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Haghayegh S, Gao C, Sugg E, Zheng X, Yang HW, Saxena R, Rutter MK, Weedon M, Ibanez A, Bennett DA, Li P, Gao L, Hu K. Association of Rest-Activity Rhythm and Risk of Developing Dementia or Mild Cognitive Impairment in the Middle-Aged and Older Population: Prospective Cohort Study. JMIR Public Health Surveill 2024; 10:e55211. [PMID: 38713911 PMCID: PMC11109857 DOI: 10.2196/55211] [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: 12/11/2023] [Revised: 02/21/2024] [Accepted: 03/16/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND The relationship between 24-hour rest-activity rhythms (RARs) and risk for dementia or mild cognitive impairment (MCI) remains an area of growing interest. Previous studies were often limited by small sample sizes, short follow-ups, and older participants. More studies are required to fully explore the link between disrupted RARs and dementia or MCI in middle-aged and older adults. OBJECTIVE We leveraged the UK Biobank data to examine how RAR disturbances correlate with the risk of developing dementia and MCI in middle-aged and older adults. METHODS We analyzed the data of 91,517 UK Biobank participants aged between 43 and 79 years. Wrist actigraphy recordings were used to derive nonparametric RAR metrics, including the activity level of the most active 10-hour period (M10) and its midpoint, the activity level of the least active 5-hour period (L5) and its midpoint, relative amplitude (RA) of the 24-hour cycle [RA=(M10-L5)/(M10+L5)], interdaily stability, and intradaily variability, as well as the amplitude and acrophase of 24-hour rhythms (cosinor analysis). We used Cox proportional hazards models to examine the associations between baseline RAR and subsequent incidence of dementia or MCI, adjusting for demographic characteristics, comorbidities, lifestyle factors, shiftwork status, and genetic risk for Alzheimer's disease. RESULTS During the follow-up of up to 7.5 years, 555 participants developed MCI or dementia. The dementia or MCI risk increased for those with lower M10 activity (hazard ratio [HR] 1.28, 95% CI 1.14-1.44, per 1-SD decrease), higher L5 activity (HR 1.15, 95% CI 1.10-1.21, per 1-SD increase), lower RA (HR 1.23, 95% CI 1.16-1.29, per 1-SD decrease), lower amplitude (HR 1.32, 95% CI 1.17-1.49, per 1-SD decrease), and higher intradaily variability (HR 1.14, 95% CI 1.05-1.24, per 1-SD increase) as well as advanced L5 midpoint (HR 0.92, 95% CI 0.85-0.99, per 1-SD advance). These associations were similar in people aged <70 and >70 years, and in non-shift workers, and they were independent of genetic and cardiovascular risk factors. No significant associations were observed for M10 midpoint, interdaily stability, or acrophase. CONCLUSIONS Based on findings from a large sample of middle-to-older adults with objective RAR assessment and almost 8-years of follow-up, we suggest that suppressed and fragmented daily activity rhythms precede the onset of dementia or MCI and may serve as risk biomarkers for preclinical dementia in middle-aged and older adults.
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Affiliation(s)
- Shahab Haghayegh
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute, Cambridge, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Chenlu Gao
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute, Cambridge, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Elizabeth Sugg
- Massachusetts General Hospital, Boston, MA, United States
| | - Xi Zheng
- Brigham and Women's Hospital, Boston, MA, United States
| | - Hui-Wen Yang
- Brigham and Women's Hospital, Boston, MA, United States
| | - Richa Saxena
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute, Cambridge, MA, United States
| | - Martin K Rutter
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | | | | | | | - Peng Li
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute, Cambridge, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Lei Gao
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kun Hu
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute, Cambridge, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
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Wendt A, Bielemann RM, Wehrmeister FC, Ricardo LIC, Müller WDA, Machado AKF, da Cruz MF, Bertoldi AD, Brage S, Ekelund U, Tovo-Rodrigues L, Crochemore-Silva I. Is rest-activity rhythm prospectively associated with all-cause mortality in older people regardless of sleep and physical activity level? The 'Como Vai?' Cohort study. PLoS One 2024; 19:e0298031. [PMID: 38363743 PMCID: PMC10871497 DOI: 10.1371/journal.pone.0298031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE This study aims to test the association of rest-activity rhythm (intradaily variability and interdaily stability) with all-cause mortality in an older adult cohort in Brazil. It also assesses whether the amount of time spent at each intensity level (i.e., physical activity and nocturnal sleep) interferes with this association. METHODS This cohort study started in 2014 with older adults (≥60 years). We investigated deaths from all causes that occurred until April 2017. Rest-activity rhythm variables were obtained using accelerometry at baseline. Intradaily variability indicates higher rhythm fragmentation, while interdaily stability indicates higher rhythm stability. Cox proportional-hazard models were used to test the associations controlling for confounders. RESULTS Among the 1451 older adults interviewed in 2014, 965 presented valid accelerometry data. During the follow-up period, 80 individuals died. After adjusting the analysis for sociodemographic, smoking, morbidity score, and number of medicines, an increase of one standard deviation in interdaily stability decreased 26% the risk of death. The adjustment for total sleep time and inactivity did not change this association. On the other hand, the association was no longer significant after adjusting for overall physical activity and moderate to vigorous physical activity. CONCLUSION Rest-activity rhythm pattern was not associated with mortality when physical activity was considered, possibly because this pattern could be driven by regular exercise. Promoting physical activity remains a relevant strategy to improve population health.
