The interplay of stress and sleep impacts BDNF level

Depression in older adults and its associations with sleep and synaptic density

BACKGROUND

Depression among older adults is a global concern, contributing to disability and overall illness burden. Understanding its trajectory, associated risk factors, and implications for mortality is essential for effective intervention. Moreover, the relationship between depression, sleep disturbances, and synaptic density in the ageing brain remains complex and poorly understood.

METHODS

Using data from the University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age cohort, comprising 6375 participants, we conducted comprehensive assessments of depression trajectories using generalized linear mixed models and mortality risks using Cox mixed-effects models. Generalized structural equation modelling was performed to explore longitudinal associations between sleep duration and depression. Lastly, associations between post-mortem synaptic density and depression were investigated.

RESULTS

Our findings revealed that depression rates declined until age 80 before increasing again. Depression was associated with a 10 % increased risk of mortality in older adults. Reduced sleep was correlated with depression, and depression measured early in the study predicted future reduced sleep. Post-mortem analysis showed a global reduction in synaptic density associated with depression, particularly pronounced in the frontal lobe.

LIMITATIONS

Limitations include recall bias, limiting generalizability due to dominantly including White British participants and difficulty in establishing causation between synaptic density and depression.

CONCLUSION

Our study underscores the significance of addressing depression in older adults, not only for mental health but also for mortality risk and neurobiological health. Early detection and intervention strategies are crucial for improving outcomes in elderly populations, potentially mitigating adverse effects on sleep, synaptic density, cognitive health, and longevity.

Lifestyle Changes in Aging and their Potential Impact on POAG

Primary open angle glaucoma is a primary mitochondrial disease with oxidative stress triggering neuroinflammation, eventually resulting in neurodegeneration. This affects many other areas of the brain in addition to the visual system. Aging also leads to inflammaging - a low-grade chronic inflammatory reaction in mitochondrial dysfunction, so these inflammatory processes overlap in the aging process and intensify pathophysiological processes associated with glaucoma. Actively counteracting these inflammatory events involves optimising treatment for any manifest systemic diseases while maintaining chronobiology and improving the microbiome. Physical and mental activity also provides support. This requires a holistic approach towards optimising neurodegeneration treatment in primary open angle glaucoma in addition to reducing intraocular pressure according personalised patient targets.

The importance of oxidative biomarkers in diagnosis, treatment, and monitoring schizophrenia patients

INTRODUCTION

The etiology of schizophrenia (SCZ), an incredibly complex disorder, remains multifaceted. Literature suggests the involvement of oxidative stress (OS) in the pathophysiology of SCZ.

OBJECTIVES

Determination of selected OS markers and brain-derived neurotrophic factor (BDNF) in patients with chronic SCZ and those in states predisposing to SCZ-first episode psychosis (FP) and ultra-high risk (UHR).

MATERIALS AND METHODS

Determination of OS markers and BDNF levels by spectrophotometric methods and ELISA in 150 individuals (116 patients diagnosed with SCZ or in a predisposed state, divided into four subgroups according to the type of disorder: deficit schizophrenia, non-deficit schizophrenia, FP, UHR). The control group included 34 healthy volunteers.

RESULTS

Lower activities of analyzed antioxidant enzymes and GSH and TAC concentrations were found in all individuals in the study group compared to controls (p < 0.001). BDNF concentration was also lower in all groups compared to controls except in the UHR subgroup (p = 0.01). Correlations were observed between BDNF, R-GSSG, GST, GPx activity, and disease duration (p < 0.02). A small effect of smoking on selected OS markers was also noted (rho<0.06, p < 0.03).

CONCLUSIONS

OS may play an important role in the pathophysiology of SCZ before developing the complete clinical pattern of the disorder. The redox imbalance manifests itself with such severity in individuals with SCZ and in a state predisposing to the development of this psychiatric disease that natural antioxidant systems become insufficient to compensate against it completely. The discussed OS biomarkers may support the SCZ diagnosis and predict its progression.

Controlled Hypoxia Acutely Prevents Physical Inactivity-Induced Peripheral BDNF Decline

Brain-derived neurotrophic factor (BDNF) is a crucial mediator of neuronal plasticity. Here, we investigated the effects of controlled normobaric hypoxia (NH) combined with physical inactivity on BDNF blood levels and executive functions. A total of 25 healthy adults (25.8 ± 3.3 years, 15 female) were analyzed in a randomized controlled cross-over study. Each intervention began with a 30 min resting phase under normoxia (NOR), followed by a 90 min continuation of NOR or NH (peripheral oxygen saturation [SpO2] 85-80%). Serum and plasma samples were collected every 15 min. Heart rate and SpO2 were continuously measured. Before and after each exposure, cognitive tests were performed and after 24 h another follow-up blood sample was taken. NH decreased SpO2 (p < 0.001, ηp2 = 0.747) and increased heart rate (p = 0.006, ηp2 = 0.116) significantly. The 30-min resting phase under NOR led to a significant BDNF reduction in serum (p < 0.001, ηp2 = 0.581) and plasma (p < 0.001, ηp2 = 0.362). Continuation of NOR further significantly reduced BDNF after another 45 min (p = 0.018) in serum and after 30 min (p = 0.040) and 90 min (p = 0.005) in plasma. There was no significant BDNF decline under NH. A 24 h follow-up examination showed a significant decline in serum BDNF, both after NH and NOR. Our results show that NH has the potential to counteract physical inactivity-induced BDNF decline. Therefore, our study emphasizes the need for a physically active lifestyle and its positive effects on BDNF. This study also demonstrates the need for a standardized protocol for future studies to determine BDNF in serum and plasma.

Acupuncture for primary insomnia: Effectiveness, safety, mechanisms and recommendations for clinical practice

Primary insomnia (PI) is an increasing concern in modern society. Cognitive-behavioral therapy for insomnia is the first-line recommendation, yet limited availability and cost impede its widespread use. While hypnotics are frequently used, balancing their benefits against the risk of adverse events poses challenges. This review summarizes the clinical and preclinical evidence of acupuncture as a treatment for PI, discussing its potential mechanisms and role in reliving insomnia. Clinical trials show that acupuncture improves subjective sleep quality, fatigue, cognitive impairments, and emotional symptoms with minimal adverse events. It also positively impacts objective sleep processes, including prolonging total sleep time, improving sleep efficiency, reducing sleep onset latency and wake after sleep onset, and enhancing sleep architecture/structure, including increasing N3% and REM%, and decreasing N1%. However, methodological shortcomings in some trials diminish the overall quality of evidence. Animal studies suggest that acupuncture restores circadian rhythms in sleep-deprived rodents and improves their performance in behavioral tests, possibly mediated by various clinical variables and pathways. These may involve neurotransmitters, brain-derived neurotrophic factors, inflammatory cytokines, the hypothalamic-pituitary-adrenal axis, gut microbiota, and other cellular events. While the existing findings support acupuncture as a promising therapeutic strategy for PI, additional high-quality trials are required to validate its benefits.

Impaired sleep is associated with tau deposition on 18F-flortaucipir PET and accelerated cognitive decline, accounting for medications that affect sleep

BACKGROUND

Impaired sleep is commonly associated with Alzheimer's disease (AD), although the underlying mechanisms remain unclear. Furthermore, the moderating effects of sleep-affecting medications, which have been linked to AD pathology, are incompletely characterized. Using data from the Alzheimer's Disease Neuroimaging Initiative, we investigated whether a medical history of impaired sleep, informant-reported nighttime behaviors, and sleep-affecting medications are associated with beta-amyloid and tau deposition on PET and cognitive change, cross-sectionally and longitudinally.

METHODS

We included 964 subjects with 18F-florbetapir PET scans. Measures of sleep impairment and medication use were obtained from medical histories and the Neuropsychiatric Inventory Questionnaire. Multivariate models, adjusted for covariates, were used to assess associations among sleep-related features, beta-amyloid and tau, and cognition. Cortical tau deposition, categorized by Braak stage, was assessed using the standardized uptake value peak alignment (SUVP) method on 18F-flortaucipir PET.

RESULTS

Medical history of sleep impairment was associated with greater baseline tau in the meta-temporal, Braak 1, and Braak 4 regions (p = 0.04, p < 0.001, p = 0.025, respectively). Abnormal nighttime behaviors were also associated with greater baseline tau in the meta-temporal region (p = 0.024), and greater cognitive impairment, cross-sectionally (p = 0.007) and longitudinally (p < 0.001). Impaired sleep was not associated with baseline beta-amyloid (p > 0.05). Short-term use of selective serotonin reuptake inhibitors and benzodiazepines slightly weakened the sleep-tau relationship.

