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André C, Martineau-Dussault MÈ, Baril AA, Marchi NA, Daneault V, Lorrain D, Hudon C, Bastien CH, Petit D, Thompson C, Poirier J, Montplaisir J, Gosselin N, Carrier J. Reduced rapid eye movement sleep in late middle-aged and older apolipoprotein E ɛ4 allele carriers. Sleep 2024; 47:zsae094. [PMID: 38634644 PMCID: PMC11236949 DOI: 10.1093/sleep/zsae094] [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: 02/01/2024] [Revised: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
STUDY OBJECTIVES Apolipoprotein E ɛ4 (APOE4) is the strongest genetic risk factor for Alzheimer's disease (AD). In addition, APOE4 carriers may exhibit sleep disturbances, but conflicting results have been reported, such that there is no clear consensus regarding which aspects of sleep are impacted. Our objective was to compare objective sleep architecture between APOE4 carriers and non-carriers, and to investigate the modulating impact of age, sex, cognitive status, and obstructive sleep apnea (OSA). METHODS A total of 198 dementia-free participants aged >55 years old (mean age: 68.7 ± 8.08 years old, 40.91% women, 41 APOE4 carriers) were recruited in this cross-sectional study. They underwent polysomnography, APOE4 genotyping, and a neuropsychological evaluation. ANCOVAs assessed the effect of APOE4 status on sleep architecture, controlling for age, sex, cognitive status, and the apnea-hypopnea index. Interaction terms were added between APOE4 status and covariates. RESULTS Rapid eye movement (REM) sleep percentage (F = 9.95, p = .002, ηp2 = 0.049) and duration (F = 9.23, p = .003, ηp2 = 0.047) were lower in APOE4 carriers. The results were replicated in a subsample of 112 participants without moderate-to-severe OSA. There were no significant interactions between APOE4 status and age, sex, cognitive status, and OSA in the whole sample. CONCLUSIONS Our results show that APOE4 carriers exhibit lower REM sleep duration, including in cognitively unimpaired individuals, possibly resulting from early neurodegenerative processes in regions involved in REM sleep generation and maintenance.
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Affiliation(s)
- Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Nicola Andrea Marchi
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique Daneault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Dominique Lorrain
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- Department of Psychology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carol Hudon
- CERVO Brain Research Centre, Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada
- School of Psychology, Université Laval, Québec City, QC, Canada
| | - Célyne H Bastien
- CERVO Brain Research Centre, Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada
- School of Psychology, Université Laval, Québec City, QC, Canada
| | - Dominique Petit
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
| | - Judes Poirier
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, CIUSSS de l’Ouest-de-l’Ile-de-Montréal, Verdun, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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Pivac LN, Brown BM, Sewell KR, Doecke JD, Villemagne VL, Doré V, Weinborn M, Sohrabi HR, Gardener SL, Bucks RS, Laws SM, Taddei K, Maruff P, Masters CL, Rowe C, Martins RN, Rainey‐Smith SR. Suboptimal self-reported sleep efficiency and duration are associated with faster accumulation of brain amyloid beta in cognitively unimpaired older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12579. [PMID: 38651160 PMCID: PMC11033837 DOI: 10.1002/dad2.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION This study investigated whether self-reported sleep quality is associated with brain amyloid beta (Aβ) accumulation. METHODS Linear mixed effect model analyses were conducted for 189 cognitively unimpaired (CU) older adults (mean ± standard deviation 74.0 ± 6.2; 53.2% female), with baseline self-reported sleep data, and positron emission tomography-determined brain Aβ measured over a minimum of three time points (range 33.3-72.7 months). Analyses included random slopes and intercepts, interaction for apolipoprotein E (APOE) ε4 allele status, and time, adjusting for sex and baseline age. RESULTS Sleep duration <6 hours, in APOE ε4 carriers, and sleep efficiency <65%, in the whole sample and APOE ε4 non-carriers, is associated with faster accumulation of brain Aβ. DISCUSSION These findings suggest a role for self-reported suboptimal sleep efficiency and duration in the accumulation of Alzheimer's disease (AD) neuropathology in CU individuals. Additionally, poor sleep efficiency represents a potential route via which individuals at lower genetic risk may progress to preclinical AD. Highlights In cognitively unimpaired older adults self-report sleep is associated with brain amyloid beta (Aβ) accumulation.Across sleep characteristics, this relationship differs by apolipoprotein E (APOE) genotype.Sleep duration <6 hours is associated with faster brain Aβ accumulation in APOE ε4 carriers.Sleep efficiency < 65% is associated with faster brain Aβ accumulation in APOE ε4 non-carriers.Personalized sleep interventions should be studied for potential to slow Aβ accumulation.
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Affiliation(s)
- Louise N. Pivac
- Centre for Healthy Ageing, Health Futures InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
- Alzheimer's Research Australia, Sarich Neuroscience Research InstituteNedlandsWestern AustraliaAustralia
| | - Belinda M. Brown
- Centre for Healthy Ageing, Health Futures InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Kelsey R. Sewell
- Centre for Healthy Ageing, Health Futures InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
| | - James D. Doecke
- Australian E‐Health Research Centre, CSIROHerstonQueenslandAustralia
| | | | - Vincent Doré
- Australian E‐Health Research Centre, CSIROHerstonQueenslandAustralia
- Department of Molecular ImagingAustin HealthHeidelbergVictoriaAustralia
| | - Michael Weinborn
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Hamid R. Sohrabi
- Centre for Healthy Ageing, Health Futures InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Samantha L. Gardener
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Romola S. Bucks
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
- School of Population and Global HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Simon M. Laws
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Centre for Precision HealthEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Collaborative Genomics and Translation GroupEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Curtin Medical SchoolCurtin UniversityBentleyWestern AustraliaAustralia
| | - Kevin Taddei
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Paul Maruff
- Cogstate Ltd., MelbourneMelbourneVictoriaAustralia
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Colin L. Masters
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Christopher Rowe
- Department of Molecular ImagingAustin HealthHeidelbergVictoriaAustralia
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Ralph N. Martins
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Department of Biomedical SciencesMacquarie UniversityMacquarie UniversitySydneyNew South WalesAustralia
| | - Stephanie R. Rainey‐Smith
- Centre for Healthy Ageing, Health Futures InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
- Alzheimer's Research Australia, Sarich Neuroscience Research InstituteNedlandsWestern AustraliaAustralia
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
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Yu X, Zhou X, He Z, He B, Wan K, Wei M, Guo T, Han Y. Sleep and APOE-ε4 have a synergistic effect on plasma biomarkers and longitudinal cognitive decline in older adults. CNS Neurosci Ther 2024; 30:e14558. [PMID: 38421124 PMCID: PMC10850800 DOI: 10.1111/cns.14558] [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: 08/24/2023] [Revised: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Sleep disorders are prevalent among patients with Alzheimer's disease (AD), and the APOE ε4 genotype is a key genetic risk factor for sporadic AD. However, the combined effect of the genotype and sleep disorders on cognitive decline remains uncertain. METHODS A total of 972 participants were drawn from the SILCODE cohort, comprising 655 without the ε4 allele (APOE-) and 317 with ε4 allele (APOE+). Data were collected, including neuropsychological assessments, sleep measurements, plasma biomarkers, and PET imaging. A Sleep Composite Index (SCI) was created, categorizing participants into high risk (Sleep+) and low risk (Sleep-). RESULTS Significant predictions of dementia risk associated with plasma p-tau181, neurofilament light chain (NfL), and SCI. Individuals with both Sleep+ and APOE+ had a higher risk of dementia compared to those with Sleep-. The Sleep+/APOE+ group had higher plasma NfL levels than the Sleep-/APOE- group. Similar trends emerged in plasma NfL levels among the Aβ PET-positive subgroup. Plasma NfL levels explained 23% of the relationship between SCI and cognitive impairment. CONCLUSION Our study highlights sleep disorder was associated with cognitive decline, with plasma NfL playing a partial mediating role. These findings explain how sleep disorders affect cognitive function and emphasize the importance of healthy sleep for older adults.
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Affiliation(s)
- Xianfeng Yu
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Xia Zhou
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Zhengbo He
- Institute of Biomedical EngineeringShenzhen Bay LaboratoryShenzhenChina
| | - Beiqi He
- School of Information and Communication EngineeringHainan UniversityHaikouChina
| | - Ke Wan
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Min Wei
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Tengfei Guo
- Institute of Biomedical EngineeringShenzhen Bay LaboratoryShenzhenChina
| | - Ying Han
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
- School of Information and Communication EngineeringHainan UniversityHaikouChina
- Center of Alzheimer's DiseaseBeijing Institute for Brain DisordersBeijingChina
- National Clinical Research Center for Geriatric DisordersBeijingChina
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Wei W, Wang K, Shi J, Li Z. The Relationship Between Sleep Disturbance and Apolipoprotein E ε4 in Adults With Mild Cognitive Impairment and Alzheimer's Disease Dementia: An Integrative Review. Biol Res Nurs 2022; 24:327-337. [PMID: 35439097 DOI: 10.1177/10998004221081044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Apolipoprotein E ε4 (APOE ε4) was shown to be a risk factor for mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia. When coupled with sleep disturbance, APOE ε4 posed additional risks to cognitive impairment. But the literature on the association between sleep disturbance and the APOE ε4 status of persons who are cognitively impaired has not yet been systematically examined. OBJECTIVES To explore and synthesize the relationship between sleep disturbance and APOE ε4 status of adults with MCI and AD. METHODS An integrative review was guided by Whittemore and Knafl's methodology. Systematic searches identified studies with multiple sources published before May 20, 2021. A matrix and narrative synthesis was employed to organize and synthesize the findings. Joanna Briggs Institute (JBI) Critical Appraisal tools (2020) were used to evaluate the quality of the selected studies. RESULTS A total of 7 studies were included. APOE ε4 was associated with poor sleep quality in terms of the deterioration of nighttime total sleep time, 24-hour total sleep time, rapid eye movement, sleep efficiency, sleep latency, and wake after sleep onset in a population with MCI or AD. The interacted and adjusted relationship between sleep disturbance and APOE ε4 on the progression of cognitive decline was inconsistent. CONCLUSIONS There is evidence to support an association between sleep disturbance and APOE ε4 in individuals with cognitive impairment, but a further examination of the relationship between sleep parameters and APOE ε4 is warranted, especially as the causal or dose-response relationship remains unclear.