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Affiliation(s)
- Andrea Wendt
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Renata Moraes Bielemann
- Post-Graduation Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- School of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | | | - Luiza I. C. Ricardo
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | - Andréa D. Bertoldi
- Post-Graduation Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Soren Brage
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic diseases, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Inácio Crochemore-Silva
- Post-Graduation Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduation Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
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3
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Yam D, Smagula SF. Open Questions Regarding the Efficacy, Mechanisms, and Moderators of Treatments for Circadian Sleep-Wake Disruption in People With Dementia. Am J Geriatr Psychiatry 2024:S1064-7481(24)00027-7. [PMID: 38331666 DOI: 10.1016/j.jagp.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Dorothy Yam
- Medical Student, School of Medicine, University of Pittsburgh (DY), Pittsburgh, PA
| | - Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh (SFS), Pittsburgh, PA.
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Antonsdottir IM, Low DV, Chen D, Rabinowitz JA, Yue Y, Urbanek J, Wu MN, Zeitzer JM, Rosenberg PB, Friedman LF, Sheikh JI, Yesavage JA, Zipunnikov V, Spira AP. 24 h Rest/Activity Rhythms in Older Adults with Memory Impairment: Associations with Cognitive Performance and Depressive Symptomatology. Adv Biol (Weinh) 2023; 7:e2300138. [PMID: 37423973 DOI: 10.1002/adbi.202300138] [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: 04/07/2023] [Revised: 06/16/2023] [Indexed: 07/11/2023]
Abstract
Little is known about links of circadian rhythm alterations with neuropsychiatric symptoms and cognition in memory impaired older adults. Associations of actigraphic rest/activity rhythms (RAR) with depressive symptoms and cognition are examined using function-on-scalar regression (FOSR). Forty-four older adults with memory impairment (mean: 76.84 ± 8.15 years; 40.9% female) completed 6.37 ± 0.93 days of actigraphy, the Beck depression inventory-II (BDI-II), mini-mental state examination (MMSE) and consortium to establish a registry for Alzheimer's disease (CERAD) delayed word recall. FOSR models with BDI-II, MMSE, or CERAD as individual predictors adjusted for demographics (Models A1-A3) and all three predictors and demographics (Model B). In Model B, higher BDI-II scores are associated with greater activity from 12:00-11:50 a.m., 2:10-5:50 p.m., 8:40-9:40 p.m., 11:20-12:00 a.m., higher CERAD scores with greater activity from 9:20-10:00 p.m., and higher MMSE scores with greater activity from 5:50-10:50 a.m. and 12:40-5:00 p.m. Greater depressive symptomatology is associated with greater activity in midafternoon, evening, and overnight into midday; better delayed recall with greater late evening activity; and higher global cognitive performance with greater morning and afternoon activity (Model B). Time-of-day specific RAR alterations may affect mood and cognitive performance in this population.
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Affiliation(s)
- Inga M Antonsdottir
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, 21224, USA
| | - Dominique V Low
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Diefei Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, 21205, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Yiwei Yue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Jacek Urbanek
- Regeneron Pharmaceuticals Inc., Johns Hopkins University, 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Paul B Rosenberg
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, 21224, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Leah F Friedman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Javaid I Sheikh
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, 24144, Qatar
| | - Jerome A Yesavage
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Adam P Spira
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
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Ishimaru D, Tanaka H, Nagata Y, Ogawa Y, Fukuhara K, Nishikawa T. Aspects of Rest-Activity Rhythms Associated With Behavioral and Psychological Symptoms in Moderate and Severe Dementia: Results of a Cross-sectional Analysis. Alzheimer Dis Assoc Disord 2023; 37:322-327. [PMID: 37824629 DOI: 10.1097/wad.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Disturbances in rest-activity rhythms (RAR) are commonly observed in patients with dementia; however, the influence thereof on behavioral and psychological symptoms of dementia (BPSD) remains unexplored. This study aimed to determine whether there is an association between RAR and BPSD among patients with moderate and severe dementia. METHODS RAR analyses of 64 participants were performed using actigraphy. BPSD was assessed using the Neuropsychiatric Inventory-Nursing Home (NPI-NH) scale, and other clinical variables were assessed by the Mini-Mental State Examination, Cognitive Test for Severe Dementia, and Hyogo Activities of Daily Living Scale. Correlations among RAR, sleep time, and BPSD were analyzed. A stepwise multiple linear regression analysis was conducted to examine the association of RAR and sleep time with BPSD. The demographic variables were also adjusted. Variables were compared between two groups with aberrant and nonaberrant activity peak timing. RESULTS Correlation analysis showed that longer maximum durations of activity and shorter daytime sleep were associated with higher NPI-NH scores. Stepwise multiple linear regression analysis showed that maximum activity duration predicted the NPI-NH score after adjustment for the demographic variables. There was no significant difference in any variables between the groups with aberrant and nonaberrant activity peak timing. CONCLUSION RAR is associated with BPSD in moderate-to-severe dementia, which should be considered with regard to treatment.