CONCLUSIONS

Sleep impairment was associated with tauopathy and cognitive decline, which could be linked to increased tau secretion from neuronal hyperactivity. Clinically, our results help identify high-risk individuals who could benefit from sleep-related interventions aimed to delay cognitive decline and AD.

Isolation and Identification of the High-Affinity DNA Aptamer Target to the Brain-Derived Neurotrophic Factor (BDNF)

Aptamers are functional oligonucleotide ligands used for the molecular recognition of various targets. The natural characteristics of aptamers make them an excellent alternative to antibodies in diagnostics, therapeutics, and biosensing. DNA aptamers are mainly single-stranded oligonucleotides (ssDNA) that possess a definite binding to targets. However, the application of aptamers to the fields of brain health and neurodegenerative diseases has been limited to date. Herein, a DNA aptamer against the brain-derived neurotrophic factor (BDNF) protein was obtained by in vitro selection. BDNF is a potential biomarker of brain health and neurodegenerative diseases and has functions in the synaptic plasticity and survival of neurons. We identified eight aptamers that have binding affinity for BDNF from a 50-nucleotide library. Among these aptamers, NV_B12 showed the highest sensitivity and selectivity for detecting BDNF. In an aptamer-linked immobilized sorbent assay (ALISA), the NV_B12 aptamer strongly bound to BDNF protein, in a dose-dependent manner. The dissociation constant (Kd) for NV_B12 was 0.5 nM (95% CI: 0.4-0.6 nM). These findings suggest that BDNF-specific aptamers could be used as an alternative to antibodies in diagnostic and detection assays for BDNF.

Deaddicta® for maintenance treatment of Opioid-dependence: A six-month follow-up

Background

Opioid dependence, is one of the world's most critical health problems. Deaddicta is a herbal product considered an effective treatment for opioid addiction. Deaddicta's efficacy in the maintenance treatment of patients with opioid use disorder has recently been demonstrated through a double-blind randomized controlled trial (RCT). This study aimed to evaluate the permanence of Deaddicta's efficacy six months after the end of the maintenance treatment for opioid dependence.

Methods

This study was performed following the previous RCT on the maintenance treatment of opioid addicts. Out of 41 participants who completed the study for three months in the previous research, 15 from the intervention group (Deaddicta capsules, 1500 mg/day) returned for follow-up. They all previously fulfilled the DSM-IV criteria for addiction, were aged 18 to 65, and had discontinued Deaddicta for six months. The outcome measures included addiction severity, depression and anxiety levels, and craving score. The scores of each parameter were compared in three phases: before intervention; after three months of intervention; and six months after the end of the study.

Results

Depression, anxiety, and craving scores decreased six months after the end of the previous study. This decrease was significant in the craving score (P = 0.011). No significant increase was observed in the frequency of use. The regression analysis showed a negative relationship between craving and the progression of phases.

Conclusion

The Deaddicta product may have desirable and effective properties in decreasing temptation and, as a result, the maintenance treatment of opioid dependence.

Interplay between stress, sleep, and BDNF in a high-risk sample of young adults

Children in institutional care have a high risk to experience childhood adversities (CAs), with consequences for physical and mental well-being. The long-term effects of CAs on the brain, including consequences for neuronal plasticity and sleep, are poorly understood. This study examined the interplay between stress (including CAs), sleep, and brain-derived neurotrophic factor (BDNF), a prominent marker for neuronal plasticity. Participants (N = 131, mean age = 26.3±3.4 years, 40 females) with residential youth-care history completed questionnaires measuring CAs (Childhood Trauma Questionnaire, CTQ), psychological well-being (World Health Organization-Five Well-Being Index, WHO-5), and sleep disturbances (Pittsburgh Sleep Quality Inventory, PSQI). Hair cortisol and serum BDNF concentration were measured using enzyme-linked immunosorbent assays. The analyses were conducted by using bootstrap regression models. There was no association of stress parameters or sleep with BDNF concentration. However, we found a significant association of CAs and well-being with sleep disturbances. Last, we found an association between CAs and BDNF in sleep-healthy but not sleep-disturbed participants. Our findings indicated a role of sleep disturbance in the association between stress and BDNF. Still, further studies are warranted using vulnerable groups at-risk to understand long-term effects on mental health and sleep.

The neurotrophic activities of brain-derived neurotrophic factor are potentiated by binding with apigenin, a common flavone in vegetables, in stimulating the receptor signaling

AIMS

We aimed to identify the neurotrophic activities of apigenin (4',5,7-trihydroxyflavone) via its coordination with brain-derived neurotrophic factor (BNDF) and an elevated signaling of tyrosine kinase receptor B (Trk B receptor).

METHODS

The direct binding of apigenin to BDNF was validated by ultrafiltration and biacore assay. Neurogenesis, triggered by apigenin and/or BDNF, was determined in cultured SH-SY5Y cells and rat cortical neurons. The amyloid-beta (Aβ)25-35 -induced cellular stress was revealed by propidium iodide staining, mitochondrial membrane potential, bioenergetic analysis, and formation of reactive oxygen species levels. Activation of Trk B signaling was tested by western blotting.

RESULTS

Apigenin and BDNF synergistically maintained the cell viability and promoted neurite outgrowth of cultured neurons. In addition, the BDNF-induced neurogenesis of cultured neurons was markedly potentiated by applied apigenin, including the induced expressions of neurofilaments, PSD-95 and synaptotagmin. Moreover, the synergy of apigenin and BDNF alleviated the (Aβ)25-35 -induced cytotoxicity and mitochondrial dysfunction. The synergy could be accounted by phosphorylation of Trk B receptor, and which was fully blocked by a Trk inhibitor K252a.

CONCLUSION

Apigenin potentiates the neurotrophic activities of BDNF through direct binding, which may serve as a possible treatment for its curative efficiency in neurodegenerative diseases and depression.

Decreased serum BDNF contributes to the onset of REM sleep behavior disorder in Parkinson's disease patients

BACKGROUND

Brain-derived neurotrophic factor (BDNF) promotes neuroprotection and neuroregeneration. BDNF enhances the survival of dopaminergic neurons and improves dopaminergic neurotransmission and motor performance in patients with Parkinson's disease (PD). However, the association between BDNF levels and rapid eye movement (REM) sleep behavior disorder (RBD) in PD patients has received limited attention.

METHODS

We employed the Rapid Eye Movement Sleep Behavior Disorder Questionnaire-Hong Kong version (RBDQ-HK) and the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ) for RBD diagnosis. Patients were categorized into three groups: healthy controls (n = 53), PD patients without RBD (PD-nRBD; n = 56), and PD patients with RBD (PD-RBD; n = 45). Serum BDNF concentrations, demographic information, medical history, and motor/non-motor manifestations were compared between the three groups. Logistic regression analysis was performed to identify independent factors associated with PD and RBD. P-trend analysis was used to assess the relationship between BDNF levels and the risk of PD and RBD onset. Interaction effects were analyzed between BDNF, patients' age, and gender on the risk of RBD onset in PD patients.

RESULTS

Our findings indicate that serum BDNF levels were significantly lower in PD patients compared to healthy controls (p < 0.001). PD-RBD patients exhibited higher motor symptom scores (UPDRS III) than PD-nRBD patients (p = 0.021). Additionally, the PD-RBD group demonstrated lower cognitive function scores as measured by the Montreal Cognitive Assessment (MoCA) (p < 0.001) and Mini-Mental State Examination (MMSE) (p = 0.015). PD-RBD patients displayed significantly lower BDNF levels compared to both PD-nRBD and healthy control groups (p < 0.001). Univariate and multivariate logistic regression analyses showed that reduced BDNF levels were associated with an increased risk of RBD in PD patients (p = 0.005). P-trend analysis further confirmed the progressive relationship between decreased BDNF levels and the risk of PD and RBD onset. Furthermore, our interaction analysis highlighted the importance of monitoring younger PD patients with low serum BDNF levels for potential RBD onset.

CONCLUSIONS

This study illustrates that decreased serum BDNF levels may be linked to the development of RBD in PD patients, highlighting the potential utility of BDNF as a biomarker in clinical practice.

A Narrative Review of Commercial Platforms Offering Tracking of Heart Rate Variability in Corporate Employees to Detect and Manage Stress

The COVID-19 pandemic has resulted in employees being at risk of significant stress. There is increased interest by employers to offer employees stress monitoring via third party commercial sensor-based devices. These devices assess physiological parameters such as heart rate variability and are marketed as an indirect measure of the cardiac autonomic nervous system. Stress is correlated with an increase in sympathetic nervous activity that may be associated with an acute or chronic stress response. Interestingly, recent studies have shown that individuals affected with COVID will have some residual autonomic dysfunction that will likely render it difficult to track both stress and stress reduction using heart rate variability. The aims of the present study are to explore web and blog information using five operational commercial technology solution platforms that offer heart rate variability for stress detection. Across five platforms we found a number that combined HRV with other biometrics to assess stress. The type of stress being measured was not defined. Importantly, no company considered cardiac autonomic dysfunction because of post-COVID infection and only one other company mentioned other factors affecting the cardiac autonomic nervous system and how this may impact HRV accuracy. All companies suggested they could only assess associations with stress and were careful not to claim HRV could diagnosis stress. We recommend that managers think carefully about whether HRV is accurate enough for their employees to manage their stress during COVID.