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Affiliation(s)
- Wanrui Wei
- School of Nursing, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kairong Wang
- School of Nursing, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiyuan Shi
- School of Nursing, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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5
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Blackman J, Love S, Sinclair L, Cain R, Coulthard E. APOE ε4, Alzheimer's disease neuropathology and sleep disturbance, in individuals with and without dementia. Alzheimers Res Ther 2022; 14:47. [PMID: 35354468 PMCID: PMC8969347 DOI: 10.1186/s13195-022-00992-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/20/2022] [Indexed: 12/20/2022]
Abstract
Background Apolipoprotein E epsilon 4 (APOE-ε4) carrier status is an established risk factor for Alzheimer’s disease (AD) dementia. It has also been linked with sleep disturbance in healthy older adults and increased insomnia risk. This association may be driven by the effect of APOE-ε4 on AD pathological change, itself associated with sleep abnormalities. To assess this relationship, we have evaluated post-mortem neuropathological findings in patients with and without cognitive impairment and AD pathology, who had extensive clinical assessment within 12 months of death. Methods This retrospective cohort study used UK Brain Banks Network data. Eligible subjects were aged over 50, with pre-mortem neuropsychiatry inventory scores of sleep disturbance (NPI-K), neurocognitive testing and functional cognitive status assessment (Clinical Dementia Rating scale). Neuropathological data included Thal phase, Braak stage and CERAD scores (measures of Aβ plaque distribution, tangle distribution and neuritic plaque density, respectively) combined to form the National Institute on Aging Alzheimer’s Association (NIA-AA) ABC score reflecting AD neuropathology. Participants with other significant intracerebral pathology or pathological features of non-AD dementia were excluded. Multivariate linear regression was performed with NPIK Global Score (NPIK frequency score multiplied by severity score) as the dependent variable and APOE-ε4 heterozygosity or homozygosity as independent variables. Covariates included age, gender, APOE-ε2 status and ABC NPI measures reflecting depression and anxiety. Further models stratified by ABC score and functional cognitive status were also produced. Results Seven hundred twenty-eight records were identified. Two hundred two participants were included in the final analysis: mean (SD) age 84.0 (9.2) and MMSE 14.0 (11.8). Mean sleep disturbance scores were highest in ε4 homozygosity (n=11), 4.55 (5.4); intermediate in ε4 heterozygosity (n=95), 2.03 (4.0); and lowest in non-ε4 carriers (n=96), 1.36 (3.3). Within the full sample, controlling for pathological status, age, gender, depression, anxiety and CDR-SOB status, APOE-ε4 homozygosity was associated with sleep disturbance (β 2.53, p=0.034). APOE-ε4 heterozygosity was similarly associated in individuals without dementia (β 1.21, p=0.048). Conclusion These findings lend weight to the hypothesis that APOE-ε4 affects sleep by mechanisms independent of AD pathological change. Evaluation of those mechanisms would enhance understanding of sleep disturbance pathways and potentially provide treatment targets. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-00992-y.
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Affiliation(s)
| | - Seth Love
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK
| | - Lindsey Sinclair
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK
| | - Richard Cain
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK
| | - Elizabeth Coulthard
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK.
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Abstract
Sleep homeostasis is a complex neurobiologic phenomenon involving a number of molecular pathways, neurotransmitter release, synaptic activity, and factors modulating neural networks. Sleep plasticity allows for homeostatic optimization of neural networks and the replay-based consolidation of specific circuits, especially important for cognition, behavior, and information processing. Furthermore, research is currently moving from an essentially brain-focused to a more comprehensive view involving other systems, such as the immune system, hormonal status, and metabolic pathways. When dysfunctional, these systems contribute to sleep loss and fragmentation as well as to sleep need. In this chapter, the implications of neural plasticity and sleep homeostasis for the diagnosis and treatment of some major sleep disorders, such as insomnia and sleep deprivation, obstructive sleep apnea syndrome, restless legs syndrome, REM sleep behavior disorder, and narcolepsy are discussed in detail with their therapeutical implications. This chapter highlights that sleep is necessary for the maintenance of an optimal brain function and is sensitive to both genetic background and environmental enrichment. Even in pathologic conditions, sleep acts as a resilient plastic state that consolidates prior information and prioritizes network activity for efficient brain functioning.
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Kelberman MA, Anderson CR, Chlan E, Rorabaugh JM, McCann KE, Weinshenker D. Consequences of Hyperphosphorylated Tau in the Locus Coeruleus on Behavior and Cognition in a Rat Model of Alzheimer's Disease. J Alzheimers Dis 2022; 86:1037-1059. [PMID: 35147547 PMCID: PMC9007891 DOI: 10.3233/jad-215546] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The locus coeruleus (LC) is one of the earliest brain regions to accumulate hyperphosphorylated tau, but a lack of animal models that recapitulate this pathology has hampered our understanding of its contributions to Alzheimer's disease (AD) pathophysiology. OBJECTIVE We previously reported that TgF344-AD rats, which overexpress mutant human amyloid precursor protein and presenilin-1, accumulate early endogenous hyperphosphorylated tau in the LC. Here, we used TgF344-AD rats and a wild-type (WT) human tau virus to interrogate the effects of endogenous hyperphosphorylated rat tau and human tau in the LC on AD-related neuropathology and behavior. METHODS Two-month-old TgF344-AD and WT rats received bilateral LC infusions of full-length WT human tau or mCherry control virus driven by the noradrenergic-specific PRSx8 promoter. Rats were subsequently assessed at 6 and 12 months for arousal (sleep latency), anxiety-like behavior (open field, elevated plus maze, novelty-suppressed feeding), passive coping (forced swim task), and learning and memory (Morris water maze and fear conditioning). Hippocampal microglia, astrocyte, and AD pathology were evaluated using immunohistochemistry. RESULTS In general, the effects of age were more pronounced than genotype or treatment; older rats displayed greater hippocampal pathology, took longer to fall asleep, had reduced locomotor activity, floated more, and had impaired cognition compared to younger animals. TgF344-AD rats showed increased anxiety-like behavior and impaired learning and memory. The tau virus had negligible influence on most measures. CONCLUSION Effects of hyperphosphorylated tau on AD-like neuropathology and behavioral symptoms were subtle. Further investigation of different forms of tau is warranted.
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Affiliation(s)
- Michael A Kelberman
- Department of Human Genetics, Emory University, Atlanta, GA, USA.,Neuroscience Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | | | - Eli Chlan
- Neuroscience Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Abstract
This review summarizes the available data about genetic factors which can link ischemic stroke and sleep. Sleep patterns (subjective and objective measures) are characterized by heritability and comprise up to 38-46%. According to Mendelian randomization analysis, genetic liability for short sleep duration and frequent insomnia symptoms is associated with ischemic stroke (predominantly of large artery subtype). The potential genetic links include variants of circadian genes, genes encoding components of neurotransmitter systems, common cardiovascular risk factors, as well as specific genetic factors related to certain sleep disorders.
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Affiliation(s)
- Lyudmila Korostovtseva
- Sleep Laboratory, Research Department for Hypertension, Department for Cardiology, Almazov National Medical Research Centre, 2 Akkuratov Str., Saint Petersburg, 197341, Russia.
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Abstract
Sleep is essential for healthy being and healthy functioning of human body as a whole, as well as each organ and system. Sleep disorders, such as sleep-disordered breathing, insomnia, sleep fragmentation, and sleep deprivation are associated with the deterioration in human body functioning and increased cardiovascular risks. However, owing to the complex regulation and heterogeneous state sleep per se can be associated with cardiovascular dysfunction in susceptible subjects. The understanding of sleep as a multidimensional concept is important for better prevention and treatment of cardiovascular diseases.
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Affiliation(s)
- Lyudmila Korostovtseva
- Sleep Laboratory, Research Department for Hypertension, Department for Cardiology, Almazov National Medical Research Centre, 2 Akkuratov Street, St Petersburg 197341, Russia.
| | - Mikhail Bochkarev
- Sleep Laboratory, Research Department for Hypertension, Almazov National Medical Research Centre, 2 Akkuratov Street, St Petersburg 197341, Russia
| | - Yurii Sviryaev
- Research Department for Hypertension, Almazov National Medical Research Centre, 2 Akkuratov Street, St Petersburg 197341, Russia
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Sumsuzzman DM, Choi J, Jin Y, Hong Y. Neurocognitive effects of melatonin treatment in healthy adults and individuals with Alzheimer's disease and insomnia: A systematic review and meta-analysis of randomized controlled trials. Neurosci Biobehav Rev 2021; 127:459-473. [PMID: 33957167 DOI: 10.1016/j.neubiorev.2021.04.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 04/01/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023]
Abstract
Endogenous melatonin levels are inversely associated with age and cognitive deficits. Although melatonin can improve psychopathological behavior disturbances in clinical trials, whether melatonin may also enhance cognitive function remains elusive. This study examined cognitive outcomes from randomized trials of melatonin treatment for Alzheimer's disease (AD), insomnia, and healthy-subjects. Twenty-two studies met the inclusion criteria (AD = 9, insomnia = 2, healthy-subjects = 11). AD patients receiving >12 weeks of melatonin treatment improved mini-mental state examination (MMSE) score [MD: 1.82 (1.01; 2.63) p < 0.0001]. Importantly, melatonin significantly improved MMSE score in mild stage of AD [MD: 1.89 (0.96; 2.82) p < 0.0001]. In healthy-subjects, although daytime melatonin treatment notably decreased in accuracy by correct responses [SMD: -0.74 (-1.03; -0.45) p < 0.00001], the reaction-time score on different stimuli (p = 0.37) did not increased. Additionally, by pooling of short-term, spatial, and visual memory scores, melatonin did not reduce memory function (p = 0.08). Meta-analysis of MMSE score suggested that melatonin is effective in treatment for mild stage of AD. Additionally, we propose that melatonin may be preferable to traditional hypnotics in management of insomnia.