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Affiliation(s)
- Daiki Ishimaru
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Department of Medical Technology, Osaka University Hospital
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine
| | - Hiroyuki Tanaka
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
| | - Yuma Nagata
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine
| | - Yasuhiro Ogawa
- Department of Occupational Therapy, Morinomiya University of Medical Sciences, Osaka
| | - Keita Fukuhara
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Division of Clinical Therapeutics, Naragakuen University Graduate School of Rehabilitation Sciences, Nara, Japan
| | - Takashi Nishikawa
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Division of Clinical Therapeutics, Naragakuen University Graduate School of Rehabilitation Sciences, Nara, Japan
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Sauers SC, Toedebusch CD, Richardson R, Spira AP, Morris JC, Holtzman DM, Lucey BP. Chronotype is Associated with Sleep Quality in Older Adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.04.23294997. [PMID: 37732218 PMCID: PMC10508806 DOI: 10.1101/2023.09.04.23294997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Introduction Disrupted sleep is common in individuals with Alzheimer's disease (AD) and may be a marker for AD risk. The timing of sleep or chronotype affects sleep-wake activity and is also associated with AD, but little is known about links between sleep and chronotype in older adults. In this study, we tested if different measures of sleep and chronotype are associated among older adults even after adjusting for multiple potentially confounding variables. Methods Participants (N=243) with a mean age of 74 underwent standardized cognitive assessments, measurement of CSF AD biomarkers, and sleep monitoring via single-channel EEG, actigraphy, and self-reported sleep logs. Chronotype was defined as the midpoint of sleep measured by actigraphy. Results Later mid-point of sleep (i.e., late chronotype) was associated with African American race and greater night-to-night variability in the sleep mid-point. After controlling for age, race, sex, cognitive status, AD biomarkers, and sleep disorders, a later mid-point of sleep was associated with longer rapid eye movement (REM) onset latency, decreased REM sleep time, lower sleep efficiency, increased sleep onset latency, and more awakenings at night. Late chronotype was also associated with increased <2 Hz non-REM slow-wave activity. Conclusions To identify individuals at risk for cognitive impairment before symptoms onset, non-invasive in vivo markers of brain function, such as sleep, are needed to track both future risk of cognitive impairment and response to interventions. Chronotype is a potential modifiable AD risk factor and should also be taken into account when using sleep as a marker for AD risk.
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Affiliation(s)
- Scott C. Sauers
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110
| | | | - Rachel Richardson
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110
| | - Adam P. Spira
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, MD 21205
- The Johns Hopkins Center on Aging and Health, Baltimore, MD 21205
| | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO 63110
| | - David M. Holtzman
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO 63110
- Center on Biological Rhythms and Sleep, Washington University School of Medicine, St Louis, MO 63110
| | - Brendan P. Lucey
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110
- Center on Biological Rhythms and Sleep, Washington University School of Medicine, St Louis, MO 63110
- Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO 63110
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Stahl ST, Skidmore E, Kringle E, Shih M, Baum C, Hammel J, Krafty R, Covassin N, Li J, Smagula SF. Rest-Activity Rhythm Characteristics Associated With Depression Symptoms in Stroke Survivors. Arch Phys Med Rehabil 2023; 104:1203-1208. [PMID: 36736806 PMCID: PMC10802795 DOI: 10.1016/j.apmr.2023.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine which 24-hour rest-activity rhythm (RAR) characteristics are associated with depression symptoms in stroke survivors. DESIGN Cross-sectional observational study examining associations of RAR characteristics with the presence of depression symptoms adjusting for age, sex, race, and medical comorbidity. SETTING Community setting. PARTICIPANTS Stroke survivors: (1) recruited locally (N women=35, N men=28) and (2) a nationally representative probability sample (the National Health and Nutrition Examination Survey [NHANES]; N women=156, N men=124). INTERVENTIONS None. MEASUREMENTS Objective RAR characteristics derived from accelerometer recordings including activity onset/offset times and non-parametric measures of RAR strength (relative amplitude), stability (interdaily stability), and fragmentation (intradaily variability). The presence of depression symptoms was categorized using Patient Health Questionnaire scores. RESULTS In both samples, the only RAR characteristic associated with depression symptoms was intradaily variability (fragmentation): local sample, odds ratio=1.96 [95% confidence interval=1.05-3.63]; NHANES sample, odds ratio=1.34, [95% confidence interval=1.01-1.78]). In the NHANES sample, which included both mild and moderate/severe depression, the association between 24-hour sleep-wake fragmentation and depression symptoms was driven by moderate-to-severe cases. CONCLUSIONS Stroke survivors with higher levels of RAR fragmentation were more likely to have depression symptoms in both samples. These findings have implications, given prior studies in general samples linking RAR fragmentation with future depression and dementia risk. Research is needed to establish the potential consequences, mechanisms, and modifiability of RAR fragmentation in stroke survivors.