The Interaction Between Brain-Derived Neurotrophic Factor Levels and Alcohol Consumption, Sleep Disturbance and Sex-Hormones in Alcohol Use Disorders

AIMS

Brain-derived neurotrophic factor (BDNF) levels may be associated with alcohol use disorders (AUD) and alcohol consumption, correlate with sleep disturbance and be influenced by sex differences and sex hormones. These associations have not been examined in a single sample accounting for all these factors.

METHODS

Data from 190 participants (29.4% female) with AUD were utilized. Sleep quality, craving intensity, depression, anxiety and alcohol consumption were assessed using the Pittsburgh Sleep Quality Index (PSQI), Penn Alcohol Craving Scale (PACS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Timeline Follow Back for 90 days(TLFB 90). Inventory of Drug Taking Situations (IDTS) assessed the tendency to drink in positive/negative emotional states. Serum BDNF (sBDNF) and plasma sex hormones (estrogen, progesterone, testosterone, FSH and SHBG) were measured. Pearson correlation analyses were used to examine the association between sBDNF and these measures in the entire sample and in men and women separately. Higher order interaction effects between these factors were evaluated for their association with sBDNF using a backward selection model.

RESULTS

No significant correlations between sBDNF levels and sex hormones, PSQI, PHQ-9, PACS, IDTS scores and alcohol consumption were found (all P-values > 0.05). sBDNF levels were negatively correlated with GAD-7 scores in men (r = -0.1841; P = 0.03). When considering all quadratic and two-way interactions among PSQI, PHQ-9, GAD-7, mean and max drinks/day, number of drinking days, heavy drinking days, and sex no higher order moderating effects of sBDNF levels were found.

CONCLUSION

Our study revealed no significant associations between sBDNF and alcohol measures, sleep, depression and sex hormones suggesting limited utility as a biomarker.

Lifestyle risk factors for obsessive-compulsive symptoms and related phenomena: What should lifestyle interventions target?

OBJECTIVE

Understanding the impact of lifestyle on mental illness symptoms is important for informing psycho-education and developing interventions which target mental and physical comorbidities. Obsessive-compulsive and related disorders can have a significant impact on health-related quality of life and physical health. However, our understanding of the impact of lifestyle on obsessive-compulsive symptoms and broader compulsive and impulsive problematic repetitive behaviours is limited.

AIMS

We investigated whether lifestyle factors predicted change in obsessive-compulsive symptoms and problematic repetitive behaviours in a general population sample over a 3-month period.

METHODS

Eight hundred thirty-five participants completed an online questionnaire battery assessing lifestyle and mental health. Of these, 538 participants completed the same battery 3 months later. We conducted negative binomial regressions to analyse the association of lifestyle factors at baseline with future (1) obsessive-compulsive symptoms, (2) compulsive problematic repetitive behaviours and (3) impulsive problematic repetitive behaviours, adjusting for baseline obsessive-compulsive symptoms and problematic repetitive behaviours.

RESULTS

Lower vegetable (p = 0.020) and oily fish (p = 0.040) intake and lower moderate intensity physical activity (p = 0.008) predicted higher obsessive-compulsive symptoms at follow-up. Higher intake of high-fat foods (p < 0.001) predicted higher compulsive problematic repetitive behaviours at follow-up. No lifestyle factors significantly predicted impulsive problematic repetitive behaviours at follow-up.

CONCLUSION

Our results speak to the potential importance of lifestyle quality screening, education and lifestyle interventions (e.g. an anti-inflammatory diet) for individuals experiencing compulsivity-related behaviours and/or symptoms. Further research into potential mechanisms of action will allow for more targeted approaches to lifestyle interventions for transdiagnostic compulsive behaviours.

Peripheral brain-derived neurotrophic factor (BDNF) in insomnia: A systematic review and meta-analysis

The brain-derived neurotrophic factor (BDNF) is associated with emotional and cognitive functioning, and it is considered a transdiagnostic biomarker for mental disorders. Literature on insomnia related BDNF changes yielded contrasting results and it has never been synthetized using meta-analysis. To fill this gap, we conducted a systematic review and meta-analysis of case-control studies examining the levels of peripheric BDNF in individuals with insomnia and healthy controls using the PRISMA guidelines. PubMed, Scopus, Medline, PsycINFO and CINAHL were searched up to Nov 2022. Nine studies met the inclusion criteria and were assessed using the Newcastle-Ottawa Scale. Eight studies reported sufficient data for meta-analysis. Random-effects models showed lower BDNF in subjects with insomnia (n = 446) than in controls (n = 706) (Hedge's g = -0.86, 95% CI: -1.39 to -0.32, p = .002). Leave-one-out sensitivity analysis confirmed that the pooled effect size was robust and not driven by any single study. However, given the small sample size, the cross-sectional nature of the measurement, and the high heterogeneity of included data, the results should be cautiously interpreted. Progress in the study of BDNF in insomnia is clinically relevant to better understand the mechanisms that may explain the relationship between disturbed sleep and mental disorders.

Melatonin Treatment of Circadian Rhythm Sleep-Wake Disorder in Obese Children Affects the Brain-Derived Neurotrophic Factor Level

BACKGROUND

 Previous studies proved that the brain-derived neurotrophic factor (BDNF) is correlated with sleep regulation, yet how BDNF functions and reacts in the melatonin treatment of circadian rhythm sleep-wake disorder (CRSWD) among obese children remain enigmatic. Focusing on CRSWD in obese children, this study monitored their sleep efficiency and serum BDNF level changes during the treatment of melatonin.

METHODS

 In total, 35 obese children diagnosed with CRSWD were included in this study and administrated melatonin (3 mg/night) for 3 months. Blood samples were collected 24 hours before and after the treatment (08:00, 12:00, 16:00, 20:00, 24:00, and 04:00). Subsequently, the plasma melatonin level and serum BDNF level were measured by enzyme-linked immunosorbent assay. Sleep parameters, including sleep quality, Pittsburgh Sleep Quality Index as well as melatonin and BDNF levels before and after treatment, were recorded to profile the effectiveness and safety of melatonin treatment.

RESULTS

 Melatonin treatment increased plasma melatonin concentration and restored circadian rhythm. Besides, the serum BDNF level showed a significant increase, representing a strong positive correlation with melatonin concentration (p = 0.026). Patients experienced much-improved sleep efficiency (P < 0.001), with longer actual sleep time (P < 0.001), shorter sleep onset latency, and fewer awakenings after treatment (P < 0.001). Besides, melatonin was well tolerated by patients without producing severe side effects.

CONCLUSION

 Melatonin treatment effectively improved CRSWD among obese children with their serum BDNF levels increased, indicating that BDNF is a key regulator in CRSWD in obese children. This study may offer theoretical support for melatonin treatment of CRSWD in obese children.

The LEISURE Study: A Longitudinal Randomized Controlled Trial Protocol for a Multi-Modal Lifestyle Intervention Study to Reduce Dementia Risk in Healthy Older Adults

Dementia is understood to arise from a mixed etiology, enveloping chronic inflammatory and vascular impacts on the brain, driven by a constellation of modifiable risk factors which are largely mediated by lifestyle-related behaviors. These risk factors manifest over a prolonged preclinical period and account for up to 40% of the population attributable risk for dementia, representing viable targets for early interventions aimed at abating disease onset and progression. Here we outline the protocol for a 12-week randomized control trial (RCT) of a multimodal Lifestyle Intervention Study for Dementia Risk Reduction (LEISURE), with longitudinal follow-up at 6-months and 24-months post-intervention. This trial integrates exercise, diet, sleep, and mindfulness to simultaneously target multiple different etiopathogenetic mechanisms and their interplay in a healthy older adult population (aged 50-85 years), and assesses dementia risk reduction as the primary endpoint. The LEISURE study is located in the Sunshine Coast region of Australia, which has one of the nation's highest proportions of adults aged over 50 years (36.4%), and corresponding dementia prevalence. This trial is novel in its inclusion of mindfulness and sleep as multidomain lifestyle targets, and in its comprehensive suite of secondary outcomes (based on psychological, physical health, sleep activity, and cognitive data) as well as exploratory neuroimaging (magnetic resonance imaging and electroencephalography) and molecular biology measures. These measures will provide greater insights into the brain-behavioral underpinnings of dementia prevention, as well as the predictors and impacts of the proposed lifestyle intervention. The LEISURE study was prospectively registered (ACTRN12620000054910) on 19 January 2020.