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Affiliation(s)
- Dewan Md Sumsuzzman
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, 50834, Republic of Korea; Biohealth Products Research Center (BPRC), Inje University, Gimhae, 50834, Republic of Korea; Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae, 50834, Republic of Korea; Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, 50834, Republic of Korea.
| | - Jeonghyun Choi
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, 50834, Republic of Korea; Biohealth Products Research Center (BPRC), Inje University, Gimhae, 50834, Republic of Korea; Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae, 50834, Republic of Korea; Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, 50834, Republic of Korea.
| | - Yunho Jin
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, 50834, Republic of Korea; Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae, 50834, Republic of Korea; Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, 50834, Republic of Korea.
| | - Yonggeun Hong
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, 50834, Republic of Korea; Biohealth Products Research Center (BPRC), Inje University, Gimhae, 50834, Republic of Korea; Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae, 50834, Republic of Korea; Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, 50834, Republic of Korea; Department of Medicine, Division of Hematology/Oncology, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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11
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Basta M, Zaganas I, Simos P, Koutentaki E, Dimovasili C, Mathioudakis L, Bourbouli M, Panagiotakis S, Kapetanaki S, Vgontzas A. Apolipoprotein E ɛ4 (APOE ɛ4) Allele is Associated with Long Sleep Duration Among Elderly with Cognitive Impairment. J Alzheimers Dis 2021; 79:763-771. [DOI: 10.3233/jad-200958] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Apolipoprotein E gene (APOE) ɛ4 allele increases the risk for Alzheimer’s disease (AD). Furthermore, among patients with cognitive impairment, longer sleep duration is associated with worse cognitive performance. To date, literature examining the associations between APOE ɛ4 allele and objective sleep duration is limited. Objective: Our aim was to assess the association between APOE ɛ4 and objective sleep duration, among patients with mild cognitive impairment (MCI) and AD. A sub-sample of 89 patients with AD (n = 49) and MCI (n = 40) were recruited from a large, population-based cohort of 3,140 elders (>60 years) residing on Crete, Greece. Methods: All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, 3-day 24 h actigraphy and APOE ɛ4 allele genotyping. Comparisons of sleep duration variables between APOE ɛ4 allele carriers and non-carriers were assessed using ANCOVA, controlling for confounders. Results: The sample included 18 APOE ɛ4 carriers and 71 non-carriers, aged 78.6±6.6 and 78.2±6.5 years, respectively. Comparisons between the APOE ɛ4 carriers and non-carriers revealed no significant differences in terms of demographic and clinical variables. In terms of objective sleep duration across the two groups, APOE ɛ4 carriers compared to non-carriers had significantly longer nighttime Total Sleep Time (nTST) (7.7±1.4 versus 7.2±1.3 h, respectively, p = 0.011), as well as 24 h TST (8.5±1.6 versus 7.8±1.5 h, respectively, p = 0.012). Conclusion: Among patients with MCI and AD, APOE ɛ4 carriers have longer objective nighttime and 24 h sleep duration compared to non-carriers. These findings further support that objective long sleep duration is a genetically-driven pre-clinical marker associated with worse prognosis in elderly with cognitive impairment.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Ioannis Zaganas
- Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Computational Biomedicine Lab, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Eirini Koutentaki
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | | | | | - Mara Bourbouli
- Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | | | | | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
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12
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Romanella SM, Roe D, Tatti E, Cappon D, Paciorek R, Testani E, Rossi A, Rossi S, Santarnecchi E. The Sleep Side of Aging and Alzheimer's Disease. Sleep Med 2021; 77:209-225. [PMID: 32912799 PMCID: PMC8364256 DOI: 10.1016/j.sleep.2020.05.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 01/23/2023]
Abstract
As we age, sleep patterns undergo significant modifications in micro and macrostructure, worsening cognition and quality of life. These are associated with remarkable brain changes, like deterioration in synaptic plasticity, gray and white matter, and significant modifications in hormone levels. Sleep alterations are also a core component of mild cognitive impairment (MCI) and Alzheimer's Disease (AD). AD night time is characterized by a gradual decrease in slow-wave activity and a substantial reduction of REM sleep. Sleep abnormalities can accelerate AD pathophysiology, promoting the accumulation of amyloid-β (Aβ) and phosphorylated tau. Thus, interventions that target sleep disturbances in elderly people and MCI patients have been suggested as a possible strategy to prevent or decelerate conversion to dementia. Although cognitive-behavioral therapy and pharmacological medications are still first-line treatments, despite being scarcely effective, new interventions have been proposed, such as sensory stimulation and Noninvasive Brain Stimulation (NiBS). The present review outlines the current state of the art of the relationship between sleep modifications in healthy aging and the neurobiological mechanisms underlying age-related changes. Furthermore, we provide a critical analysis showing how sleep abnormalities influence the prognosis of AD pathology by intensifying Aβ and tau protein accumulation. We discuss potential therapeutic strategies to target sleep disruptions and conclude that there is an urgent need for testing new therapeutic sleep interventions.
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Affiliation(s)
- S M Romanella
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - D Roe
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Tatti
- Department of Molecular, Cellular & Biomedical Sciences, CUNY, School of Medicine, New York, NY, USA
| | - D Cappon
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - R Paciorek
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - E Testani
- Sleep Medicine Center, Department of Neurology, Policlinico Santa Maria Le Scotte, Siena, Italy
| | - A Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - S Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - E Santarnecchi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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13
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Kelberman M, Keilholz S, Weinshenker D. What's That (Blue) Spot on my MRI? Multimodal Neuroimaging of the Locus Coeruleus in Neurodegenerative Disease. Front Neurosci 2020; 14:583421. [PMID: 33122996 PMCID: PMC7573566 DOI: 10.3389/fnins.2020.583421] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/16/2020] [Indexed: 01/04/2023] Open
Abstract
The locus coeruleus (LC) has long been underappreciated for its role in the pathophysiology of Alzheimer’s disease (AD), Parkinson’s disease (PD), and other neurodegenerative disorders. While AD and PD are distinct in clinical presentation, both are characterized by prodromal protein aggregation in the LC, late-stage degeneration of the LC, and comorbid conditions indicative of LC dysfunction. Many of these early studies were limited to post-mortem histological techniques due to the LC’s small size and location deep in the brainstem. Thus, there is a growing interest in utilizing in vivo imaging of the LC as a predictor of preclinical neurodegenerative processes and biomarker of disease progression. Simultaneously, neuroimaging in animal models of neurodegenerative disease holds promise for identifying early alterations to LC circuits, but has thus far been underutilized. While still in its infancy, a handful of studies have reported effects of single gene mutations and pathology on LC function in disease using various neuroimaging techniques. Furthermore, combining imaging and optogenetics or chemogenetics allows for interrogation of network connectivity in response to changes in LC activity. The purpose of this article is twofold: (1) to review what magnetic resonance imaging (MRI) and positron emission tomography (PET) have revealed about LC dysfunction in neurodegenerative disease and its potential as a biomarker in humans, and (2) to explore how animal models can be used to test hypotheses derived from clinical data and establish a mechanistic framework to inform LC-focused therapeutic interventions to alleviate symptoms and impede disease progression.
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Affiliation(s)
- Michael Kelberman
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - Shella Keilholz
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - David Weinshenker
- Department of Human Genetics, Emory University, Atlanta, GA, United States
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14
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Liguori C, Maestri M, Spanetta M, Placidi F, Bonanni E, Mercuri NB, Guarnieri B. Sleep-disordered breathing and the risk of Alzheimer's disease. Sleep Med Rev 2020; 55:101375. [PMID: 33022476 DOI: 10.1016/j.smrv.2020.101375] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022]
Abstract
Sleep-disordered breathing is highly prevalent in the elderly population. Obstructive sleep apnea (OSA) represents the most common sleep disorder among the adult and elderly population. Recently, OSA diagnosis has been associated with an increased risk of developing cognitive decline and dementia, including vascular dementia and Alzheimer's disease (AD). Subsequently, there have been studies on AD biomarkers investigating cerebrospinal fluid, blood, neuroimaging, and nuclear medicine biomarkers in patients with OSA. Furthermore, studies have attempted to assess the possible effects of continuous positive airway pressure (CPAP) treatment on the cognitive trajectory and AD biomarkers in patients with OSA. This review summarizes the findings of studies on each AD biomarker (cognitive, biofluid, neuroimaging, and nuclear medicine imaging) in patients with OSA, also accounting for the related effects of CPAP treatment. In addition, the hypothetical model connecting OSA to AD in a bi-directional interplay is analyzed. Finally, the sex-based differences in prevalence and clinical symptoms of OSA between men and women have been investigated in relation to AD risk. Further studies investigating AD biomarkers changes in patients with OSA and the effect of CPAP treatment should be auspicated in future for identifying strategies to prevent the development of AD.