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Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emily Kringle
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Minmei Shih
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carolyn Baum
- Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO
| | - Joy Hammel
- Department of Occupational Therapy, College of Allied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Robert Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jingen Li
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Yang PL, Chaytor NS, Burr RL, Kapur VK, McCurry SM, Vitiello MV, Hough CL, Parsons EC. Rest-Activity Rhythm Fragmentation and Weaker Circadian Strength Are Associated With Cognitive Impairment in Survivors of Acute Respiratory Failure. Biol Res Nurs 2023; 25:5-13. [PMID: 35759356 DOI: 10.1177/10998004221109925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Survivors of acute respiratory failure (ARF) experience long-term cognitive impairment and circadian rhythm disturbance after hospital discharge. Although prior studies in aging and neurodegenerative diseases indicate actigraphy-estimated rest-activity circadian rhythm disturbances are risk factors for cognitive impairment, it is unclear if this applies to ARF survivors. This study explored the relationships of actigraphy-estimated rest-activity circadian rhythms with cognitive functioning in ARF survivors at 3 months after discharge. Methods: 13 ARF survivors (mean age 51 years and 69% males) completed actigraphy and sleep diaries for 9 days, followed by at-home neuropsychological assessment. Principal component factor analysis created global cognition and circadian rhythm variables, and these first components were used to examine the global relationships between circadian rhythm and cognitive measure scores. Results: Global circadian function was associated with global cognition function in ARF survivors (r = .70, p = .024) after adjusting for age, education, and premorbid cognition. Also, greater fragmented rest-activity circadian rhythm (estimated by intradaily variability, r = .85, p = .002), and weaker circadian strength (estimated by amplitude, r = .66, p = .039; relative strength, r = .70, p = .024; 24-h lag serial autocorrelation, r = .67, p = .035), were associated with global cognition and individual cognitive tests. Conclusions: These results suggest circadian rhythm disturbance is associated with poorer global cognition in ARF survivors. Future prospective research with larger samples is needed to confirm these results and increase understanding of the relationship between disrupted circadian rhythms and cognitive impairment among ARF survivors.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, 106177National Defense Medical Center, Taipei, Taiwan
| | - Naomi S Chaytor
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, 6760Washington State University, Spokane, WA, USA
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 16181University of Washington, Seattle, WA, USA.,Office of Nursing Research, School of Nursing, 16181University of Washington, Seattle, WA, USA
| | - Vishesh K Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, 205280University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- School of Nursing, 16181University of Washington, Seattle, WA, USA
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, 7284University of Washington, WA, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, 89020Oregon Health and Science University School of Medicine, Portland, USA
| | - Elizabeth C Parsons
- Division of Pulmonary, Critical Care and Sleep Medicine, 205280University of Washington, Seattle, WA, USA.,Pulmonary and Critical Care Section, VA Puget Sound Health Care System, Seattle, WA, USA
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Roh HW, Choi SJ, Jo H, Kim D, Choi JG, Son SJ, Joo EY. Associations of actigraphy derived rest activity patterns and circadian phase with clinical symptoms and polysomnographic parameters in chronic insomnia disorders. Sci Rep 2022; 12:4895. [PMID: 35318367 PMCID: PMC8941088 DOI: 10.1038/s41598-022-08899-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/04/2022] [Indexed: 12/13/2022] Open
Abstract
We explored the associations of actigraphy-derived rest-activity patterns and circadian phase parameters with clinical symptoms and level 1 polysomnography (PSG) results in patients with chronic insomnia to evaluate the clinical implications of actigraphy-derived parameters for PSG interpretation. Seventy-five participants underwent actigraphy assessments and level 1 PSG. Exploratory correlation analyses between parameters derived from actigraphy, PSG, and clinical assessments were performed. First, participants were classified into two groups based on rest-activity pattern variables; group differences were investigated following covariate adjustment. Participants with poorer rest-activity patterns on actigraphy (low inter-day stability and high intra-daily variability) exhibited higher insomnia severity index scores than participants with better rest-activity patterns. No between-group differences in PSG parameters were observed. Second, participants were classified into two groups based on circadian phase variables. Late-phase participants (least active 5-h and most active 10-h onset times) exhibited higher insomnia severity scores, longer sleep and rapid eye movement latency, and lower apnea-hypopnea index than early-phase participants. These associations remained significant even after adjusting for potential covariates. Some actigraphy-derived rest-activity patterns and circadian phase parameters were significantly associated with clinical symptoms and PSG results, suggesting their possible adjunctive role in deriving plans for PSG lights-off time and assessing the possible insomnia pathophysiology.