Intricate role of sleep deprivation in modulating depression: focusing on BDNF, VEGF, serotonin, cortisol, and TNF-α

In this review article, we aimed to discuss intricate roles of SD in modulating depression in preclinical and clinical studies. Decades of research have shown the inconsistent effects of SD on depression, focusing on SD duration. However, inconsistent role of SD seems to be more complicated, and SD duration cannot be the only one factor. Regarding this issue, we chose some important factors involved in the effects of SD on cognitive functions and mood including brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), serotonin, cortisol, and tumor necrosis factor-alpha (TNF-α). It was concluded that SD has a wide-range of inconsistent effects on BDNF, VEGF, serotonin, and cortisol levels. It was noted that BDNF diurnal rhythm is significantly involved in the modulatory role of SD in depression. Furthermore, the important role of VEGF in blood-brain barrier permeability which is involved in modulating depression was discussed. It was also noted that there is a negative correlation between cortisol and BDNF that modulates depression. Eventually, it was concluded that TNF-α regulates sleep/wake cycle and is involved in the vulnerability to cognitive and behavioral impairments following SD. TNF-α also increases the permeability of the blood-brain barrier which is accompanied by depressive behavior. In sum, it was suggested that future studies should focus on these mechanisms/factors to better investigate the reasons behind intricate roles of SD in modulating depression.

Sleep, stress and aggression: Meta-analyses investigating associations and causality

Prior research suggests that sleep is associated with increased subjective stress and aggression, but important questions remain about the typical magnitude of these relationships, as well as their potential moderators. We therefore conducted the first meta-analysis of this literature. Across 340 associational and experimental studies, significant associations were identified between sleep with both subjective stress (r = 0.307, p < .001) and aggression (r = 0.258, p < .001) in individuals from the general population, as well as between sleep with subjective stress (r = 0.425, p < .001) in individuals with sleep disorders. Experimental sleep restriction also led to increased subjective stress (g = 0.403, p = .017) and aggression (g = 0.330, p = .042). These findings suggest that poorer sleep is associated with - and leads to - heightened levels of subjective stress and aggression. These findings, and their implications, are discussed in relation to neurobiological literature, which highlights the complex interplay between metabolic activity in the brain, hormonal changes, and behavior.

Insomnia, sleep loss, and circadian sleep disturbances in mood disorders: a pathway toward neurodegeneration and neuroprogression? A theoretical review

The present paper aims at reviewing and commenting on the relationships between sleep and circadian phasing alterations and neurodegenerative/neuroprogressive processes in mood disorder. We carried out a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, in PubMed, PsycINFO, and Embase electronic databases for literature related to mood disorders, sleep disturbances, and neurodegenerative/neuroprogressive processes in relation to (1) neuroinflammation, (2) activation of the stress system, (3) oxidative stress, (4) accumulation of neurotoxic proteins, and (5) neuroprotection deficit. Seventy articles were collectively selected and analyzed. Experimental and clinical studies revealed that insomnia, conditions of sleep loss, and altered circadian sleep may favor neurodegeneration and neuroprogression in mood disorders. These sleep disturbances may induce a state of chronic inflammation by enhancing neuroinflammation, both directly and indirectly, via microglia and astrocytes activation. They may act as neurobiological stressors that by over-activating the stress system may negatively influence neural plasticity causing neuronal damage. In addition, sleep disturbances may favor the accumulation of neurotoxic proteins, favor oxidative stress, and a deficit in neuroprotection hence contributing to neurodegeneration and neuroprogression. Targeting sleep disturbances in the clinical practice may hold a neuroprotective value for mood disorders.

Treating Agitation in Patients with Dementia with a Therapy Dog in a Milieu Therapy Setting on a Geropsychiatric Ward

BACKGROUND

Animal-assisted intervention has become a common therapeutic practice used for patients with dementia in home-dwelling and institutions. The most established procedure is a visiting service by specially trained dogs and their owners to improve social interactions and reduce symptoms of agitation.

OBJECTIVES

The study aims to investigate the effects of a therapy dog on agitation of inpatients with dementia in a gerontopsychiatric ward.

MATERIALS AND METHODS

The severity of agitation was assessed by a rater blinded for the presence of the dog via the Overt Agitation Severity Scale (OASS). The scale was conducted on 1 day with the dog and his handler present (resident doctor on the ward) and on another day with only the handler present. Each patient was his/her own control. Heart rate variability (HRV) and serum level of brain-derived neurotrophic factor (BDNF) of the patients were measured on both days. 26 patients with the Mini-Mental Status Examination (MMSE) score <21 and the diagnosis of dementia were included in the study.

RESULTS

A significant reduction of agitation in the OASS could be shown when the dog was present (p = 0.006). The data neither demonstrated a difference in the HRV for the parameters mean heart rate (p = 0.65), root mean square of successive differences (p = 0.63), and high frequencies (p = 0.27) nor in serum BDNF concentrations (p = 0.42).

DISCUSSION

Therapy dogs can be implemented as a therapeutic tool in a gerontopsychiatric ward to reduce symptoms of agitation in patients with dementia. The study was registered in the German Clinical Trials Register (DRKS00024093).

The possible mechanism of Datura stramonium on pentobarbital-induced sleep in mice

BACKGROUND

Insomnia leads to the development of mental problems and missing of accuracy in affected persons. Various investigations have previously revealed which medicinal plants play a role in the improvement of insomnia. In this study, we evaluated the effect of hydro-alcoholic extract of Datura stramonium on insomnia in mice.

METHODS

The extracts and fractions at different concentrations were injected intraperitoneally (i.p.) to mice 30 min before the sodium pentobarbital (30 mg/kg, i.p.). Additionally, the blood was collected from cardiac and serum separated to measure brain-derived neurotrophic factor (BDNF). The LC-MS was done to identify the active components. Flumazenil or naloxone were also applied to study the possible mechanism of extract. The PC12 cells were then exposed to different doses of extract and fractions, in order to evaluate cytotoxicity by MTT assay and the measured LD₅₀.

RESULTS

The hydro-alcoholic extracts of calyx, seed and petal elevated sleep duration and decreased sleep latency. In addition, water, ethyl acetate and n-butanol fractions of hydro-alcoholic extract of petal increased sleep duration. Of note, Naloxone significantly reversed the hypnotic effect of the extract. The extract increased the level of BDNF in serums. As well, the toxicity assessment revealed that the extracts had not toxic on PC12 cells. The LD₅₀ value was obtained as 4.8 g/kg.

CONCLUSION

This research demonstrated that D. stramonium (including seed, petal and calyx) increased the hypnotic effect without neurotoxicity on PC12 cells. Sleep induction may be related to its active ingredients as well as the effect on opioid receptors.

Sleep markers in psychiatry: do insomnia and disturbed sleep play as markers of disrupted neuroplasticity in mood disorders? A proposed model

INTRODUCTION

Since insomnia and disturbed sleep may affect neuroplasticity, we aimed at reviewing their potential role as markers of disrupted neuroplasticity involved in mood disorders.

METHOD

We performed a systematic review, according to PRIMA, on PubMed, PsycINFO and Embase electronic databases for literature regarding mood disorders, insomnia, sleep loss/deprivation in relation to different pathways involved in the impairment of neuroplasticity in mood disorders such as 1] alterations in neurodevelopment 2] activation of the stress system 3] neuroinflammation 4] neurodegeneration/neuroprogression, 4] deficit in neuroprotection.

RESULTS

Sixty-five articles were analyzed and a narrative/ theoretical review was conducted. Studies showed that insomnia, sleep loss and sleep deprivation might impair brain plasticity of those areas involved in mood regulation throughout different pathways. Insomnia and disrupted sleep may act as neurobiological stressors that by over-activating the stress and inflammatory systems may affect neural plasticity causing neuronal damage. In addition, disturbed sleep may favor a deficit in neuroprotection hence contributing to impaired neuroplasticity.

CONCLUSIONS

Insomnia and disturbed sleep may play a role as markers of alteration in brain plasticity in mood disorders. Assessing and targeting insomnia in the clinical practice may potentially play a neuroprotective role, contributing to "repairing" alterations in neuroplasticity or to the functional recovery of those areas involved in mood and emotion regulation.

The role of psychological distress in the relationship between lifestyle and compulsivity: An analysis of independent, bi-national samples

BACKGROUND

Poor mental health is a state of psychological distress that is influenced by lifestyle factors such as sleep, diet, and physical activity. Compulsivity is a transdiagnostic phenotype cutting across a range of mental illnesses including obsessive-compulsive disorder, substance-related and addictive disorders, and is also influenced by lifestyle. Yet, how lifestyle relates to compulsivity is presently unknown, but important to understand to gain insights into individual differences in mental health. We assessed (a) the relationships between compulsivity and diet quality, sleep quality, and physical activity, and (b) whether psychological distress statistically contributes to these relationships.