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Affiliation(s)
- Claudio Liguori
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Michelangelo Maestri
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Matteo Spanetta
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Nicola B Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Santa Lucia Foundation, Rome, Italy
| | - Biancamaria Guarnieri
- Center of Sleep Medicine, Department of Neurology, Villa Serena Hospital, Città S. Angelo, Pescara, Italy; Villa Serena Foundation for the Research, Città S. Angelo, Pescara, Italy
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15
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Korostovtseva L, Alieva A, Rotar O, Bochkarev M, Boyarinova M, Sviryaev Y, Konradi A, Shlyakhto E. Sleep Duration, Lipid Profile and Insulin Resistance: Potential Role of Lipoprotein(a). Int J Mol Sci 2020; 21:E4680. [PMID: 32630105 PMCID: PMC7369827 DOI: 10.3390/ijms21134680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022] Open
Abstract
Lipoprotein (a) (Lp(a)) is considered a genetic factor for cardiovascular disease playing an important role in atherogenesis and thrombosis, but the evidence about its association with sleep duration is controversial. We evaluated the relation between self-reported sleep duration and Lp(a). Among 1600 participants of the population-based sample, we selected 1427 subjects without previously known cardiovascular events, who answered the questions about their sleep duration; had valid lipid profile results (total cholesterol, low- and high-density lipoproteins, Lp(a), apolipoprotein AI (ApoAI), ApoB, and ApoB/ApoAI); and did not take lipid-lowering drugs (mean age 46 ± 12 years). We performed a structured interview, which included questions about lifestyle, medical history, complaints, and sleep duration (How long have you been sleeping per night during the last month?). Sleep duration was classified as follows: <6 h/night-short, 6-9 h/night-normal, and ≥10 h/night-long. Overall, 73 respondents (5.2%) were short-sleepers and 69 (4.8%) long-sleepers. Males were slightly more prevalent among short-sleepers. The groups matched by age, body mass index, blood pressure, diabetes mellitus, and hypertension rate. Short-sleepers had lower rates of high total cholesterol (≥5.0 mmol/L), lower Lp(a) levels and lower rates of increased Lp(a) ≥0.5 g/L, and higher insulin and insulin resistance (assessed by the homeostatic model assessment for insulin resistance (HOMA-IR)). ApoAI, ApoB, their ratio, and other lab tests were similar in the groups. The multinomial logistic regression demonstrated that only the short sleep duration was independently (odds ratio (OR) 0.29, 95% confidence interval (CI) (0.09-0.91), p = 0.033) associated with Lp(a) (χ2 = 41.58, p = 0.003). Other influencing factors were smoking and HOMA-IR. Such an association was not found for long-sleepers. In conclusion, a short-sleep duration is associated with Lp(a). The latter might mediate the higher insulin resistance and higher cardiometabolic risks in short-sleepers.
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Affiliation(s)
- Lyudmila Korostovtseva
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
| | - Asiiat Alieva
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
| | - Oxana Rotar
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
| | - Mikhail Bochkarev
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
| | - Maria Boyarinova
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
| | - Yurii Sviryaev
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
- Sechenov Institute of Evolutionary Physiology and Biochemistry of RAS, St Petersburg 194223, Russia
| | - Aleksandra Konradi
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
- Institute of Translational Medicine, ITMO University, St Petersburg 197101, Russia
| | - Eugene Shlyakhto
- Almazov National Medical Research Centre, St Petersburg 197341, Russia; (A.A.); (O.R.); (M.B.); (M.B.); (Y.S.); (A.K.); (E.S.)
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16
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Koo KYG, Schweizer TA, Fischer CE, Munoz DG. Abnormal Sleep Behaviours Across the Spectrum of Alzheimer's Disease Severity: Influence of APOE Genotypes and Lewy Bodies. Curr Alzheimer Res 2020; 16:243-250. [PMID: 30605058 DOI: 10.2174/1567205016666190103161034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/24/2018] [Accepted: 01/03/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Apolipoprotein (APOE) ε4 allele is a well-known risk factor for Alzheimer's Disease (AD), and sleep disturbances are commonly associated with AD. However, few studies have investigated the relationship between APOE ε4 and abnormal sleep patterns (N+) in AD. OBJECTIVE To examine the relationship between APOE genotype, Lewy body pathology, and abnormal sleep patterns in a large group of subjects with known AD load evaluated upon autopsy. METHOD Data from 2,368 cases obtained from the National Alzheimer's Coordinating Centre database were categorized as follows: Braak Stage V/VI and CERAD frequent neuritic plaques as high load AD, Braak Stage III/IV and moderate CERAD as intermediate load AD, and Braak Stage 0/I/II and infrequent CERAD as no to low load AD. Cases discrepant between the two measures were discarded. RESULTS Disrupted sleep was more frequent in males (42.4%) compared to females (35.1%), and in carriers (42.3%) as opposed to non-carriers (36.5%) of ε4. Amongst female subjects with high AD load and Lewy body pathology, homozygous (ε4/ε4) carriers experienced disrupted sleep more often compared with heterozygous (ε4/x) or non-carriers of ε4. Such recessive, gender-specific, and Lewy body association is reminiscent of the ε4 effect on psychosis in AD. However, such association was lost after adjusting for covariates. In subjects with no to low AD pathology, female ε4 carriers had significantly more nighttime disturbances than non-carriers; this effect is independent of the presence of Lewy body pathology. CONCLUSION The influence of APOE ε4 on sleep disturbances is dependent on gender and severity of AD load.
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Affiliation(s)
- Ka Yi G Koo
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, ON, M5S 1A8, Canada.,Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - David G Munoz
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada.,Division of Pathology, St. Michael's Hospital, Toronto, ON, Canada
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17
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Sleep disorders and cognitive alterations in women. Maturitas 2019; 126:25-27. [DOI: 10.1016/j.maturitas.2019.04.214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/20/2019] [Accepted: 04/10/2019] [Indexed: 02/03/2023]
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18
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Guadagni V, Clark CM, Tyndall A, Raneri JK, Parboosingh JS, Hogan DB, Hanly PJ, Poulin MJ. Effects of Six-Month Aerobic Exercise Intervention on Sleep in Healthy Older Adults in the Brain in Motion Study: A Pilot Study. J Alzheimers Dis Rep 2018; 2:229-238. [PMID: 30599044 PMCID: PMC6311349 DOI: 10.3233/adr-180079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Sleep disturbances have been shown to be associated with the presence of the apolipoprotein (APOE) ɛ4 allele, the well-known genetic risk factor for late-onset sporadic Alzheimer's disease (AD). Objective This study quantifies the effects of a six-month aerobic exercise intervention on objective and subjective sleep quality in middle-aged to older individuals including those at increased genetic risk for late-onset sporadic Alzheimer's disease (AD), who carry the apolipoprotein (APOE) ɛ4 risk allele. Methods 199 sedentary men and women without significant cognitive impairments were enrolled in the Brain in Motion study, a quasi-experimental single group pre-test/post-test study with no control group. Participants completed a six-month aerobic exercise intervention and consented to genetic testing. Genotyping of APOE confirmed that 54 individuals were carriers of the ɛ4 allele. Participants' subjective quality of sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI) pre- and post-intervention. A convenience sample of participants (n = 29, APOE ɛ4+ = 7) consented to undergo two nights of in-home polysomnography (PSG) pre- and post intervention. Sleep architecture and respiratory variables were assessed. Results The six-month aerobic exercise intervention significantly improved participants' total PSQI score, sleep efficiency, and sleep latency in the full sample (n = 199). PSG results showed that total sleep time and sleep onset latency significantly improved over the course of the exercise intervention only in individuals who carried the APOE ɛ4 allele. These results are, however, exploratory and need to be carefully interpreted due to the rather small number of APOE ɛ4+ in the PSG subgroup. Conclusions The six-month aerobic exercise intervention significantly improved participants' sleep quality with beneficial effects on PSG shown in individuals at increased genetic risk for late-onset sporadic AD.
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Affiliation(s)
- Veronica Guadagni
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cameron M Clark
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amanda Tyndall
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jill K Raneri
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Sleep Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Jillian S Parboosingh
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, AB, Canada
| | - David B Hogan
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Patrick J Hanly
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Sleep Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Marc J Poulin
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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19
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Tranah GJ, Yaffe K, Nievergelt CM, Parimi N, Glymour MM, Ensrud KE, Cauley JA, Ancoli-Israel S, Mariani S, Redline S, Stone KL. APOEε4 and slow wave sleep in older adults. PLoS One 2018; 13:e0191281. [PMID: 29370207 PMCID: PMC5784964 DOI: 10.1371/journal.pone.0191281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/02/2018] [Indexed: 12/19/2022] Open
Abstract
Slow wave (or stage N3) sleep has been linked to a variety of cognitive processes. However, the role of stage N3 in the elderly is debated. The link between stage N3 and episodic memory may be weakened or changed in the older adult population, possibly due to several altered mechanisms impacting the cellular structure of the brain. The bases for the age-related dissociation between stage N3 and cognition are not understood. Since APOEε4 status is the strongest genetic risk factor for cognitive decline, we assessed whether the ε4 allele is associated with stage N3 sleep. Participants were from the population-based Osteoporotic Fractures in Men (MrOS) cohort with polysomnography and APOEε4 genotype data (n = 2,302, 100% male, mean age 76.6 years). Sleep stages were objectively measured using overnight in-home polysomnography and central electroencephalogram data were used to score stage N3 sleep. Cognitive function was assessed using the Modified Mini Mental State Exam (3MS). The APOE rs429358 single nucleotide polymorphism, which defines the APOEε4 allele, was genotyped using a custom genotyping array. Total time in stage N3 sleep was significantly higher (p<0.0001) among the 40 MrOS participants carrying two copies of the ε4 allele (62±5.2 minutes) compared with 43±1.5 minutes for carriers of one ε4 allele (n = 515) and 40±0.8 minutes for ε4 non-carriers (n = 1747). All results were independent of sleep efficiency, number of sleep cycles, and apnea hypopnea index. These findings support an association between APOEε4 genotype and sleep stage N3 in the elderly. Increased total stage N3 duration among ε4/ε4 carriers does not appear to reflect compensation for prior cognitive decline and may reflect overactive downscaling of synapses during sleep. If confirmed, these results might in part explain the high risk of age-related cognitive decline and AD among APOE ε4/ε4 carriers.