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Affiliation(s)
- Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Su Jung Choi
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyunjin Jo
- Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dongyeop Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jung-Gu Choi
- Yonsei Graduate Program in Cognitive Science, Yonsei University, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Zhao X, Tang Q, Feng Z, Zhào H. Executive Performance Is Associated With Rest-Activity Rhythm in Nurses Working Rotating Shifts. Front Neurosci 2022; 16:805039. [PMID: 35281500 PMCID: PMC8908420 DOI: 10.3389/fnins.2022.805039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/20/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Rest-activity rhythms (RAR) is one of the most fundamental biological patterns that influence basic physical and mental health, as well as working performance. Nowadays, with the utilization of actigraphy device in detecting and analyzing RAR objectively, evidence has confirmed that RAR could be interrupted by shift work. Nurses need to participate shift work in their daily routine. The aim of the present study is to identify the RAR of nurses working rotating shifts and find out the relationship between RAR and executive function. Methods A total of 11 female nurses on day-shift (DS), 11 female nurses on rotating-shift (RS) were recruited. Demographic features, non-parametric variables of RAR as well as sleep variables according to actigraphy data, and a series of cognitive function evaluations during work time were collected. Results The Student’s t-test comparison revealed that RS group nurses showed significant shorter total sleep time (TST), lower level of interdaily stability (IS) and relative amplitude (RA), as well as poorer executive performance compared with DS nurses. The linear regression analysis demonstrated that several aspects of executive performance such as choice reaction test (CRT) (reflecting attention and concentration) and trail making test (TMT) -B (reflecting cognitive flexibility) were associated with IS in RS group nurses. Conclusion These results elucidated that RAR was disrupted for nurses working rotating shifts, and executive performance was associated with IS from day to day in nurses working rotating shifts.
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Affiliation(s)
- Xiuli Zhao
- Department of Neurology, NO 984 Hospital of PLA, Beijing, China
| | - Quan Tang
- Department of Medical Psychology, NO 984 Hospital of PLA, Beijing, China
- Department of Medical Psychology, Army Medical University, Chongqing, China
| | - Zhengzhi Feng
- Department of Medical Psychology, Army Medical University, Chongqing, China
- *Correspondence: Zhengzhi Feng,
| | - Hóngyi Zhào
- Department of Psychiatry, NO 984 Hospital of PLA, Beijing, China
- Hóngyi Zhào,
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11
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Moderie C, Carrier J, Dang-Vu TT. [Sleep disorders in patients with a neurocognitive disorder]. Encephale 2021; 48:325-334. [PMID: 34916075 DOI: 10.1016/j.encep.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sleep disorders are prevalent in patients with a neurocognitive disorder, and diagnosis and treatment in these patients remain challenging in clinical practice. METHODS This narrative review offers a systematic approach to diagnose and treat sleep disorders in neurocognitive disorders. RESULTS Alzheimer's disease is often associated with circadian rhythm disorders, chronic insomnia, and sleep apnea-hypopnea syndrome. Alpha-synucleinopathies (e.g., Parkinson's disease and Lewy body dementia) are often associated with a rapid eye movement sleep behavior disorder, restless legs syndrome, chronic insomnia, and sleep apnea-hypopnea syndrome. A focused history allows to diagnose most sleep disorders. Clinicians should ensure to gather the following information in all patients with a neurocognitive disorder: (1) the presence of difficulties falling asleep or staying asleep, (2) the impact of sleep disturbances on daily functioning (fatigue, sleepiness and other daytime consequences), and (3) abnormal movements in sleep. Sleep diaries and questionnaires can assist clinicians in screening for specific sleep disorders. Polysomnography is recommended if a rapid eye movement sleep behavior disorder or a sleep apnea-hypopnea syndrome are suspected. Sleep complaints should prompt clinicians to ensure that comorbidities interfering with sleep are properly managed. The main treatment for moderate to severe obstructive sleep apnea-hypopnea syndrome remains continuous positive airway pressure, as its efficacy has been demonstrated in patients with neurocognitive disorders. Medications should also be reviewed, and time of administration should be optimized (diuretics and stimulating medications in the morning, sedating medications in the evening). Importantly, cholinesterase inhibitors (especially donepezil) may trigger insomnia. Switching to morning dosing or to an alternative drug may help. Cognitive-behavioral therapy for insomnia is indicated to treat chronic insomnia in neurocognitive disorders. False beliefs regarding sleep should be addressed with the patient and their caregiver. The sleep environment should be optimized (decrease light exposure at night, minimize noise, avoid taking vital signs, etc.). Sleep restriction can be considered as patients with a neurocognitive disorder often spend too much time in bed. The need for naps should be assessed case by case as naps may contribute to insomnia in some patients but allow others to complete their diurnal activities. Trazodone (50mg) may also be used under certain circumstances in chronic insomnia. Recent evidence does not support a role for exogenous melatonin in patients with a neucognitive disorder and insomnia. Patients in long-term care facilities are often deprived of an adequate diurnal exposure to light. Increasing daytime exposure to light may improve sleep and mood. Patients with circadian rhythm disorders can also benefit from light therapy (morning bright light therapy in case of phase delay and evening bright light therapy in case of phase advance). Rapid eye movement sleep behavior disorder can lead to violent behaviors, and the sleeping environment should be secured (e.g., mattress on the floor, remove surrounding objects). Medication exacerbating this disorder should be stopped if possible. High dose melatonin (6 to 18mg) or low dose clonazepam (0.125-0.25mg) at bedtime may be used to reduce symptoms. Melatonin is preferred in first-line as it is generally well tolerated with few side effects. Patients with restless legs syndrome should be investigated for iron deficiency. Medication decreasing dopaminergic activity should be reduced or stopped if possible. Behavioral strategies such as exercise and leg massages may be beneficial. Low-dose dopamine agonists (such as pramipexole 0.125mg two hours before bedtime) can be used to treat the condition, but a prolonged treatment may paradoxically worsen the symptoms. Alpha-2-delta calcium channel ligands can also be used while monitoring for the risk of falls. CONCLUSION Multiple and sustained nonpharmacological approaches are recommended for the treatment of sleep disturbances in patients with neurocognitive disorder. Pharmacological indications remain limited, and further randomized clinical trials integrating a multimodal approach are warranted to evaluate the treatment of sleep disorders in specific neurocognitive disorders.