METHODS

We collected harmonized data on compulsivity, psychological distress, and lifestyle from two independent samples (Australian n = 880 and US n = 829). We used mediation analyses to investigate bidirectional relationships between compulsivity and lifestyle factors, and the role of psychological distress.

RESULTS

Higher compulsivity was significantly related to poorer diet and sleep. Psychological distress statistically mediated the relationship between poorer sleep quality and higher compulsivity, and partially statistically mediated the relationship between poorer diet and higher compulsivity.

CONCLUSIONS

Lifestyle interventions in compulsivity may target psychological distress in the first instance, followed by sleep and diet quality. As psychological distress links aspects of lifestyle and compulsivity, focusing on mitigating and managing distress may offer a useful therapeutic approach to improve physical and mental health. Future research may focus on the specific sleep and diet patterns which may alter compulsivity over time to inform lifestyle targets for prevention and treatment of functionally impairing compulsive behaviors.

Brain-Derived Neurotrophic Factor and Psychophysiological Response in Youth Badminton Athletes During the Season

PURPOSE

To analyze peripheral brain-derived neurotrophic factor (BDNF) levels and psychophysiological parameters in youth badminton athletes during the season and to determine the relationship between variables.

METHODS

Fourteen young badminton athletes were assessed over the season (preseason, middle season, and final season). Serum BDNF (sBDNF) was determined during the preseason and final season. Sleep time, total physical activity, and time in vigorous activity were measured using an accelerometer. The fat-free mass, skeletal muscle mass, fat mass, handgrip strength, cardiorespiratory fitness (VO2max), and dietary intake were evaluated during the season. The Stroop Color and Word Test was employed to assess cognitive tasks. To evaluate the mood, the Brunel Mood Scale was used.

RESULTS

There  were lower sBDNF levels (-16.3% [46.8%]; P = .007) and sleep time (final season = 5.7 [1.1] vs preseason = 6.6 [1.1] h·night-1, P = .043) during the end of the season. The total calories and carbohydrate intake decreased across the season (P < .05). Conversely, better cognitive function was found in the final season with respect to the preseason (P < .05). There were significant correlations between BDNF and VO2max only in the preseason (r = .61, P = .027), but no significant relationship was found among sBDNF and cognitive performance, sleep time, and percentage of won games.

CONCLUSIONS

Youth badminton athletes decreased their sBDNF levels, sleep time, carbohydrate, and calorie intake across the season. The athletes improved in cognitive function; however, only the females improved in body composition, and the males improved their VO2max in the middle season. The sBDNF levels were positively correlated with the VO2max in the preseason, and no correlations were observed among the sBDNF and psychological parameters, sleep time, and sport performance during the season.

Lifestyle Interventions in the Treatment of Obsessive-Compulsive and Related Disorders: A Systematic Review

OBJECTIVE

Lifestyle medicine is increasingly important in psychiatry for its efficacy as a transdiagnostic treatment, its preventative potential, and its increased tolerability compared with first-line strategies. Although the impact of lifestyle medicine is strong across many psychiatric illnesses, our understanding of the effectiveness of lifestyle interventions in treating obsessive-compulsive and related disorders (OCRDs) is minimal. We aimed to conduct a systematic review examining the effect of lifestyle interventions (targeting diet, exercise, sleep, stress management, and tobacco/alcohol use) on OCRD symptoms.

METHODS

We systematically searched four electronic databases for published randomized controlled trials reporting on lifestyle interventions for OCRDs. We qualitatively synthesized results of eligible studies and calculated mean changes in symptom severity from baseline to end point and standardized between-group effect sizes.

RESULTS

We identified 33 eligible studies. Poor efficacy was noted across a number of rigorous dietary supplement interventions with some promising data in four (of six) studies regarding N-acetylcysteine for trichotillomania, skin picking, and obsessive-compulsive disorder. Stress management interventions, generally characterized by high risk of bias, reported mild effectiveness with greater effects noted for mind-body exercises (yoga) for obsessive-compulsive disorder. Greater improvements may be achieved when lifestyle intervention is adjunct to first-line treatments and delivered by facilitators.

CONCLUSIONS

Diet (particularly N-acetylcysteine) and stress management interventions seem promising avenues for OCRDs treatment. We present an action plan to move the lifestyle interventions for OCRDs field forward. Further high-quality lifestyle interventions are required to improve the certainty of findings and to inform clinical treatment guidelines.Review Registration Number: CRD42020151407.

Brain-Derived Neurotrophic Factor (BDNF) Depression and Subjective Sleep Quality in the First Trimester of Pregnancy Among Migrant Workers in Thailand

Introduction

Brain-derived neurotrophic factor (BDNF) influences neurodevelopment during pregnancy. Maternal sleep quality and depression are suggested to influence BDNF levels. The objective of this study was to assess the association between depression, sleep quality, and BDNF levels among Myanmar migrant pregnancies.

Methods

A cross-sectional study was conducted at Krathum Baen Hospital, Samut Sakhon province, from June to October 2018. A total of 108 first-trimester women were recruited into our study. Maternal blood was collected to analyze BDNF. Depression levels were assessed using the Patient Health Questionnaire (PHQ-9) instrument. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was applied to evaluate subjective sleep quality. Because BDNF was skewed, binary logistic regression was analyzed.

Results

We found that 28.7% of pregnant women reported poor sleep quality, and 33.4% were classified as having mild to moderate depression. After adjusting for covariate variables, pregnant women with depression had higher BDNF levels than those without depression (OR = 2.972, 95% CI = [1.111, 7.949], p = 0.030). Pregnant women with poor sleep quality had lower BDNF levels than those who had good sleep quality (OR = 0.359, 95% CI = [0.132, 0.972], p = 0.044).

Discussion

The results suggested that BDNF might be an alternative tool to assess sleep quality in pregnant women.

Influence of excessive daily sleeping and sleep quality on BDNF and NGF serum levels in adolescents

INTRODUCTION

The brain-derived neurotrophic factor (BDNF) and neural growth factor (NGF) are widely expressed in the brain and play an important role in neuroplasticity, neurogenesis, and increased neuronal connections. Previous studies have shown that reduced serum levels of these proteins are associated with disorders in human sleep.

OBJECTIVE

Current study evaluates the prevalence in adolescents of excessive daytime sleepiness (EDS) and sleep quality, and analyzes the influence of these factors on BDNF and NGF serum levels.

METHODS

A cross-section population-based study was conducted with data from a Brazilian birth cohort, with a sample of five hundred and thirteen 18-19-year-old adolescents. Sleep quality was assessed by the Pittsburgh Sleep Quality Index and EDS by Epworth Sleepiness Scale. Neurotrophins serum levels were measured by Luminex™ technology kits. Analysis consisted of marginal structural models which compared people who were exposed and not exposed to sleep quality and EDS.

RESULTS

Poor sleep quality and EDS were detected in 62.57% and 36.35% of the sample. Adolescents with poor sleep quality and EDS had -0.39 (p-value = 0.049) and -0.51 pg/ml in NGF (p-value = 0.009). Individuals with self-reported sleep disorder had lower serum levels of NGF (Coef. -0.41, p-value = 0.045).

CONCLUSION

High prevalence of EDS and low sleep quality in a population of adolescents were evidenced. Poor sleep quality and EDS were associated with lower NGF levels, whilst adolescents with self-reported sleep disorder had lower serum levels of NGF.

Effects of acupuncture versus cognitive behavioral therapy on brain-derived neurotrophic factor in cancer survivors with insomnia: an exploratory analysis

INTRODUCTION

Decreased brain-derived neurotrophic factor (BDNF) is associated with poor sleep. This study examined the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on serum BDNF and sleep outcomes in cancer survivors with insomnia.

METHODS

This was an exploratory analysis of a randomized clinical trial (n = 160) comparing acupuncture versus CBT-I for cancer survivors with insomnia. Interventions were delivered over 8 weeks. Outcomes were assessed at baseline and week 8. Serum BDNF was evaluated with enzyme-linked immunosorbent assay (ELISA). Sleep was evaluated with the insomnia severity index and consensus sleep diary. Pearson correlations between BDNF and sleep outcomes were calculated. Data analysis was limited to 87 survivors who provided serum samples.