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Affiliation(s)
- Gregory J. Tranah
- Research Institute, California Pacific Medical Center, San Francisco, California, United States of America
| | - Kristine Yaffe
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, California, United States of America
- Medical Center, San Francisco VA, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics University of California San Francisco, San Francisco, California, United States of America
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Neeta Parimi
- Research Institute, California Pacific Medical Center, San Francisco, California, United States of America
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics University of California San Francisco, San Francisco, California, United States of America
| | - Kristine E. Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Jane A. Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Sara Mariani
- Division of Sleep & Circadian Disorders, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California, United States of America
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Kahya M, Vidoni E, Burns JM, Thompson AN, Meyer K, Siengsukon CF. The Relationship Between Apolipoprotein ε4 Carrier Status and Sleep Characteristics in Cognitively Normal Older Adults. J Geriatr Psychiatry Neurol 2017; 30:273-279. [PMID: 28747136 PMCID: PMC5845771 DOI: 10.1177/0891988717720301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The apolipoprotein (APOE) ε4 allele, a well-described genetic risk factor for late-onset Alzheimer disease (AD), is associated with sleep disturbances even in cognitively normal older adults, although it is not clear whether this association is independent of sleep apnea. We sought to extend previous studies by examining whether cognitively normal older adults without self-reported sleep apnea who carry the APOE ε4 allele have altered sleep characteristics compared to noncarriers. Data from N = 36 (APOE ε4 carriers [n = 9], noncarriers [n = 27]) cognitively normal older adults (Clinical Dementia Rating [CDR] scale = 0) without self-reported sleep apnea were used for these analyses. Participants wore an actigraph for 7 days to determine sleep characteristics. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to assess sleep quality and daytime sleepiness, respectively. The APOE ε4 carriers had a higher number of awakenings compared to the noncarriers ( P = .02). There was no significant difference in the PSQI global score and the ESS; however, the PSQI subcomponent of daily disturbances was significantly higher in APOE ε4 carriers ( P = .03), indicating increased daytime dysfunction is related to disrupted sleep. This study provides evidence that individuals who are cognitively normal and genetically at risk of AD may have disrupted sleep. These findings are consistent with prior studies and suggest that sleep disruption may be present in the presymptomatic stages of AD.
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Affiliation(s)
- Melike Kahya
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| | - Eric Vidoni
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Jeffrey M. Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Ashley N Thompson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Kayla Meyer
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Catherine F. Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
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Kang DW, Lee CU, Lim HK. Role of Sleep Disturbance in the Trajectory of Alzheimer's Disease. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:89-99. [PMID: 28449556 PMCID: PMC5426492 DOI: 10.9758/cpn.2017.15.2.89] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/21/2022]
Abstract
Sleep disturbances such as insomnia, hypersomnia, and circadian rhythm disturbance are common in normal elderly and Alzheimer’s disease (AD) patients. To date, special attention has been paid to sleep disturbance in the clinical course of AD insofar as the interaction of sleep disturbance with the pathogenesis of AD may impact the clinical course and cognitive function of AD patients. This review covers the bidirectional relationship between sleep disturbance and AD pathogenesis; the associations between sleep disturbance and AD-specific neurotransmitters, brain structure, and aspects of sleep disturbance in each phase of AD; and the effects of sleep disturbance on the cognitive functions of patients in each phase of AD. We consider several factors required to exactly interpret the results and suggest a direction for future studies on the role of sleep disturbance in AD.
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Affiliation(s)
- Dong Woo Kang
- Department of Psychiatry, Seoul Saint Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul Saint Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Saint Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon, Korea
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Drogos LL, Gill SJ, Tyndall AV, Raneri JK, Parboosingh JS, Naef A, Guild KD, Eskes G, Hanly PJ, Poulin MJ. Evidence of association between sleep quality and APOE ε4 in healthy older adults: A pilot study. Neurology 2017; 87:1836-1842. [PMID: 27777343 DOI: 10.1212/wnl.0000000000003255] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/06/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It has been estimated that the prevalence of Alzheimer disease (AD) and related dementias will triple by 2035, unless effective interventions or treatments are found for the neurodegenerative disease. Understanding sleep changes as a marker for both AD risk and progression is a burgeoning area of investigation. Specifically, there is emerging evidence that both sleep disturbances and the APOE ε4 allele are associated with increased dementia risk. Previous research has suggested that in AD, individuals carrying the APOE ε4 allele have decreased sleep quality compared to individuals without the APOE ε4 allele. This observational trial aimed to determine if healthy older adults with the risk allele (APOE ε4+) have more sleep complaints or evidence of objective sleep disruption compared to healthy older adults without the risk allele (APOE ε4-). METHODS Within the larger Brain in Motion study, a subset of participants completed at-home polysomnography (PSG) and actigraphy sleep assessment. Subjective sleep complaints were determined using the Pittsburgh Sleep Quality Index. RESULTS This investigation found a significant relationship between presence of APOE ε4 allele and objective sleep disturbances measured by both actigraphy and PSG, but not subjective sleep complaints in a healthy population screened for dementia. CONCLUSIONS These data suggest that the influence of APOE ε4 allele on objective sleep quality may precede subjective sleep complaints in individuals at increased risk for dementia.
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Affiliation(s)
- Lauren L Drogos
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Stephanie J Gill
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Amanda V Tyndall
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Jill K Raneri
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Jillian S Parboosingh
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Aileen Naef
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Kyle D Guild
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Gail Eskes
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Patrick J Hanly
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada
| | - Marc J Poulin
- From the Department of Physiology & Pharmacology (L.L.D., A.V.T., A.N., K.D.G., G.E., M.J.P.), Hotchkiss Brain Institute (L.L.D., S.J.G., A.V.T., A.N., K.D.G., P.J.H., M.J.P.), Department of Medical Sciences (S.J.G.), Department of Medicine (J.K.R., P.J.H.), Department of Medical Genetics (J.S.P.), Department of Clinical Neurosciences (M.J.P.), and Libin Cardiovascular Institute of Alberta (M.J.P.), Cumming School of Medicine, and Alberta Children's Hospital Research Institute for Child and Maternal Health (J.S.P.), Faculty of Kinesiology (M.J.P.), and Sleep Centre, Foothills Medical Centre (J.K.R., P.J.H.), University of Calgary; and Department of Psychiatry, Faculty of Medicine (G.E.), and Department of Psychology and Neuroscience, Faculty of Science (G.E.), Dalhousie University, Halifax, Canada.
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The role of depression in the insomnia of people with subjective memory impairment, mild cognitive impairment, and dementia in a community sample of elderly individuals in South Korea. Int Psychogeriatr 2017; 29:653-661. [PMID: 27921991 DOI: 10.1017/s1041610216002076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study investigates the relationship between insomnia and cognitive dysfunctions including, subjective memory impairment (SMI), mild cognitive impairment (MCI), and dementia, by considering depression in a community sample of elderly individuals. METHODS Data for 1,740 elderly individuals aged 65 years and over were obtained from a nationwide dementia epidemiological study conducted in South Korea. Cognitive functional status was assessed by the Mini-Mental State Examination and the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet Clinical Assessment Battery. Insomnia was defined as the presence of at least one of the four sleep complaints (difficulty in initiating sleep, difficulty in maintaining sleep, early morning awakening, and non-restorative sleep), accompanied by moderate to severe daytime consequences. Depression was evaluated using the Geriatric Depression Scale. RESULTS The prevalence of insomnia in the patients with SMI, MCI, and dementia was found to be 23.2%, 19.6%, and 31.0%, respectively. The patients with SMI, MCI, and dementia were significantly more likely to have insomnia and the four sleep complaints than the normal comparison patients. After adjusting for sociodemographic factors, the significant relationships between cognitive dysfunctional status and insomnia remained. However, after adjusting for sociodemographic factors and depression, no significant relationships with any of the sleep complaints or insomnia remained. CONCLUSION Insomnia is a very common complaint in the elderly with SMI, MCI, and dementia. Depression might play an important factor in the relationship between insomnia and cognitive dysfunctional status in the elderly.
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Burke SL, Maramaldi P, Cadet T, Kukull W. Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer's disease: dementia. Int Psychogeriatr 2016; 28:1409-24. [PMID: 27020605 PMCID: PMC4963299 DOI: 10.1017/s1041610216000405] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative brain disease that causes cognitive impairment and dementia. Within the US, AD is the most common form of dementia in the elderly, affecting 1 in 10 people over the age of 65. Sleep disturbance has been called a "public health epidemic" and, like depression, is a prodromal symptom of AD but may also contribute to the risk of developing AD. It was hypothesized that sleep disturbance, depression, and the apolipoprotein E (APOE) genotype increase the likelihood of AD. METHODS Utilizing data from the National Alzheimer's Coordinating Center, information from evaluations of 11,453 cognitively asymptomatic participants was analyzed. Survival analysis was used to explore the independent relationships between depression, sleep disturbance, and APOE genotypes with eventual AD diagnosis. Cox proportional hazard models were utilized to explore the main effects and synergistic effects of psychosocial factors as moderated by APOE genotypes. RESULTS This study reinforced the association between APOE and AD. The hazard of developing AD was eight times higher for those with recent depression and the Ɛ4 homozygote (HR = 8.15 [3.70-17.95]). Among Ɛ4 carriers with clinician-verified depression, the hazard was ten times that of the reference group (HR = 10.11 [4.43-23.09]). The hazard for Ɛ4 carriers reporting sleep disturbance was almost 7 times greater than the reference group (HR = 6.79 [2.38-19.37]). CONCLUSION Findings suggest that sleep disturbance, depression, and APOE Ɛ4 genotype are associated with AD during follow-up evaluations among a group of initially cognitively asymptomatic participants. This study contributes to the literature base exploring an increased hazard or risk of AD due to potential modifiable risk factors as well as genetic biomarkers, such as APOE.