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Affiliation(s)
- C Moderie
- Département de psychiatrie, université McGill, Montréal, Québec, Canada
| | - J Carrier
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; Département de psychologie, université de Montréal, Montréal, Québec, Canada; Centre d'études avancées en médecine du sommeil, Montréal, Québec, Canada
| | - T T Dang-Vu
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; Département de psychologie, université de Montréal, Montréal, Québec, Canada; Département de santé, kinésiologie et physiologie appliquée, centre d'études en neurobiologie comportementale et centre PERFORM, université Concordia, Montréal, Québec, Canada.
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12
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Xiao Q, Sampson JN, LaCroix AZ, Shadyab AH, Zeitzer JM, Ancoli-Israel S, Yaffe K, Stone K. Nonparametric parameters of 24-hour rest-activity rhythms and long-term cognitive decline and incident cognitive impairment in older men. J Gerontol A Biol Sci Med Sci 2021; 77:250-258. [PMID: 34558603 DOI: 10.1093/gerona/glab275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
Altered 24-hour rest-activity rhythms may be associated with cognitive impairment in older adults, but evidence from prospective studies is limited. Non-parametric methods were used to assess actigraphy-based activity patterns in 2,496 older men. Incident cognitive impairment was assessed four times over 12 years using the Modified Mini Mental State Examination (3MS) and Trails B tests, self-reported medication use, and clinical diagnosis. The highest quartile (vs. the lowest) of intradaily variability and the lowest quartiles (vs. the highest) of interdaily stability and relative amplitude were associated with incident cognitive impairment ((Hazard ratio (95% confidence interval): 1.82 (1.31, 2.53)), 1.36 (0.99, 1.86), and 1.85 (1.33, 2.56), respectively). A larger increase in intradaily variability over 7.5 years was associated with a greater subsequent decline in 3MS scores but not in Trails B performance. In conclusion, less stable and more variable rest-activity rhythms may represent early biomarkers of cognitive impairment in older men.
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Affiliation(s)
- Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Joshua N Sampson
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto CA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, Center for Circadian Biology, University of California, San Diego, La Jolla, CA
| | - Kristin Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
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13
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The Effect of Bright Light Treatment on Rest-Activity Rhythms in People with Dementia: A 24-Week Cluster Randomized Controlled Trial. Clocks Sleep 2021; 3:449-464. [PMID: 34563054 PMCID: PMC8482074 DOI: 10.3390/clockssleep3030032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Bright light treatment is an effective way to influence circadian rhythms in healthy adults, but previous research with dementia patients has yielded mixed results. The present study presents a primary outcome of the DEM.LIGHT trial, a 24-week randomized controlled trial conducted at nursing homes in Bergen, Norway, investigating the effects of a bright light intervention. The intervention consisted of ceiling-mounted LED panels providing varying illuminance and correlated color temperature throughout the day, with a peak of 1000 lx, 6000 K between 10 a.m. and 3 p.m. Activity was recorded using actigraphs at baseline and after 8, 16, and 24 weeks. Non-parametric indicators and extended cosine models were used to investigate rest-activity rhythms, and outcomes were analyzed with multi-level regression models. Sixty-one patients with severe dementia (median MMSE = 4) were included. After 16 weeks, the acrophase was advanced from baseline in the intervention group compared to the control group (B = -1.02, 95%; CI = -2.00, -0.05). There was no significant difference between the groups on any other rest-activity measures. When comparing parametric and non-parametric indicators of rest-activity rhythms, 25 out of 35 comparisons were significantly correlated. The present results indicate that ambient bright light treatment did not improve rest-activity rhythms for people with dementia.