RESULTS

Among 87 survivors, the mean age was 61.9 (SD: 11.4) years, 51.7% were women, and 24.1% were non-White. Mean serum BDNF did not significantly increase in acupuncture (n = 50) or CBT-I (n = 37) groups. When analysis was restricted to patients with low baseline BDNF (i.e. levels below the sample median of 47.1 ng/mL), the acupuncture group (n = 22) demonstrated a significant 7.2 ng/mL increase in mean serum BDNF (P = 0.03), whereas the CBT-I group (n = 21) demonstrated a non-significant 2.9 ng/mL increase (P = 0.28). Serum BDNF was not significantly correlated with sleep outcomes (all P > 0.05).

CONCLUSION

Among cancer survivors with insomnia and low baseline BDNF, acupuncture significantly increased serum BDNF levels; however, the clinical significance of this finding requires further investigation.Trial registration no. NCT02356575 (ClinicalTrials.gov).

Aerobic Exercise and Stretching as Add-On to Inpatient Treatment for Depression Have No Differential Effects on Stress-Axis Activity, Serum-BDNF, TNF-Alpha and Objective Sleep Measures

(1) Background: While the antidepressant effects of aerobic exercise (AE) are well documented, fewer studies have examined impact of AE as an add-on treatment. Moreover, various effects on neurobiological variables have been suggested. This study examines effects of AE on Cortisol Awakening Reaction (CAR), serum Brain Derived Neurotrophic Factor (sBDNF), Tumor Necrosis Factor alpha (TNF-alpha) and sleep. (2) Methods: Inpatients with moderate-to-severe depression (N = 43) were randomly assigned to the AE or stretching condition (active control) taking place 3x/week for 6 weeks. CAR, sBDNF and TNF-alpha were assessed at baseline, after 2 weeks and post-intervention. The 17-item Hamilton Depression Rating Scale (HDRS17), subjective sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were obtained at baseline and post-intervention. (3) Results: Stress axis activity decreased in both groups from baseline to post-intervention. sBDNF showed a significant increase over time, whereas the number of awakenings significantly decreased. No significant time by group interactions were detected for any of the study variables. Correlational analyses showed that higher improvements in maximum oxygen capacity (VO₂max) from baseline to post-intervention were associated with reduced scores on the HDRS17, PSQI and REM-latency post-intervention. (4) Conclusions: While some neurobiological variables improved during inpatient treatment (CAR, sBDNF), no evidence was found for differential effects between AE and an active control condition (stretching). However, patients in which cardiorespiratory fitness increased showed higher improvements in depression severity and depression-related sleep-parameters.

Sleep quality as a mediator of the association between coping styles and mental health: a population-based ten-year comparative study in a Chinese population

BACKGROUNDS

Little is known about the variation in sleep quality and its association with coping style and mental health in 21^st century China, despite of enormous socioeconomic changes. This study aims to document the variation in sleep quality and its contribution to the association between coping style and mental health in China.

METHODS

Pooled cross-sectional data of 46,561 adults was obtained from the 2004 and 2015 mental health surveys conducted in Shandong Province, China. A Simplified Coping Style Questionnaire and the Pittsburgh Sleep Quality Index were assessed, with mental health measured by the General Health Questionnaire (GHQ). A mediation regression model was run to test the mediating effect of sleep quality.

RESULTS

Above 10% reported poor sleep quality or median-to-high risk of mental disorders according to GHQ results in year 2015, and a significant but small improvement for sleep quality and mental health came during the studied decade, with the exception of poor sleep quality increasing among males. In 2015, a one-point increase in sleep quality score was associated with an increase of 0.17 (95% CI, 0.16-0.18) and 0.16 (95% CI, 0.14-0.17) points on the GHQ for males and females, respectively. Sleep quality mediated the relationship between negative tendency of coping style and elevated GHQ scores, and the mediating effects grew stronger in 2015 than those in 2004.

LIMITATION

The study is a cross-sectional study, and the sample is not nationally representative.

CONCLUSION

An integrative intervention of mental health promotion is recommended to account for sleep quality and coping strategies..

Associations Between Cardiorespiratory Fitness and Endocrine, Autonomous and Psychological Stress Reactivity in Male Adolescents

Abstract. High stress burden during adolescence can have severe long-term health consequences. While some studies reported that adults with higher fitness levels show lower stress reactivity, research on adolescents is scarce. Accordingly, the aim of the present study was to investigate the association between cardiorespiratory fitness and physiological and psychological stress reactivity in male adolescents. Forty-three healthy, male adolescents aged 16–20 years underwent the Physical Working Capacity 170 bicycle ergometer test to determine cardiorespiratory fitness. The Trier Social Stress Test (TSST) was used to trigger a stress reaction, which was measured physiologically with changes in salivary cortisol and alpha-amylase concentrations, and psychologically using self-rated changes in state-anxiety. Under consideration of potential confounders, hierarchical regression analyses were calculated for each outcome. For cortisol and psychological stress reactivity, fitness did not significantly explain variance. However, 28% of variance in alpha-amylase reactivity were explained by fitness and sleep complaints [adjusted R2 = .28, F(2, 36) = 8.36, p = .001], with 16% of variance explained by fitness alone (β = −.41, p = .006). Accordingly, higher fitness was associated with lower stress reactivity of the autonomous nervous system in male adolescents. The promotion of cardiorespiratory fitness may therefore be considered an important factor in preventing negative health consequences of stress in this age group.

Plasma Brain-Derived Neurotropic Factor Levels Are Associated with Aging and Smoking But Not with Future Dementia in the Rotterdam Study

BACKGROUND

Brain-derived neurotropic factor (BDNF) plays a vital role in neuronal survival and plasticity and facilitates long-term potentiation, essential for memory. Alterations in BDNF signaling have been associated with cognitive impairment, dementia, and Alzheimer's disease. Although peripheral BDNF levels are reduced in dementia patients, it is unclear whether changes in BDNF levels precede or follow dementia onset.

OBJECTIVE

In the present study, we examined the association between BDNF plasma levels and dementia risk over a follow-up period of up to 16 years.

METHODS

Plasma BDNF levels were assessed in 758 participants of the Rotterdam Study. Dementia was assessed from baseline (1997-1999) to follow-up until January 2016. Associations of plasma BDNF and incident dementia were assessed with Cox proportional hazards models, adjusted for age and sex. Associations between plasma BDNF and lifestyle and metabolic factors are investigated using linear regression.

RESULTS

During a follow up of 3,286 person-years, 131 participants developed dementia, of whom 104 had Alzheimer's disease. We did not find an association between plasma BDNF and risk of dementia (adjusted hazard ratio 0.99; 95%CI 0.84-1.16). BDNF levels were positively associated with age (B = 0.003, SD = 0.001, p = 0.002), smoking (B = 0.08, SE = 0.01, p = < 0.001), and female sex (B = 0.03, SE = 0.01, p = 0.03), but not with physical activity level (B = -0.01, SE = 0.01, p = 0.06).

CONCLUSION

The findings suggest that peripheral BDNF levels are not associated with an increased risk of dementia.

Exploring the effectiveness of a specialized therapy programme for burnout using subjective report and biomarkers of stress

The increasing prevalence of stress-related disorders such as burnout urges the need for specialized treatment approaches. Programmes combining psychotherapy and regenerative interventions emerge to be the most successful. However, evaluated therapy programmes are scarce and usually involve subjective symptom quantification without consideration of physiologic parameters. The aim of the present exploratory, single-group study was the multimodal investigation of the effectiveness of a specialized holistic therapy programme by assessing symptoms and biological markers of chronic stress. Seventy-one in-patients (39 men/32 women; age 46.8 ± 9.9 years) of a specialized burnout ward with the additional diagnosis of burnout (Z73.0) in conjunction with a main diagnosis of depressive disorder (F32 or F33) according to the International Classification of Diseases (ICD)-10 were included in the study. In addition to symptomatology, the stress-responsive biomarkers heart rate variability (HRV) and serum brain-derived neurotrophic factor (BDNF) were measured in patients at admittance to and discharge from the burnout ward applying a 6-week specialized treatment programme. At discharge, patients showed a significant reduction of symptom burden and a significant increase in serum BDNF, while HRV remained unchanged. The findings implicate that the therapy programme may have beneficial effects on symptomatology and neuroplasticity of patients with burnout. As therapy was often supplemented by psychopharmacological treatment, a relevant influence of antidepressant medication especially on BDNF has to be considered.

Neuroprotective activities of bacopa, lycopene, astaxanthin, and vitamin B12 combination on oxidative stress-dependent neuronal death

Oxidative stress is considered the common effector of the cascade of degenerative events in many neurological conditions. Thus, in this paper we tested different nutraceuticals in H2 O2 in vitro model to understand if could represent an adjuvant treatment for neurological diseases. In this study, nutraceuticals bacopa, lycopene, astaxanthin, and vitamin B12 were used alone or in combination in human neuronal differentiated SH-SY5Y cells upon hydrogen peroxide-induced injury and neuroprotective, neuronal death pathways were analyzed. The nutraceuticals analyzed were able to protect H2 O2 cytotoxic effects, through increasing cell viability and proteins involved in neuroprotection pathways and restoring proteins involved in cell death pathways. On this basis, it is possible to propose the use of these compounds as dietary supplement for the prevention or as adjuvant to the only symptomatic treatments so far available for neurodegenerative diseases.