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Affiliation(s)
- Shanna L Burke
- Florida International University,Robert Stempel College of Public Health and Social Work,School of Social Work,Miami,FL,USA
| | | | - Tamara Cadet
- Simmons College School of Social Work,Boston,MA,USA
| | - Walter Kukull
- National Alzheimer's Coordinating Center (NACC),University of Washington School of Public Health,Department of Epidemiology,Seattle,WA,USA
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Lee JH, Jung WS, Choi WH, Lim HK. Aberrant brain stem morphometry associated with sleep disturbance in drug-naïve subjects with Alzheimer's disease. Neuropsychiatr Dis Treat 2016; 12:2089-93. [PMID: 27601903 PMCID: PMC5003099 DOI: 10.2147/ndt.s114383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Among patients with Alzheimer's disease (AD), sleep disturbances are common and serious noncognitive symptoms. Previous studies of AD patients have identified deformations in the brain stem, which may play an important role in the regulation of sleep. The aim of this study was to further investigate the relationship between sleep disturbances and alterations in brain stem morphology in AD. MATERIALS AND METHODS In 44 patients with AD and 40 healthy elderly controls, sleep disturbances were measured using the Neuropsychiatry Inventory sleep subscale. We employed magnetic resonance imaging-based automated segmentation tools to examine the relationship between sleep disturbances and changes in brain stem morphology. RESULTS Analyses of the data from AD subjects revealed significant correlations between the Neuropsychiatry Inventory sleep-subscale scores and structural alterations in the left posterior lateral region of the brain stem, as well as normalized brain stem volumes. In addition, significant group differences in posterior brain stem morphology were observed between the AD group and the control group. CONCLUSION This study is the first to analyze an association between sleep disturbances and brain stem morphology in AD. In line with previous findings, this study lends support to the possibility that brain stem structural abnormalities might be important neurobiological mechanisms underlying sleep disturbances associated with AD. Further longitudinal research is needed to confirm these findings.
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Affiliation(s)
- Ji Han Lee
- Washington University in St Louis, St Louis, MO, USA
| | | | | | - Hyun Kook Lim
- Department of Psychiatry, Saint Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
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ApoE2 Exaggerates PTSD-Related Behavioral, Cognitive, and Neuroendocrine Alterations. Neuropsychopharmacology 2015; 40:2443-53. [PMID: 25857685 PMCID: PMC4538360 DOI: 10.1038/npp.2015.95] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/23/2015] [Accepted: 03/31/2015] [Indexed: 01/05/2023]
Abstract
Apolipoprotein E (apoE) is an essential component of lipoprotein particles in both the brain and periphery, and exists in three isoforms in the human population: E2, E3, and E4. ApoE has numerous, well-established roles in neurobiology. Most notably, E4 is associated with earlier onset and increased risk of Alzheimer's disease (AD). Although possession of E2 is protective in the context of AD, E2 appears to confer an increased incidence and severity of posttraumatic stress disorder (PTSD). However, the biological processes underlying this link remain unclear. In this study, we began to elucidate these associations by examining the effects of apoE on PTSD severity in combat veterans, and on PTSD-like behavior in mice with human apoE. In a group of 92 veterans with PTSD, we observed significantly higher Clinician-Administered PTSD Scale and PTSD Checklist scores in E2+ individuals, as well as alterations in salivary cortisol levels. Furthermore, we measured behavioral and biological outcomes in mice expressing human apoE after a single stressful event as well as following a period of chronic variable stress, a model of combat-related trauma. Mice with E2 showed impairments in fear extinction, and behavioral, cognitive, and neuroendocrine alterations following trauma. To the best of our knowledge, these data constitute the first translational demonstration of PTSD severity in men and PTSD-like symptoms in mice with E2, and point to apoE as a novel biomarker of susceptibility, and potential therapeutic target, for PTSD.
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Kang D, Lim HK, Jung WS, Jeong JH, Kim TW, Han JH, Lee CU, Hong SC. Sleep and Alzheimer’s Disease. SLEEP MEDICINE RESEARCH 2015. [DOI: 10.17241/smr.2015.6.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cipriani G, Lucetti C, Danti S, Nuti A. Sleep disturbances and dementia. Psychogeriatrics 2015; 15:65-74. [PMID: 25515641 DOI: 10.1111/psyg.12069] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 12/20/2022]
Abstract
Sleep is a complex behavioural state, the ultimate functions of which remain poorly understood. It becomes more fragmented as we age, with more night-time awakenings and greater tendency for daytime sleep. The magnitude of disordered sleep among individuals affected by dementia has been clearly demonstrated, and disturbed sleep is a major clinical problem in dementia. Comorbid insomnia and other sleep disturbances are common in patients with neurodegenerative disorders, such Alzheimer's disease and other dementing disorders. How and when sleep problems manifest themselves can depend on the type of dementia involved as well as the stage of the dementia. However, differences in sleep pattern presentation show more variation during the initial stages of dementias than they do during the later stages. Effective, pragmatic interventions are largely anecdotal and untested.
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Sleep and Alzheimer's disease. Sleep Med Rev 2015; 19:29-38. [DOI: 10.1016/j.smrv.2014.03.007] [Citation(s) in RCA: 234] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 03/03/2014] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
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30
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de Oliveira FF, Bertolucci PHF, Chen ES, Smith MDAC. Assessment of sleep satisfaction in patients with dementia due to Alzheimer’s disease. J Clin Neurosci 2014; 21:2112-7. [DOI: 10.1016/j.jocn.2014.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 05/15/2014] [Indexed: 12/11/2022]
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Ownby RL, Peruyera G, Acevedo A, Loewenstein D, Sevush S. Subtypes of sleep problems in patients with Alzheimer disease. Am J Geriatr Psychiatry 2014; 22:148-56. [PMID: 23567445 DOI: 10.1016/j.jagp.2012.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 07/25/2012] [Accepted: 08/01/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep disturbances are common in patients with Alzheimer disease (AD) and can contribute to cognitive dysfunction and a negative impact on patients' and caregivers' quality of life. The purpose of this study was to evaluate whether subtypes of sleep disturbance could be identified in patients with AD and to assess the relation of these subtypes to patient characteristics and caregiver mood. METHODS As part of routine clinical assessment, primary caregivers of 344 patients with AD completed a questionnaire that included five items about the patients' sleep. Patients' cognitive and functional status and their mood were assessed as was caregivers' mood. Latent class analysis was used to define subgroups of patients based on their sleep patterns. After identification of groups of sleep disturbance, the relation of group membership to patient and caregiver characteristics was also evaluated. RESULTS Analyses revealed groups with moderate and severe sleep problems as well as a group without problems. Patients with more severe sleep disturbance were older, less well educated, and had poorer cognitive and functional status. Caregiver and patient depression was related to membership in the severe group, suggesting that both may contribute to caregivers' ratings of more severe sleep disturbance, whereas only patient depression was related to membership in the moderate group. CONCLUSION Sleep problems in patients with AD are related to poorer cognitive and functional status and patient and caregiver depression. Caregiver depression was most closely related to more severe patient sleep disturbance.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL.
| | - Gloria Peruyera
- Center on Aging, University of Miami Miller School of Medicine, Miami, FL
| | - Amarilis Acevedo
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL; Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL
| | - David Loewenstein
- Center on Aging, University of Miami Miller School of Medicine, Miami, FL
| | - Steven Sevush
- Center on Aging, University of Miami Miller School of Medicine, Miami, FL
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Clark CN, Warren JD. A hypnic hypothesis of Alzheimer's disease. NEURODEGENER DIS 2013; 12:165-76. [PMID: 23635607 PMCID: PMC3884167 DOI: 10.1159/000350060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/19/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Understanding the pathophysiology of Alzheimer's disease (AD) is of fundamental importance for improved diagnosis, monitoring and ultimately, treatment. OBJECTIVE A role for the sleep-wake cycle in the pathogenesis of AD has been proposed, but remains to be worked out in detail. METHODS Here we draw together several lines of previous work to outline a 'hypnic hypothesis' of AD. RESULTS We propose that altered function of brainstem neurotransmitter pathways associated with sleep, promotes regionally specific disintegration of a cortico-subcortical 'default mode' brain network that is selectively vulnerable in AD. CONCLUSION The formation of a dynamic toxic state within this vulnerable network linked to sleep-wake disruption, would in turn lead to failure of synaptic repair, increased transmission of pathogenic misfolded proteins and a self-amplifying neurodegenerative process. We consider the evidence for this hypnic hypothesis and the implications that follow on from it.
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Affiliation(s)
- Camilla N Clark
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
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Abstract
Sleep has been described as being of the brain, by the brain, and for the brain. This fundamental neurobiological behavior is controlled by homeostatic and circadian (24-hour) processes and is vital for normal brain function. This review will outline the normal sleep-wake cycle, the changes that occur during aging, and the specific patterns of sleep disturbance that occur in association with both mental health disorders and neurodegenerative disorders. The role of primary sleep disorders such as insomnia, obstructive sleep apnea, and REM sleep behavior disorder as potential causes or risk factors for particular mental health or neurodegenerative problems will also be discussed.
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Affiliation(s)
- Kirstie N Anderson
- Department of Neurology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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Rothman SM, Mattson MP. Sleep disturbances in Alzheimer's and Parkinson's diseases. Neuromolecular Med 2012; 14:194-204. [PMID: 22552887 PMCID: PMC4544709 DOI: 10.1007/s12017-012-8181-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/10/2012] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative disorders and exact a burden on our society greater than cardiovascular disease and cancer combined. While cognitive and motor symptoms are used to define AD and PD, respectively, patients with both disorders exhibit sleep disturbances including insomnia, hypersomnia and excessive daytime napping. The molecular basis of perturbed sleep in AD and PD may involve damage to hypothalamic and brainstem nuclei that control sleep-wake cycles. Perturbations in neurotransmitter and hormone signaling (e.g., serotonin, norepinephrine and melatonin) and the neurotrophic factor BDNF likely contribute to the disease process. Abnormal accumulations of neurotoxic forms of amyloid β-peptide, tau and α-synuclein occur in brain regions involved in the regulation of sleep in AD and PD patients, and are sufficient to cause sleep disturbances in animal models of these neurodegenerative disorders. Disturbed regulation of sleep often occurs early in the course of AD and PD, and may contribute to the cognitive and motor symptoms. Treatments that target signaling pathways that control sleep have been shown to retard the disease process in animal models of AD and PD, suggesting a potential for such interventions in humans at risk for or in the early stages of these disorders.
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Affiliation(s)
- Sarah M Rothman
- Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA.
