produced modest effects on RARs and did not show modification of dementia's course. Altogether, these findings suggest studies are needed to understand how RARs relate to changes in brain health earlier in the disease process. Better understanding of the biopsychosocial mechanisms linking RARs with future dementia risk can help further target intervention development.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Swathi Gujral
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Veterans Administration, Veterans Integrated Service Network 4, Mental Illness Research, Education and Clinical Center of Excellence, Pittsburgh, PA, United States
| | - Chandler S Capps
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Robert T Krafty
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA, United States
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32
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Wei W, Chen Y, Lei D, Zhang Y, Weng X, Zhou Y, Zhang L. Plasma brain natriuretic peptide is a biomarker for screening ischemic cerebral small vessel disease in patients with hypertension. Medicine (Baltimore) 2018; 97:e12088. [PMID: 30170428 PMCID: PMC6392776 DOI: 10.1097/md.0000000000012088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/02/2018] [Indexed: 11/26/2022] Open
Abstract
Plasma brain natriuretic peptide (BNP), a diagnostic marker of cardiovascular diseases, has been previously linked to cerebrovascular diseases. Our goal was to determine whether plasma BNP level is helpful for identifying high-risk individuals who are likely to present with the 3 main subtypes of cerebral small vessel diseases (CSVDs), namely, white matter lesions, lacunar infarcts, and cerebral microbleeds, on magnetic resonance imaging (MRI) in patients with hypertension.Three hundred forty-six consecutive hypertensive patients presenting at our cardiology or neurology clinic were investigated. Plasma BNP level was measured by chemiluminescent microparticle immunoassay. The presence of CSVD was assessed by 1.5-T brain MRI. Multivariate linear regression was used to determine whether individual or combined MRI-defined CSVD subtypes were associated with BNP level, after adjustment for several covariates.The mean age of patients was 69.1 ± 9.8 years, and 44.2% were female. The highest quartile BNP group was positively associated with advanced age, female sex, clinically manifesting cardiac diseases, and ischemic CSVD (white matter lesions and lacunar infarcts) and no association with cerebral microbleeds. According to multivariate linear regression, white matter lesions [β = 0.722; 95% confidence interval (95% CI), 0.624-0.819] and lacunar infarcts (β = 0.635; 95% CI, 0.508-0.762) were independently associated with BNP level, even after controlling for vascular risk factors and clinically manifesting cardiac diseases. Combined white matter lesions and lacunar infarcts were more strongly associated with BNP level than each subtype alone. With the cutoff value of 106.4 pg/mL, BNP level had a sensitivity, a specificity, and an area under the curve of 95.2%, 64.9%, and 0.799, respectively, for white matter lesions, whereas the values were 143.0 pg/mL, 81.6%, 73.5%, and 0.848, respectively, for lacunar infarcts.Plasma BNP level, which is independently correlated with individual or combined white matter lesions and lacunar infarcts, is a useful molecular marker for identifying ischemic CSVD in patients with hypertension.
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Affiliation(s)
- Weimin Wei
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
- Department of Neurology, Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University)
| | - Yan Chen
- School of Clinical Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou
| | - Da Lei
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
| | - Yanan Zhang
- Veterinary medicine, Northeast Agricultural University, Haerbin, China
| | - Xiuhong Weng
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
| | - Yuliang Zhou
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
| | - Li Zhang
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
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Medial temporal lobe atrophy relates more strongly to sleep-wake rhythm fragmentation than to age or any other known risk. Neurobiol Learn Mem 2018; 160:132-138. [PMID: 29864525 DOI: 10.1016/j.nlm.2018.05.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/19/2018] [Accepted: 05/24/2018] [Indexed: 11/21/2022]
Abstract
Atrophy of the medial temporal lobe of the brain is key to memory function and memory complaints in old age. While age and some morbidities are major risk factors for medial temporal lobe atrophy, individual differences remain, and mechanisms are insufficiently known. The largest combined neuroimaging and whole genome study to date indicates that medial temporal lobe volume is most associated with common polymorphisms in the GRIN2B gene that encodes for the 2B subunit (NR2B) of the NMDA receptor. Because sleep disruption induces a selective loss of NR2B from hippocampal synaptic membranes in rodents, and because of several other reports on medial temporal lobe sensitivity to sleep disruption, we hypothesized a contribution of the typical age-related increase in sleep-wake rhythm fragmentation to medial temporal lobe atrophy. Magnetic resonance imaging and actigraphy in 138 aged individuals showed that individual differences in sleep-wake rhythm fragmentation accounted for more (19%) of the variance in medial temporal lobe atrophy than age did (15%), or any of a list of health and brain structural indicators. The findings suggest a role of sleep-wake rhythm fragmentation in age-related medial temporal lobe atrophy, that might in part be prevented or reversible.