Brain-derived neurotrophic factor (BDNF) levels in first-episode schizophrenia and healthy controls: A comparative study

BACKGROUND

Abnormalities in brain development and plasticity have been associated with the pathophysiology of schizophrenia. The role of brain-derived neurotrophic factor (BDNF) in schizophrenia is the recent area of interest because it regulates neurogenesis. The current study aimed to assess and compare serum BDNF levels between first-episode schizophrenia patients and healthy controls, and evaluate its correlation with the socio-demographic and clinical variables.

METHODOLOGY

It was a cross-sectional comparative study for the assessment of serum BDNF levels between patients with first-episode schizophrenia (N=50) and healthy controls (N-50) conducted in the Department of Psychiatry at a tertiary care public hospital attached to a medical school in North India. Participants were assessed for the socio-demographic parameters, nicotine dependence, and clinical details using structured scales. Serum BDNF level estimated using the sandwich ELISA technique. The comparison between the groups was done by using a Student t-test or chi-square test. Spearman correlation was performed between mean BDNF scores and demographic or illness variables in both first-episode schizophrenia and healthy control groups.

RESULTS

There was a significantly lower mean score of total serum BDNF levels in first-episode schizophrenia patients as compared to controls (8.44 ± 1.54 vs 10.44 ± 2.04; t = 5.52, p < 0.001; 95% CI = 1.28-2.71). The total FTND scores for smokeless tobacco use were negatively correlated to BDNF levels among healthy controls (r=-0.30, p=0.03) as well as in the first-episode schizophrenia group (r=-0.32, p= 0.04). None of the other illness-related variables were correlated to serum BDNF values in the first episode schizophrenia group.

CONCLUSION

Individuals with first-episode schizophrenia have lower serum BDNF levels than healthy controls. The illness-related factors such as duration of untreated psychosis or psychopathology were not correlated with BDNF levels. Thus abnormal signaling of BDNF can lead to abnormal brain functioning which can make an individual more susceptible to schizophrenia.

The effect of insomnia on development of Alzheimer's disease

Alzheimer's disease (AD) is the most common type of dementia and a neurodegenerative disorder characterized by memory deficits especially forgetting recent information, recall ability impairment, and loss of time tracking, problem-solving, language, and recognition difficulties. AD is also a globally important health issue but despite all scientific efforts, the treatment of AD is still a challenge. Sleep has important roles in learning and memory consolidation. Studies have shown that sleep deprivation (SD) and insomnia are associated with the pathogenesis of Alzheimer's disease and may have an impact on the symptoms and development. Thus, sleep disorders have decisive effects on AD; this association deserves more attention in research, diagnostics, and treatment, and knowing this relation also can help to prevent AD through screening and proper management of sleep disorders. This study aimed to show the potential role of SD and insomnia in the pathogenesis and progression of AD.

Modulation of sleep using electrical vestibular nerve stimulation prior to sleep onset: a pilot study

OBJECTIVES

Electrical stimulation of the vestibular system (VeNS) has been shown to improve Insomnia Severity Index (ISI) when delivered during sleep. We hypothesize that repeated electrical vestibular stimulation, when delivered prior to sleep onset, will improve ISI scores. The primary aim of this study was to assess the effect that VeNS had on ISI scores when delivered prior to sleep onset. A secondary aim was to provide initial data indicating "length of time to effect" that will allow more appropriate design of a larger randomized control trial (RCT).

METHODS

The present study was an experimental study (pre and post without control). The participants acted as self-controls. After recording the baseline values, electrical vestibular nerve stimulation was administered as intervention once in a day for 30 min, 1 h prior to sleep onset using ML1000 device (Neurovalens, UK) for 14 days.

RESULTS

There was significant decrease in the ISI scores followed by the electrical vestibular nerve stimulation. Further, participants reported a significant increase in well-rested sleep post the intervention period.

CONCLUSIONS

This study supports our hypothesis that VeNS has a positive impact on ISI scores when delivered on a regular basis prior to sleep onset.

Predicting stress resilience and vulnerability: brain-derived neurotrophic factor and rapid eye movement sleep as potential biomarkers of individual stress responses

STUDY OBJECTIVES

To examine the rapid eye movement sleep (REM) response to mild stress as a predictor of the REM response to intense stress and brain-derived neurotrophic factor (BDNF) as a potential biomarker of stress resilience and vulnerability.

METHODS

Outbred Wistar rats were surgically implanted with electrodes for recording electroencephalography (EEG) and electromyogram (EMG) and intraperitoneal Data loggers to record body temperature. Blood was also obtained to measure circulating BDNF. After recovery, rats were exposed to mild stress (novel chamber, NC) and later intense stress (shock training, ST), followed by sleep recording. Subsequently, rats were separated into resilient (Res; n=27) or vulnerable (Vul; n = 15) based on whether or not there was a 50% or greater decrease in REM after ST compared to baseline. We then compared sleep, freezing, and the stress response (stress-induced hyperthermia, SIH) across groups to determine the effects of mild and intense stress to determine if BDNF was predictive of the REM response.

RESULTS

REM totals in the first 4 hours of sleep after exposure to NC predicted REM responses following ST with resilient animals having higher REM and vulnerable animals having lower REM. Resilient rats had significantly higher baseline peripheral BDNF compared to vulnerable rats.

CONCLUSIONS

These results show that outbred rats display significant differences in post-stress sleep and peripheral BDNF identifying these factors as potential markers of resilience and vulnerability prior to traumatic stress.

Improvement in resilience and stress-related blood markers following ten months yoga practice in Antarctica

BACKGROUND

Wintering is associated with distress to humans who work in the isolated and confined environment of Antarctica and yoga has been proved helpful for coping with stress. Therefore, a study was conducted on 14 winter expedition members of Indian Scientific Antarctic Expedition (2016) to find out the effects of yoga on stress-related markers.

METHODS

Participants were divided into yoga, and control (non-yoga) groups. The yoga group practiced yoga for 10 months (from January to October 2016) daily in the morning for an hour. The Resilience test questionnaire was administrated at baseline and endpoint of the study. Blood samples were collected during the study at different intervals for the estimation of 8-hydroxydeoxyguanosine (8-OHdG), brain-derived neurotrophic factor (BDNF), serotonin and cortisol using ELISA.

RESULTS

A trend of improvement was observed in the resilience test score in the yoga group. From January to October, 8-OHdG serum values in the yoga group declined by 55.9% from 1010.0 ± 67.8 pg/mL to 445.6 ± 60.5 pg/mL (Mean ± SD); in the control group, the decline was 49.9% from 1060.4 ± 54.6 pg/mL to 531.1 ± 81.8 pg/mL. In serotonin serum levels in the yoga group, there was a 3.1% increase from 6.4 ± 1.6 ng/mL to 6.6 ± 0.4 ng/mL while no increase was noticed in the control group. Cortisol values in the yoga group decreased by 19.9% from 321.0 ± 189.6 ng/mL to 257.1 ± 133.8 ng/mL; in the control group it increased by 2.8% from 241.2 ± 51.8 ng/mL to 247.8 ± 90.9 ng/mL.

CONCLUSIONS

It could be concluded from the present study that following 10 months yoga practice may be useful for better resilience and management of stress-related blood markers for the polar sojourners.

Changes in Cortisol but Not in Brain-Derived Neurotrophic Factor Modulate the Association Between Sleep Disturbances and Major Depression

Sleep disturbance is a symptom consistently found in major depression and is associated with a longer course of illness, reduced response to treatment, increased risk of relapse and recurrence. Chronic insomnia has been associated with changes in cortisol and serum brain-derived neurotrophic factor (BDNF) levels, which in turn are also changed in major depression. Here, we evaluated the relationship between sleep quality, salivary cortisol awakening response (CAR), and serum BDNF levels in patients with sleep disturbance and treatment-resistant major depression (n = 18), and in a control group of healthy subjects with good (n = 21) and poor (n = 18) sleep quality. We observed that the patients had the lowest CAR and sleep duration of all three groups and a higher latency to sleep than the healthy volunteers with a good sleep profile. Besides, low CAR was correlated with more severe depressive symptoms and worse sleep quality. There was no difference in serum BDNF levels between groups with distinct sleep quality. Taken together, our results showed a relationship between changes in CAR and in sleep quality in patients with treatment-resistant depression, which were correlated with the severity of disease, suggesting that cortisol could be a physiological link between sleep disturbance and major depression.