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14
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Hodgson NA, Gooneratne N, Perez A, Talwar S, Huang L. A timed activity protocol to address sleep-wake disorders in home dwelling persons living with dementia: the healthy patterns clinical trial. BMC Geriatr 2021; 21:451. [PMID: 34344312 PMCID: PMC8336239 DOI: 10.1186/s12877-021-02397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/21/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sleep-wake disorders occur in most persons living with dementia and include late afternoon or evening agitation, irregular sleep-wake rhythms such as daytime hypersomnia, frequent night awakenings, and poor sleep efficiency. Sleep-wake disorders pose a great burden to family caregivers, and are the principal causes of distress, poor quality of life, and institutionalization. Regulating the sleep-wake cycle through the use of light and activity has been shown to alter core clock processes and suggests that a combination of cognitive, physical, and sensory-based activities, delivered at strategic times, may be an effective mechanism through which to reduce sleep-wake disorders. METHODS A definitive Phase III efficacy trial of the Healthy Patterns intervention, a home-based activity intervention designed to improve sleep-wake disorders and quality of life, is being conducted using a randomized two-group parallel design of 200 people living with dementia and their caregivers (dyads). Specific components of this one-month, home-based intervention involve 4 in-home visits and includes: 1) assessing individuals' functional status and interests; 2) educating caregivers on environmental cues to promote activity and sleep; and 3) training caregivers in using timed morning, afternoon, and evening activities based on circadian needs across the day. The patient focused outcomes of interest are quality of life, measures of sleep assessed by objective and subjective indicators including actigraphy, subjective sleep quality, and the presence of neuropsychiatric symptoms. Caregiver outcomes of interest are quality of life, burden, confidence using activities, and sleep disruption. Salivary measures of cortisol and melatonin are collected to assess potential intervention mechanisms. DISCUSSION The results from the ongoing study will provide fundamental new knowledge regarding the effects of timing activity participation based on diurnal needs and the mechanisms underlying timed interventions which can lead to a structured, replicable treatment protocol for use with this growing population of persons living with dementia. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov # NCT03682185 at https://clinicaltrials.gov/ ; Date of clinical trial registration: 24 September 2018.
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Affiliation(s)
- Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Fagin Hall, Curie Blvd, Philadelphia, PA, 19102, USA.
| | - Nalaka Gooneratne
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adriana Perez
- School of Nursing, University of Pennsylvania, Fagin Hall, Curie Blvd, Philadelphia, PA, 19102, USA
| | - Sonia Talwar
- School of Nursing, University of Pennsylvania, Fagin Hall, Curie Blvd, Philadelphia, PA, 19102, USA
| | - Liming Huang
- School of Nursing, University of Pennsylvania, Fagin Hall, Curie Blvd, Philadelphia, PA, 19102, USA
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15
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Suibkitwanchai K, Sykulski AM, Perez Algorta G, Waller D, Walshe C. Nonparametric time series summary statistics for high-frequency accelerometry data from individuals with advanced dementia. PLoS One 2020; 15:e0239368. [PMID: 32976498 PMCID: PMC7518630 DOI: 10.1371/journal.pone.0239368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022] Open
Abstract
Accelerometry data has been widely used to measure activity and the circadian rhythm of individuals across the health sciences, in particular with people with advanced dementia. Modern accelerometers can record continuous observations on a single individual for several days at a sampling frequency of the order of one hertz. Such rich and lengthy data sets provide new opportunities for statistical insight, but also pose challenges in selecting from a wide range of possible summary statistics, and how the calculation of such statistics should be optimally tuned and implemented. In this paper, we build on existing approaches, as well as propose new summary statistics, and detail how these should be implemented with high frequency accelerometry data. We test and validate our methods on an observed data set from 26 recordings from individuals with advanced dementia and 14 recordings from individuals without dementia. We study four metrics: Interdaily stability (IS), intradaily variability (IV), the scaling exponent from detrended fluctuation analysis (DFA), and a novel nonparametric estimator which we call the proportion of variance (PoV), which calculates the strength of the circadian rhythm using spectral density estimation. We perform a detailed analysis indicating how the time series should be optimally subsampled to calculate IV, and recommend a subsampling rate of approximately 5 minutes for the dataset that has been studied. In addition, we propose the use of the DFA scaling exponent separately for daytime and nighttime, to further separate effects between individuals. We compare the relationships between all these methods and show that they effectively capture different features of the time series.