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Activity/rest cycle and disturbances of structural backbone of cerebral networks in aging. Neuroimage 2017; 146:814-820. [DOI: 10.1016/j.neuroimage.2016.09.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/19/2016] [Accepted: 09/20/2016] [Indexed: 02/02/2023] Open
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35
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Affiliation(s)
- A H V Schapira
- Clinical Neurosciences, UCL Institute of Neurology, London, UK
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36
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Li D, Ma S, Guo D, Cheng T, Li H, Tian Y, Li J, Guan F, Yang B, Wang J. Environmental Circadian Disruption Worsens Neurologic Impairment and Inhibits Hippocampal Neurogenesis in Adult Rats After Traumatic Brain Injury. Cell Mol Neurobiol 2016; 36:1045-55. [PMID: 26886755 DOI: 10.1007/s10571-015-0295-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/23/2015] [Indexed: 11/29/2022]
Abstract
Circadian rhythms modulate many physiologic processes and behaviors. Therefore, their disruption causes a variety of potential adverse effects in humans and animals. Circadian disruption induced by constant light exposure has been discovered to produce pathophysiologic consequences after brain injury. However, the underlying mechanisms that lead to more severe impairment and disruption of neurophysiologic processes are not well understood. Here, we evaluated the effect of constant light exposure on the neurobehavioral impairment and survival of neurons in rats after traumatic brain injury (TBI). Sixty adult male Sprague-Dawley rats were subjected to a weight-drop model of TBI and then exposed to either a standard 12-/12-h light/dark cycle or a constant 24-h light/light cycle for 14 days. Our results showed that 14 days of constant light exposure after TBI significantly worsened the sensorimotor and cognitive deficits, which were associated with decreased body weight, impaired water and food intake, increased cortical lesion volume, and decreased neuronal survival. Furthermore, environmental circadian disruption inhibited cell proliferation and newborn cell survival and decreased immature cell production in rats subjected to the TBI model. We conclude that circadian disruption induced by constant light exposure worsens histologic and neurobehavioral impairment and inhibits neurogenesis in adult TBI rats. Our novel findings suggest that light exposure should be decreased and circadian rhythm reestablished in hospitalized TBI patients and that drugs and strategies that maintain circadian rhythm would offer a novel therapeutic option.
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Affiliation(s)
- Dongpeng Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.,Henan Province Red Cross Blood Center, Zhengzhou, Henan, 450014, People's Republic of China
| | - Shanshan Ma
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, People's Republic of China
| | - Dewei Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Tian Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
| | - Hongwei Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Yi Tian
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Jianbin Li
- Henan Province Red Cross Blood Center, Zhengzhou, Henan, 450014, People's Republic of China
| | - Fangxia Guan
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, People's Republic of China.
| | - Bo Yang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
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37
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Abstract
UNLABELLED Although the functions of sleep remain to be fully elucidated, it is clear that there are far-reaching effects of its disruption, whether by curtailment for a single night, by a few hours each night over a long period, or by disruption in sleep continuity. Epidemiological and experimental studies of these different forms of sleep disruption show deranged physiology from subcellular levels to complex affective behavior. In keeping with the multifaceted influence of sleep on health and well-being, we illustrate how the duration of sleep, its timing, and continuity can affect cellular ultrastructure, gene expression, metabolic and hormone regulation, mood, and vigilance. Recent brain imaging studies provide some clues on mechanisms underlying the most common cause of disrupted sleep (insomnia). These insights should ultimately result in adequate interventions to prevent and treat sleep disruption because of their high relevance to our most prevalent health problems. SIGNIFICANCE STATEMENT Disruption of the duration, timing, and continuity of sleep affects cellular ultrastructure, gene expression, appetite regulation, hormone production, vigilance, and reward functions.
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Smagula SF, Boudreau R, Stone K, Reynolds CF, Bromberger J, Ancoli-Israel S, Dam TT, Barrett-Connor E, Cauley JA. Latent activity rhythm disturbance sub-groups and longitudinal change in depression symptoms among older men. Chronobiol Int 2015; 32:1427-37. [PMID: 26594893 PMCID: PMC4729211 DOI: 10.3109/07420528.2015.1102925] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Activity rhythm disturbances and depression often co-occur among older adults. However, little is known about how activity rhythm disturbances themselves co-occur, or how disturbances to multiple aspects of the activity rhythm relate to depression over time. In this study, we performed a Latent Class Analysis to derive sub-groups of older men [total n = 2933, mean age = 76.28, standard deviation (SD) = 5.48] who shared similar patterns of activity rhythm disturbances (defined as extreme values of modeled activity rhythm parameters). We found eight sub-groups with distinct combinations of activity rhythm disturbances: one had all normative activity rhythm parameters (32.09%), one had only lower activity (10.06%), three had earlier activity (totaling 26.96%) and three had later activity (totaling 30.89%). Groups with similar timing were distinguished depending on whether the relative length of the active period was shorter and/or if the activity rhythm had lesser amplitude/robustness. We next examined whether the derived activity rhythm sub-groups were associated with different rates of change in depression symptom levels over an average of 5.5 (0.52 SD) follow-up years. The sub-group with lower activity only had faster increases in depressive symptoms over time (compared with the group with normative rhythm parameters), but this association was accounted for by adjustments for concurrently assessed health status covariates. Independent of these covariates, we found that four activity rhythm disturbance sub-groups experienced faster depressive symptom increases (compared with the normative sub-group): These included all three sub-groups that had later activity timing and one sub-group that had earlier activity timing plus a shorter active period and a dampened rhythm. Low activity rhythm height/robustness with normal timing therefore may mark depression risk that is attributable to co-occurring disease processes; in contrast, having late or combined early/compressed/dampened activity rhythms may independently contribute to depression symptom development. Our findings suggest that activity rhythm-related depression risk is heterogeneous, and may be detected when multiple aspects of rhythm timing are delayed or when early timing is accompanied by compressed/dampened activity rhythms. Future studies should consider how distinct combinations of altered activity rhythm timing and height/robustness develop and conjointly determine health risks. Further research is also needed to determine whether/how activity rhythms can be modified to improve depression outcomes.
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Affiliation(s)
- Stephen F. Smagula
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Charles F. Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Joyce Bromberger
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California San Diego, San Diego, California
| | - Thuy-Tien Dam
- Division of Geriatric Medicine and Aging, Columbia University, New York, NY, USA
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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