Analysis of Features Selected by a Deep Learning Model for Differential Treatment Selection in Depression

Background: Deep learning has utility in predicting differential antidepressant treatment response among patients with major depressive disorder, yet there remains a paucity of research describing how to interpret deep learning models in a clinically or etiologically meaningful way. In this paper, we describe methods for analyzing deep learning models of clinical and demographic psychiatric data, using our recent work on a deep learning model of STAR*D and CO-MED remission prediction.

Methods: Our deep learning analysis with STAR*D and CO-MED yielded four models that predicted response to the four treatments used across the two datasets. Here, we use classical statistics and simple data representations to improve interpretability of the features output by our deep learning model and provide finer grained understanding of their clinical and etiological significance. Specifically, we use representations derived from our model to yield features predicting both treatment non-response and differential treatment response to four standard antidepressants, and use linear regression and t-tests to address questions about the contribution of trauma, education, and somatic symptoms to our models.

Results: Traditional statistics were able to probe the input features of our deep learning models, reproducing results from previous research, while providing novel insights into depression causes and treatments. We found that specific features were predictive of treatment response, and were able to break these down by treatment and non-response categories; that specific trauma indices were differentially predictive of baseline depression severity; that somatic symptoms were significantly different between males and females, and that education and low income proved important psycho-social stressors associated with depression.

Conclusion: Traditional statistics can augment interpretation of deep learning models. Such interpretation can lend us new hypotheses about depression and contribute to building causal models of etiology and prognosis. We discuss dataset-specific effects and ideal clinical samples for machine learning analysis aimed at improving tools to assist in optimizing treatment.

Effects of lithium and valproate on behavioral parameters and neurotrophic factor levels in an animal model of mania induced by paradoxical sleep deprivation

The present study aimed to evaluate the effects of treatment with lithium (Li) and valproate (VPA) on behaviors and brain BDNF, NGF, NT-3, NT-4 and GDNF levels in mice submitted to paradoxical sleep deprivation (PSD), which induces an animal model of mania. Male C57BL/6J mice received an intraperitoneal (i.p.) injection of saline solution (NaCl 0.09%, 1 ml/kg), Li (47.3 mg/kg, 1 ml/kg) or VPA (200 mg/kg, 1 ml/kg) once a day for seven days. Animals were randomly distributed into six groups (n = 10 per group): (1) Control + Sal; (2) Control + Li; (3) Control + VPA; (4) PSD + Sal; (5) PSD + Li; or (6) PSD + VPA. Animals were submitted to 36 h of PSD, and then, they were submitted to the open field test. The frontal cortex and hippocampus were dissected from the brain. The manic-like behaviors in the mice were analyzed. Treatment with Li and VPA reversed the behavioral alterations induced by PSD. PSD decreased BDNF, NGF, and GDNF levels in the frontal cortex and hippocampus of mice. The administration of Li and VPA protected the brain against the damage induced by PSD. However, PSD and the administration of Li and VPA did not affect the levels of NT-3 and NT-4 in either brain structure evaluated. In conclusion, the PSD protocol induced manic-like behavior in rats and induced alterations in neurotrophic factor levels. It seems that neurotrophic factors and sleep are essential targets to treat BD.

The Brain-Derived Neurotrophic Factor: Missing Link Between Sleep Deprivation, Insomnia, and Depression

The brain-derived neurotrophic factor (BDNF) mediates the plasticity-related changes that associate with memory processing during sleep. Sleep deprivation and chronic stress are associated with propensity to depression, anxiety, and insomnia. We propose a model by which explain alterations in the CNS and serum expression of BDNF associated with chronic sleep deprivation, depression, and insomnia. Mild sleep deprivation activates the cerebral cortex and brainstem to generate the physiologic drive for non-rapid eye movement (NREM) and rapid eye movement (REM) sleep drive respectively, associated with BDNF upregulation in these regions. This physiological response loses effectiveness with longer episodes or during chronic of total or selective REM sleep loss, which are associated with impaired hippocampal BDNF expression, impaired memory and cognition. Chronic sleep deprivation and insomnia can act as an external stressors and result in depression, characterized by hippocampal BDNF downregulation along with disrupted frontal cortical BDNF expression, as well as reduced levels and impaired diurnal alterations in serum BDNF expression. Acute REM sleep deprivation breaks the cycle by restoration of hippocampal, and possibly restoration of cortical and serum expression of BDNF. The BDNF Val66Met polymorphism alters susceptibility to depression, anxiety, and insomnia by altering availability and expression of BDNF in brain and blood. The proposed model is testable and implies that low levels and low variability in serum BDNF are associated with poor response to anti-depressive medications, electroconvulsive therapy, and REM sleep deprivation, in patients with depression. Our mode is also backed up by the existing clinical evidence but is yet to be investigated.

Dose-Response Matters! - A Perspective on the Exercise Prescription in Exercise-Cognition Research

In general, it is well recognized that both acute physical exercises and regular physical training influence brain plasticity and cognitive functions positively. However, growing evidence shows that the same physical exercises induce very heterogeneous outcomes across individuals. In an attempt to better understand this interindividual heterogeneity in response to acute and regular physical exercising, most research, so far, has focused on non-modifiable factors such as sex and different genotypes, while relatively little attention has been paid to exercise prescription as a modifiable factor. With an adapted exercise prescription, dosage can be made comparable across individuals, a procedure that is necessary to better understand the dose-response relationship in exercise-cognition research. This improved understanding of dose-response relationships could help to design more efficient physical training approaches against, for instance, cognitive decline.

Plasma and serum brain-derived neurotrophic factor (BDNF) levels and their association with neurocognition in at-risk mental state, first episode psychosis and chronic schizophrenia patients

Objectives: Brain-derived neurotrophic factor (BDNF) is involved in numerous cognitive processes. Since cognitive deficits are a core feature of psychotic disorders, the investigation of BDNF levels in psychosis and their correlation with cognition has received increased attention. However, there are no studies investigating BDNF levels in individuals with an at-risk mental state (ARMS) for psychosis. Hence, the aims of the present study were: (1) assessing peripheral BDNF levels across different (potential) stages of psychosis; (2) investigating their association with cognition.Methods: Plasma and serum BDNF levels and neuropsychological performance were assessed in 16 ARMS, six first-episode psychosis (FEP), and 11 chronic schizophrenia (CS) patients. Neuropsychological assessment covered intelligence, verbal memory, working memory, attention and executive functioning.Results: Both plasma and serum BDNF levels were highest in CS, intermediate in FEP and lowest in ARMS. Multiple regression analysis revealed a significant positive association of plasma BDNF levels with planning ability across all groups.Conclusions: The lower peripheral BDNF levels in ARMS compared to FEP and CS might point towards an important drop of this neurotrophin prior to the onset of frank psychosis. The associations of peripheral BDNF with planning-abilities match previous findings.

Peripheral inflammatory and neurotrophic biomarkers of cognitive impairment in schizophrenia: a meta-analysis

BACKGROUND

Schizophrenia is associated with significant cognitive impairment. However, the pathophysiological mechanisms underlying cognitive dysfunction in schizophrenia remain unclear. Brain-derived neurotrophic factor (BDNF) and C-reactive protein (CRP) are among the most commonly investigated peripheral markers of cognition in schizophrenia.

METHODS

A systematic review in PubMed and Scopus databases was performed until 31 January 2019 to assess the relationship between cognitive impairment, CRP and BDNF levels in schizophrenia. A random-effects meta-analysis was conducted.

RESULTS

Current meta-analysis included 21 studies including 2449 patients with schizophrenia-spectrum disorders. Overall, both BDNF [r = 0.12, confidence interval (CI) 0.04-0.19] and CRP (r = -0.13, CI 0.08-0.18) levels were very modestly but significantly related to cognitive functioning in schizophrenia (r = 0.12, CI 0.04-0.19). In meta-analyses of cognitive domains, BDNF levels were significantly associated with verbal memory (r = 0.16, CI 0.09-0.23), working memory (r = 0.14, CI 0.06-0.22), processing speed (r = 0.18, CI 0.10-0.26) and verbal fluency (r = 0.09, CI 0-0.18) performances. Elevated CRP levels were related to all cognitive domains (r = -0.09 to -0.13) except for fluency. Subgroup analyses suggested that the relationship between cognitive and BDNF levels were more pronounced in chronic samples.

CONCLUSIONS

Current findings suggest that cognitive impairment in schizophrenia is significantly related to elevated CRP and reduced BDNF levels in schizophrenia, particularly in chronic samples. However, small effect sizes of these correlations suggest that inflammation and decreased BDNF levels do not play a major role in cognitive dysfunction in most patients with schizophrenia. Further studies are needed to investigate the potential intermediating and confounding factors which can influence the level of relationship between inflammation, neurotrophic factors and cognition in schizophrenia.