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Flirski M, Sieruta M, Golańska E, Kłoszewska I, Liberski PP, Sobów T. PRND 3'UTR polymorphism may be associated with behavioral disturbances in Alzheimer disease. Prion 2012; 6:73-80. [PMID: 22453181 DOI: 10.4161/pri.6.1.18428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The etiology of behavioral and psychological symptoms of dementia (BPSD) is complex, including putative biological, psychological, social and environmental factors. Recent years have witnessed accumulation of data on the association between genetic factors and behavioral abnormalities in Alzheimer disease (AD). In this research paper, our aim is to evaluate the association between the APOE, CYP46, PRNP and PRND genes and the profile of neuropsychiatric symptoms in Polish subjects with AD and mild cognitive impairment (MCI). We studied 99 patients with AD and 48 subjects with MCI. The presence and profile of BPSD were evaluated at baseline and prospectively with the Neuropsychiatric Inventory (NPI). Patients were dichotomized into those having ever experienced a particular symptom and those who did not over the whole disease period. Genotyping was performed using previously described standard protocols. The prevalence of comorbid behavioral symptoms and the overall level of behavioral burden were significantly greater in AD compared with the MCI group. In AD patients, carrier status of the T allele of the 3'UTR (untranslated region) PRND polymorphism was associated with an increased cumulative behavioral load and an elevated risk for delusions, anxiety, agitation/aggression, apathy and irritability/emotional ability. Among MCI subjects, APOE ε4 carriers demonstrated a reduced risk for nighttime behavior change. No other statistically significant genotype-phenotype correlations were observed, including the APOE, CYP46 and PRNP genes. A precise estimation of the exact significance of particular polymorphisms in BPSD etiology requires future studies on large populations.
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Affiliation(s)
- Marcin Flirski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland.
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Manni R, Sinforiani E, Zucchella C, Terzaghi M, Rezzani C. A sleep continuity scale in Alzheimer's disease: validation and relationship with cognitive and functional deterioration. Neurol Sci 2012; 34:701-5. [PMID: 22622870 DOI: 10.1007/s10072-012-1118-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/09/2012] [Indexed: 12/13/2022]
Abstract
Considering that disrupted sleep may be detrimental to daytime performance in people with dementia, we set out to construct a questionnaire able to identify sleep patterns potentially associated with clinical and functional disease variables in this population. Two subsets of items indicative of patterns of unstable sleep and of disordered rapid eye movement sleep (REM) were selected. The first included items investigating sleep continuity, with low sleep continuity markers considered indicative of high arousability; the second included items investigating the frequency and quality of dreams and the frequency of clinically identifiable REM sleep behaviour disorder episodes. The questionnaire was administered to 140 outpatients with a diagnosis of mild-to-moderate Alzheimer's disease. The Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Instrumental Activities of Daily Living, Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) were administered to quantify cognitive, functional and behavioural impairment. A subscale comprising items investigating sleep discontinuity/fragmentation and showing high internal consistency was constructed and found to correlate significantly with variables considered indexes of cognitive and functional deterioration in AD (MMSE, ADL and CDR). Conversely, it did not prove possible to obtain a subscale of dysfunctional REM phenomena. The use of a rapidly and easily administered sleep scale, like the one we constructed, appears to be suitable for early identification and longitudinal monitoring of sleep disturbances in AD.
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Affiliation(s)
- R Manni
- Unit of Sleep Medicine, IRCCS C. Mondino National Neurological Institute Foundation, via Mondino, 2, 27100 Pavia, Italy
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Levit-Binnun N, Golland Y. Finding behavioral and network indicators of brain vulnerability. Front Hum Neurosci 2012; 6:10. [PMID: 22347174 PMCID: PMC3273890 DOI: 10.3389/fnhum.2012.00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/21/2012] [Indexed: 11/13/2022] Open
Abstract
Resilience research has usually focused on identifying protective factors associated with specific stress conditions (e.g., war, trauma) or psychopathologies (e.g., post-traumatic stress disorder [PTSD]). Implicit in this research is the concept that resilience is a global construct, invariant to the unfavorable circumstances or the psychopathologies that may develop (i.e., the mechanisms underlying the resilience of an individual in all cases are expected to be similar). Here we contribute to the understanding of resilience—and its counterpart, vulnerability—by employing an approach that makes use of this invariant quality. We outline two main characteristics that we would expect from indicators of a vulnerable state: that they should appear across disorders regardless of specific circumstances, and that they should appear much before the disorder is evident. Next, we identify two sets of factors that exhibit this pattern of association with psychopathological states. The first was a set of “low-level” sensory, motor and regulatory irregularities that have been reported across the clinical literature; we suggest that these can serve as behavioral indicators of a vulnerable state. The second was the set of aberrations in network metrics that have been reported in the field of systems neuroscience; we suggest that these can serve as network indicators of a vulnerable state. Finally, we explore how behavioral indicators may be related to network indicators and discuss the clinical and research-related implications of our work.
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Affiliation(s)
- Nava Levit-Binnun
- School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel
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Woods DL, Phillips LR, Martin JL. Biological Basis for Sleep Disturbance and Behavioral Symptoms in Dementia: A Biobehavioral Model. Res Gerontol Nurs 2011; 4:281-93. [DOI: 10.3928/19404921-20110302-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 10/26/2010] [Indexed: 11/20/2022]
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BDNF polymorphism predicts the rate of decline in skilled task performance and hippocampal volume in healthy individuals. Transl Psychiatry 2011; 1:e51. [PMID: 22833197 PMCID: PMC3309489 DOI: 10.1038/tp.2011.47] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Numerous studies have indicated a link between the presence of polymorphism in brain-derived neurotrophic factor (BDNF) and cognitive and affective disorders. However, only a few have studied these effects longitudinally along with structural changes in the brain. This study was carried out to investigate whether valine-to-methionine substitution at position 66 (val66met) of pro-BDNF could be linked to alterations in the rate of decline in skilled task performance and structural changes in hippocampal volume. Participants consisted of 144 healthy Caucasian pilots (aged 40-69 years) who completed a minimum of 3 consecutive annual visits. Standardized flight simulator score (SFSS) was measured as a reliable and quantifiable indicator for skilled task performance. In addition, a subset of these individuals was assessed for hippocampal volume alterations using magnetic resonance imaging. We found that val66met substitution in BDNF correlated longitudinally with the rate of decline in SFSS. Structurally, age-dependent hippocampal volume changes were also significantly altered by this substitution. Our study suggests that val66met polymorphism in BDNF can be linked to the rate of decline in skilled task performance. Furthermore, this polymorphism could be used as a predictor of the effects of age on the structure of the hippocampus in healthy individuals. Such results have implications for understanding possible disabilities in older adults performing skilled tasks who are at a higher risk for cognitive and affective disorders.Translational Psychiatry (2011) 1, e51; doi:10.1038/tp.2011.47; published online 25 October 2011.
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Wang G, Grone B, Colas D, Appelbaum L, Mourrain P. Synaptic plasticity in sleep: learning, homeostasis and disease. Trends Neurosci 2011; 34:452-63. [PMID: 21840068 DOI: 10.1016/j.tins.2011.07.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/07/2011] [Accepted: 07/07/2011] [Indexed: 12/30/2022]
Abstract
Sleep is a fundamental and evolutionarily conserved aspect of animal life. Recent studies have shed light on the role of sleep in synaptic plasticity. Demonstrations of memory replay and synapse homeostasis suggest that one essential role of sleep is in the consolidation and optimization of synaptic circuits to retain salient memory traces despite the noise of daily experience. Here, we review this recent evidence and suggest that sleep creates a heightened state of plasticity, which may be essential for this optimization. Furthermore, we discuss how sleep deficits seen in diseases such as Alzheimer's disease and autism spectrum disorders might not just reflect underlying circuit malfunction, but could also play a direct role in the progression of those disorders.
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Affiliation(s)
- Gordon Wang
- Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Beckman Center, Stanford University, Palo Alto, CA 94305, USA
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Weldemichael DA, Grossberg GT. Circadian rhythm disturbances in patients with Alzheimer's disease: a review. Int J Alzheimers Dis 2010; 2010. [PMID: 20862344 PMCID: PMC2939436 DOI: 10.4061/2010/716453] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/27/2010] [Indexed: 11/20/2022] Open
Abstract
Circadian Rhythm Disturbances (CRDs) affect as many as a quarter of Alzheimer's disease (AD) patients during some stage of their illness. Alterations in the suprachiasmatic nucleus and melatonin secretion are the major factors linked with the cause of CRDs. As a result, the normal physiology of sleep, the biological clock, and core body temperature are affected. This paper systematically discusses some of the causative factors, typical symptoms, and treatment options for CRDs in patients with AD. This paper also emphasizes the implementation of behavioral and environmental therapies before embarking on medications to treat CRDs. Pharmacotherapeutic options are summarized to provide symptomatic benefits for the patient and relieve stress on their families and professional care providers. As of today, there are few studies relative to CRDs in AD. Large randomized trials are warranted to evaluate the effects of treatments such as bright light therapy and engaging activities in the reduction of CRDs in AD patients.
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Affiliation(s)
- Dawit A Weldemichael
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
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Cuturic M, Abramson RK, Vallini D, Frank EM, Shamsnia M. Sleep patterns in patients with Huntington's disease and their unaffected first-degree relatives: a brief report. Behav Sleep Med 2009; 7:245-54. [PMID: 19787493 DOI: 10.1080/15402000903190215] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Polysomnographic sleep patterns in Huntington's disease (HD) have been studied sporadically in small groups of patients, providing variable results. In this study, by comparing the polysomnographic sleep patterns of HD patients and their unaffected relatives, identifying sleep traits more specifically related to the HD gene was attempted. The results corroborated previously reported findings of prolonged sleep latency and the virtual absence of nocturnal respiratory disturbances in early HD. Sleep latency in the HD patients positively correlated with the results of a screening test for frontal lobe dysfunction. Larger, more standardized studies will be needed to correlate genetic markers and sleep patterns in HD.
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Affiliation(s)
- Miroslav Cuturic
- Department of Neuropsychiatry, University of South Carolina School of Medicine, Columbia, SC 29203, USA.
