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Bozzay ML, Joyce HE, Jiang L, De Vito AN, Emrani S, Browne J, Bayer TA, Quinn MJ, Primack JM, Kelso CM, Wu WC, Rudolph JL, McGeary JE, Kunicki ZJ. Time to Dementia Diagnosis Among Veterans with Comorbid Insomnia and Depressive Episodes. J Alzheimers Dis 2024:JAD240080. [PMID: 38995783 DOI: 10.3233/jad-240080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Background Older adults with heart failure are at elevated risk of Alzheimer's disease and related dementias (AD/ADRD). Research suggests that insomnia and depressive episodes contribute somewhat dissociable impacts on risk for AD/ADRD in this patient population, although the temporal ordering of effects is unknown. Objective This study examined time to dementia diagnosis among patients with comorbid insomnia and/or depressive episodes in an epidemiological sample. Methods Secondary data analyses were conducted using a cohort study of 203,819 Veterans with a primary admission diagnosis of heart failure in 129 VA Medical Centers. Results Patients with diagnoses of both insomnia and depressive episodes had the shortest time to a dementia diagnosis at both 1-year (Hazard ratio = 1.43, 95% CI [1.36, 1.51]) and 3-year follow-up time points (Hazard ratio = 1.40, 95% CI [1.34, 1.47]) versus patients with one or neither comorbidity. Conclusions Individuals with both comorbidities had the shortest time to dementia onset. Screening for these comorbidities may help to identify patients at elevated risk of dementia who could benefit from enhanced monitoring or early intervention strategies for more rapid detection and management of dementia symptoms.
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Affiliation(s)
- Melanie L Bozzay
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Lan Jiang
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - Alyssa N De Vito
- Butler Hospital, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sheina Emrani
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Julia Browne
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Bayer
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - McKenzie J Quinn
- VA RR& D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
| | - Jennifer M Primack
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- VA RR& D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington, DC, USA
| | - Wen-Chih Wu
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - James L Rudolph
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - John E McGeary
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Zachary J Kunicki
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Tan X, Åkerstedt T, Lagerros YT, Åkerstedt AM, Bellocco R, Adami HO, Ye W, Pei JJ, Wang HX. Interactive association between insomnia symptoms and sleep duration for the risk of dementia-a prospective study in the Swedish National March Cohort. Age Ageing 2023; 52:afad163. [PMID: 37676841 PMCID: PMC10484328 DOI: 10.1093/ageing/afad163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Given the importance of sleep in maintaining neurocognitive health, both sleep duration and quality might be component causes of dementia. However, the possible role of insomnia symptoms as risk factors for dementia remain uncertain. METHODS We prospectively studied 22,078 participants in the Swedish National March Cohort who were free from dementia and stroke at baseline. Occurrence of dementia was documented by national registers during a median follow-up period of 19.2 years. Insomnia symptoms and sleep duration were ascertained by Karolinska Sleep Questionnaire. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Compared to participants without insomnia at baseline, those who reported any insomnia symptom experienced a greater incidence of dementia during follow-up (HR 1.08, 95% CI: 1.03, 1.35). Difficulty initiating sleep versus non-insomnia (HR 1.24, 95% CI: 1.02, 1.52), but not difficulty maintaining sleep or early morning awakening was associated with an increased risk of dementia. Short sleep duration was associated with increased risk of dementia (6 h vs. 8 h, HR 1.29, 95% CI: 1.11-1.51; 5 h vs. 8 h, HR 1.26, 95% CI: 1.00-1.57). Stratified analyses suggested that insomnia symptoms increased the risk of dementia only amongst participants with ≥7 h sleep (vs. non-insomnia HR 1.24, 95% CI: 1.00-1.54, P = 0.05), but not amongst short sleepers (<7 h). Short sleep duration also did not further inflate the risk of dementia amongst insomniacs. CONCLUSION Insomnia and short sleep duration increase the risk of dementia amongst middle-aged to older adults.
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Affiliation(s)
- Xiao Tan
- Department of Big Data in Health Science, Zhejiang University School of Public Health and Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Anna Miley Åkerstedt
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jin-Jing Pei
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Hui-Xin Wang
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
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Zaheed AB, Chervin RD, Spira AP, Zahodne LB. Mental and physical health pathways linking insomnia symptoms to cognitive performance 14 years later. Sleep 2023; 46:zsac262. [PMID: 36309871 PMCID: PMC9995792 DOI: 10.1093/sleep/zsac262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/27/2022] [Indexed: 12/04/2022] Open
Abstract
STUDY OBJECTIVES Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender. METHODS Participants included 2595 adults ages 51-88 at baseline (Mage=64.00 ± 6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, night time awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographic and global cognition. RESULTS Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06 ≤ β ≤ -0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3%-19.5% of these associations and vascular disease explained 6.3%-14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender. CONCLUSIONS Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.