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Affiliation(s)
- Keerati Suibkitwanchai
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
- * E-mail:
| | - Adam M. Sykulski
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Daniel Waller
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
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16
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Roh HW, Choi JG, Kim NR, Choe YS, Choi JW, Cho SM, Seo SW, Park B, Hong CH, Yoon D, Son SJ, Kim EY. Associations of rest-activity patterns with amyloid burden, medial temporal lobe atrophy, and cognitive impairment. EBioMedicine 2020; 58:102881. [PMID: 32736306 PMCID: PMC7394758 DOI: 10.1016/j.ebiom.2020.102881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We sought to investigate the possible associations of rest-activity patterns with cortical amyloid burden, medial temporal lobe (MTL) neurodegeneration, and cognitive function in patients in the early stage of cognitive impairment. METHODS Rest-activity patterns were assessed in 100 participants (70 with mild cognitive impairment and 30 with mild dementia) using wrist actigraphy. All participants underwent 18F-flutemetamol positron emission tomography (PET) imaging to quantify cortical amyloid burden, structural brain magnetic resonance imaging (MRI) to quantify MTL grey matter volume, neuropsychological testing, and clinical diagnosis. We used multiple linear regression models adjusted for covariates, including demographics, diabetes, hypertension, depressive symptom, psychotropic medication, sleep medication, weekend effect, and apolipoprotein-ε allele status. FINDINGS After adjusting for possible confounders, we found that the midline estimation of statistic of rhythm (MESOR) associated positively with frontal/executive function (estimate = 1.17, standard error [SE] = 0.37, p = 0.002). The least active 5-h (L5) onset time associated positively with MTL grey matter volume and memory function (estimate = 1.24, SE = 0.33, p = 0.001, and estimate = 3.77, SE = 1.22, p = 0.003, respectively), particularly in amyloid-negative participants. Additional path analysis revealed that MTL grey matter volume partially mediated the association between L5 onset time and memory function in amyloid-negative participants. INTERPRETATION Decreased MESOR and advanced L5 onset time may be useful as early signs of cognitive decline or MTL neurodegeneration. Furthermore, amyloid pathology may act as a moderator of the relationships between rest-activity patterns, neurodegeneration, and cognitive function. FUNDING Korea Centres for Disease Control and Prevention (#4845-303); National Research Foundation of Korea (2019M3C7A1031905, 2019R1A5A2026045).
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Affiliation(s)
- Hyun Woong Roh
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea; Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Jung-Gu Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Na-Rae Kim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yeong Sim Choe
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sun-Mi Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea; Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Eun Young Kim
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea; Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea.
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Smyk MK, van Luijtelaar G. Circadian Rhythms and Epilepsy: A Suitable Case for Absence Epilepsy. Front Neurol 2020; 11:245. [PMID: 32411068 PMCID: PMC7198737 DOI: 10.3389/fneur.2020.00245] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Many physiological processes such as sleep, hormonal secretion, or thermoregulation, are expressed as daily rhythms orchestrated by the circadian timing system. A powerful internal clock mechanism ensures proper synchronization of vital functions within an organism on the one hand, and between the organism and the external environment on the other. Some of the pathological processes developing in the brain and body are subjected to circadian modulation as well. Epilepsy is one of the conditions which symptoms often worsen at a very specific time of a day. Variation in peak occurrence depends on the syndrome and localization of the epileptic focus. Moreover, the timing of some types of seizures is closely related to the sleep-wake cycle, one of the most prominent circadian rhythms. This review focuses on childhood absence epilepsy (CAE), a genetic generalized epilepsy syndrome, in which both, the circadian and sleep influences play a significant role in manifestation of symptoms. Human and animal studies report rhythmical occurrence of spike-wave discharges (SWDs), an EEG hallmark of CAE. The endogenous nature of the SWDs rhythm has been confirmed experimentally in a genetic animal model of the disease, rats of the WAG/Rij strain. Well-known detrimental effects of circadian misalignment were demonstrated to impact the severity of ongoing epileptic activity. SWDs are vigilance-dependent in both humans and animal models, occurring most frequently during passive behavioral states and light slow-wave sleep. The relationship with the sleep-wake cycle seems to be bidirectional, while sleep shapes the rhythm of seizures, epileptic phenotype changes sleep architecture. Circadian factors and the sleep-wake states dependency have a potential as add-ons in seizures' forecasting. Stability of the rhythm of recurrent seizures in individual patients has been already used as a variable which refines existing algorithms for seizures' prediction. On the other hand, apart from successful pharmacological approach, circadian hygiene including sufficient sleep and avoidance of internal desynchronization or sleep loss, may be beneficial for patients with epilepsy in everyday management of seizures.
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Affiliation(s)
- Magdalena K Smyk
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Gilles van Luijtelaar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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Abstract
Abstract
Purpose of Review
Circadian rhythms, including 24-h activity rhythms, change with age. Disturbances in these 24-h activity rhythms at older age have also been implied in various diseases. This review evaluates recent findings on 24-h activity rhythms and disease in older adults.
Recent Findings
Growing evidence supports that 24-h activity rhythm disturbances at older age are related to the presence and/or progression of disease. Longitudinal and genetic work even suggests a potential causal contribution of disturbed 24-h activity rhythms to disease development. Interventional studies targeting circadian and 24-h activity rhythms demonstrate that 24-h rhythmicity can be improved, but the effect of improving 24-h rhythmicity on disease risk or progression remains to be shown.
Summary
Increasing evidence suggests that 24-h activity rhythms are involved in age-related diseases. Further studies are needed to assess causality, underlying mechanisms, and the effects of treating disturbed 24-h activity rhythms on age-related disease.
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