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Cochen V, Arbus C, Soto ME, Villars H, Tiberge M, Montemayor T, Hein C, Veccherini MF, Onen SH, Ghorayeb I, Verny M, Fitten LJ, Savage J, Dauvilliers Y, Vellas B. Sleep disorders and their impacts on healthy, dependent, and frail older adults. J Nutr Health Aging 2009; 13:322-9. [PMID: 19300867 DOI: 10.1007/s12603-009-0030-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sleep disorders differ widely in the heterogeneous older adult population. Older adults can be classified into three groups based upon their overall level of disability: healthy, dependent, and frail. Frailty is an emerging concept that denotes older persons at increased risk for poor outcomes. OBJECTIVE The aim of this consensus review is to describe the sleep disorders observed in healthy and dependent older adults and to discuss the potential sleep disorders associated with frailty as well as their potential consequences on this weakened population. METHODS A review task force was created including neurologists, geriatricians, sleep specialists and geriatric psychiatrists to discuss age related sleep disorders depending on the three categories of older adults. All published studies on sleep in older adults on Ovid Medline were reviewed and 106 articles were selected for the purpose of this consensus. RESULTS Many healthy older adults have complains about their sleep such as waking not rested and too early, trouble falling asleep, daytime napping, and multiple nocturnal awakenings. Sleep architecture is modified by age with an increased percentage of time spent in stage one and a decreased percentage spent in stages three and four. Insomnia is frequent and its mechanisms include painful medical conditions, psychological distress, loss of physical activity and iatrogenic influences. Treatments are also involved in older adults' somnolence. The prevalence of primary sleep disorders such as restless legs syndrome, periodic limb movements and sleep disordered breathing increases with age. Potential outcomes relevant to these sleep disorders in old age include mortality, cardiovascular and neurobehavioral co-morbidities. Sleep in dependent older adults such as patients with Alzheimer Disease (AD) is disturbed. The sleep patterns observed in these patients are often similar to those observed in non-demented elderly but alterations are more severe. Nocturnal sleep disruption and daytime sleepiness are the main problems. They are the results of Sleep/wake circadian rhythm disorders, environmental, psychological and iatrogenic factors. They are worsened by other sleep disorders such as sleep disordered breathing. Sleep in frail older adults per se has not yet been formally studied but four axes of investigation should be considered: i) sleep architecture abnormalities, ii) insomnia iii) restless legs syndrome (RLS), iv) sleep disordered breathing. CONCLUSION Our knowledge in the field of sleep disorders in older adults has increased in recent years, yet some groups within this heterogeneous population, such as frail older adults, remain to be more thoroughly studied and characterized.
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Affiliation(s)
- V Cochen
- Unité du sommeil, Service de neurologie, CHU Rangueil, Toulouse, France
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McCurry SM, Pike KC, Vitiello MV, Logsdon RG, Teri L. Factors associated with concordance and variability of sleep quality in persons with Alzheimer's disease and their caregivers. Sleep 2008; 31:741-8. [PMID: 18517044 DOI: 10.1093/sleep/31.5.741] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To describe the day-to-day variation in sleep characteristics and the concordance between nighttime sleep of persons with Alzheimer's disease (AD) and their family caregivers. PARTICIPANTS N = 44 community-dwelling older adults with probable or possible AD and their co-residing family caregivers. DESIGN Participants wore an Actillume (Ambulatory Monitoring, Inc) for one week and completed an assessment battery to evaluate patient and caregiver mood, physical function, medication use, caregiver behavior management style, and patient cognitive status. MEASUREMENTS AND RESULTS Actigraphically derived sleep measures included bedtime, rising time, total time in bed, total sleep time, number of awakenings, total wake time, and sleep percent (efficiency). For each sleep parameter, total variance was determined for between-subject variance and within-subject variance from day-to-day. Sleep concordance was examined using multinomial logistic regression to compare trichotomous patient-caregiver combinations of good and bad sleepers. For both patients and caregivers, between-subject daily variability accounted for more of the variance in sleep than within-subject variability. Patient depression and caregiver management style were significant predictors both for concordant poor sleep (both patient and caregiver with sleep efficiency < or =85%) and patient-caregiver sleep discordance. CONCLUSIONS This study provides data that sleep disturbances for persons with AD and their family caregivers vary considerably night to night, and that poor sleep in one member of the caregiving dyad is not necessarily linked to disturbed sleep in the other. Understanding the complex interrelationship of sleep in AD patients and caregivers is an important first step towards the development of individualized and effective treatment strategies.
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Abstract
PURPOSE OF REVIEW Neuropsychiatric disturbances in dementia are prevalent, and research is uncovering their neurobiological correlates. RECENT FINDINGS Late-onset depression appears to be associated with Alzheimer's disease pathology at autopsy, and lifetime depression episodes may worsen Alzheimer's disease pathology in the hippocampus. Vascular disease and elevated homocysteine increase risk for both late-onset depression and Alzheimer's disease and may partly mediate their relationship. Monoamine changes are robust finding in Alzheimer's disease and may account for many observed depression symptoms. Risk of psychosis of Alzheimer's disease appears to be increased by several genes also implicated in schizophrenia (e.g., catechol-O-methyltransferase, neuregulin-1). Psychosis in dementia with Lewy bodies appears to be related to cholinergic deficits. Alzheimer's disease is associated with changes in the circadian sleep-wake cycles, including decreased night-time melatonin. Sleep apnea may be related to apolipoprotein E genotype and impact cognition in Alzheimer's disease. Rapid eye movement sleep behavior disorder is intricately related to synucleinopathies, such as dementia with Lewy bodies, but synuclein changes may not totally explain this relationship. SUMMARY Neuropsychiatric disturbances are a core feature of dementia and worsen many clinical outcomes. Among the most validated syndromes are depression, psychosis, and sleep disturbance of Alzheimer's disease. Neuropathology, neuroimaging, and genetic studies increasingly provide insight into the origins of these psychiatric symptoms in dementia.
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Affiliation(s)
- Thomas W Meeks
- Division of Geriatric Psychiatry, Department of Psychiatry, University of California, San Diego, and Veterans Affairs San Diego Healthcare System, San Diego, California 92161, USA.
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Bonanni E, Maestri M, Tognoni G, Fabbrini M, Nucciarone B, Manca ML, Gori S, Iudice A, Murri L. Daytime sleepiness in mild and moderate Alzheimer's disease and its relationship with cognitive impairment. J Sleep Res 2006; 14:311-7. [PMID: 16120107 DOI: 10.1111/j.1365-2869.2005.00462.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The increased tendency to fall asleep during the daytime together with increased wakefulness during the night has been demonstrated in patients with advanced Alzheimer's disease (AD). The aim of this study was to assess daytime sleep propensity in a cohort of patients with mild/moderate AD and to correlate it with cognitive impairment. Twenty drug-free AD patients meeting the NINCDS-ADRDA criteria for probable AD were evaluated. According to their Clinical Dementia Rating scores, subjects were classified into mild (CDR1; n=11) and moderate (CDR2; n=9) dementia patients. A group of 12 healthy subjects was taken as controls. The subjects were evaluated by the multiple sleep latency test (MSLT) after their nocturnal sleep pattern had been assessed by a polysomnographic recording throughout the night before. Both groups of AD patients showed a higher level of daytime sleepiness, which was statistically significant for mean daytime sleep latency (MDSL) (controls versus CDR1 and versus CDR2, CDR1 versus CDR2) and for 10:00 and 12:00 hour naps (controls versus CDR1, controls versus CDR2). In the entire group of AD patients, MDSL was significantly related with MMSE, De Renzi's Token test, verbal fluency, verbal digit span, story recall, Raven's Progressive Matrices, Weigl test and Benton's three-dimensional test. These data indicate that an increased sleep propensity during daytime occurs also in patients with mild/moderate AD detected by objective neurophysiological techniques.
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Affiliation(s)
- Enrica Bonanni
- Department of Neurosciences, Neurology Unit, University of Pisa, Pisa, Italy.
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Dowling GA, Hubbard EM, Mastick J, Luxenberg JS, Burr RL, Van Someren EJW. Effect of morning bright light treatment for rest-activity disruption in institutionalized patients with severe Alzheimer's disease. Int Psychogeriatr 2005; 17:221-36. [PMID: 16050432 PMCID: PMC2387132 DOI: 10.1017/s1041610205001584] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Disturbances in rest-activity rhythm are prominent and disabling symptoms in Alzheimer's disease (AD). Nighttime sleep is severely fragmented and daytime activity is disrupted by multiple napping episodes. In most institutional environments, light levels are very low and may not be sufficient to enable the circadian clock to entrain to the 24-hour day. The purpose of this randomized, placebo-controlled, clinical trial was to test the effectiveness of morning bright light therapy in reducing rest-activity (circadian) disruption in institutionalized patients with severe AD. METHOD Subjects (n = 46, mean age 84 years) meeting the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke--the Alzheimer's Disease and Related Disorders Association) AD diagnostic criteria were recruited from two large, skilled nursing facilities in San Francisco, California. The experimental group received one hour (09:30-10:30) of bright light exposure (> or = 2500 lux in gaze direction) Monday through Friday for 10 weeks. The control group received usual indoor light (150-200 lux). Nighttime sleep efficiency, sleep time, wake time and number of awakenings and daytime wake time were assessed using actigraphy. Circadian rhythm parameters were also determined from the actigraphic data using cosinor analysis and nonparametric techniques. Repeated measures analysis of variance (ANOVA) was used to test the primary study hypotheses. RESULTS AND CONCLUSION Although significant improvements were found in subjects with aberrant timing of their rest-activity rhythm, morning bright light exposure did not induce an overall improvement in measures of sleep or the rest-activity in all treated as compared to control subjects. The results indicate that only subjects with the most impaired rest-activity rhythm respond significantly and positively to a brief (one hour) light intervention.
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Affiliation(s)
- Glenna A Dowling
- University of California, San Francisco, Department of Physiological Nursing, 2 Koret Way, Room N631, San Francisco, CA 94143-0610, USA.
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