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Affiliation(s)
- Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD 21205, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
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Circadian disruption and sleep disorders in neurodegeneration. Transl Neurodegener 2023; 12:8. [PMID: 36782262 PMCID: PMC9926748 DOI: 10.1186/s40035-023-00340-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Disruptions of circadian rhythms and sleep cycles are common among neurodegenerative diseases and can occur at multiple levels. Accumulating evidence reveals a bidirectional relationship between disruptions of circadian rhythms and sleep cycles and neurodegenerative diseases. Circadian disruption and sleep disorders aggravate neurodegeneration and neurodegenerative diseases can in turn disrupt circadian rhythms and sleep. Importantly, circadian disruption and various sleep disorders can increase the risk of neurodegenerative diseases. Thus, harnessing the circadian biology findings from preclinical and translational research in neurodegenerative diseases is of importance for reducing risk of neurodegeneration and improving symptoms and quality of life of individuals with neurodegenerative disorders via approaches that normalize circadian in the context of precision medicine. In this review, we discuss the implications of circadian disruption and sleep disorders in neurodegenerative diseases by summarizing evidence from both human and animal studies, focusing on the bidirectional links of sleep and circadian rhythms with prevalent forms of neurodegeneration. These findings provide valuable insights into the pathogenesis of neurodegenerative diseases and suggest a promising role of circadian-based interventions.
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Calderón-Garcidueñas L, Kulesza R, Greenough GP, García-Rojas E, Revueltas-Ficachi P, Rico-Villanueva A, Flores-Vázquez JO, Brito-Aguilar R, Ramírez-Sánchez S, Vacaseydel-Aceves N, Cortes-Flores AP, Mansour Y, Torres-Jardón R, Villarreal-Ríos R, Koseoglu E, Stommel EW, Mukherjee PS. Fall Risk, Sleep Behavior, and Sleep-Related Movement Disorders in Young Urbanites Exposed to Air Pollution. J Alzheimers Dis 2023; 91:847-862. [PMID: 36502327 DOI: 10.3233/jad-220850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quadruple aberrant hyperphosphorylated tau, amyloid-β, α-synuclein, and TDP-43 pathology had been documented in 202/203 forensic autopsies in Metropolitan Mexico City ≤40-year-olds with high exposures to ultrafine particulate matter and engineered nanoparticles. Cognition deficits, gait, equilibrium abnormalities, and MRI frontal, temporal, caudate, and cerebellar atrophy are documented in young adults. OBJECTIVE This study aimed to identify an association between falls, probable Rapid Eye Movement Sleep Behavior Disorder (pRBD), restless leg syndrome (RLS), and insomnia in 2,466 Mexican, college-educated volunteers (32.5±12.4 years). METHODS The anonymous, online study applied the pRBD and RLS Single-Questions and self-reported night-time sleep duration, excessive daytime sleepiness, insomnia, and falls. RESULTS Fall risk was strongly associated with pRBD and RLS. Subjects who fell at least once in the last year have an OR = 1.8137 [1.5352, 2.1426] of answering yes to pRBD and/or RLS questions, documented in 29% and 24% of volunteers, respectively. Subjects fell mostly outdoors (12:01 pm to 6:00 pm), 43% complained of early wake up hours, and 35% complained of sleep onset insomnia (EOI). EOI individuals have an OR of 2.5971 [2.1408, 3.1506] of answering yes to the RLS question. CONCLUSION There is a robust association between falls, pRBD, and RLS, strongly suggesting misfolded proteinopathies involving critical brainstem arousal and motor hubs might play a crucial role. Nanoparticles are likely a significant risk for falls, sleep disorders, insomnia, and neurodegenerative lethal diseases, thus characterizing air particulate pollutants' chemical composition, emission sources, and cumulative exposure concentrations are strongly recommended.
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Affiliation(s)
| | - Randy Kulesza
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Glen P Greenough
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover NH, USA
| | | | | | | | | | | | | | | | | | - Yusra Mansour
- Department of Otolaryngology -Head and Neck Surgery, Henry Ford Macomb Hospital, Clinton Township, MI, USA
| | - Ricardo Torres-Jardón
- Instituto de Ciencias de la Atmósfera y Cambio Climático, Universidad Nacional, Autónoma de México, México
| | | | - Emel Koseoglu
- Neurology Department, Erciyes University, Kayseri, Turkey
| | - Elijah W Stommel
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover NH, USA
| | - Partha S Mukherjee
- Interdisciplinary Statistical Research Unit, Indian Statistical Institute, Kolkata, India
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Ferini‐Strambi L. Sleep disorders and increased risk of dementia. Eur J Neurol 2022; 29:3484-3485. [PMID: 36094745 PMCID: PMC9826356 DOI: 10.1111/ene.15562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023]
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