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Soh N, Rainey-Smith SR, Doecke JD, Canovas R, Bucks RS, Ree M, Weinborn M. Sleep discrepancy and cognitive function in community-dwelling older adults. J Sleep Res 2024:e14288. [PMID: 39054858 DOI: 10.1111/jsr.14288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
This was the first study to use cluster analysis to characterise sleep discrepancy (the discordance between self-reported and objective sleep) across multiple sleep parameters, in community-dwelling older adults. For sleep efficiency, negative discrepancy (the tendency to self-report worse sleep than objectively-measured) was associated with poorer memory, independent of insomnia severity, depressive symptoms and objective sleep. This suggests a unique role for sleep discrepancy as a possible risk factor for future cognitive decline, and warrants the need for further research.
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Affiliation(s)
- Nadia Soh
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Stephanie R Rainey-Smith
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
- Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute, Nedlands, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - James D Doecke
- Australian E-Health Research Centre, CSIRO, Herston, Queensland, Australia
| | - Rodrigo Canovas
- Australian E-Health Research Centre, CSIRO, Melbourne, Victoria, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Melissa Ree
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
- Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute, Nedlands, Western Australia, Australia
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2
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Valencia-Sanchez S, Davis M, Martensen J, Hoeffer C, Link C, Opp MR. Sleep-wake behavior and responses to sleep deprivation and immune challenge of protein kinase RNA-activated knockout mice. Brain Behav Immun 2024; 121:74-86. [PMID: 39043346 DOI: 10.1016/j.bbi.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 07/25/2024] Open
Abstract
Protein Kinase RNA-activated (PKR) is an enzyme that plays a role in many systemic processes, including modulation of inflammation, and is implicated in neurodegenerative diseases, such as Alzheimer's disease (AD). PKR phosphorylation results in the production of several cytokines involved in the regulation / modulation of sleep, including interleukin-1β, tumor necrosis factor-α and interferon-γ. We hypothesized targeting PKR would alter spontaneous sleep of mice, attenuate responses to sleep deprivation, and inhibit responses to immune challenge. To test these hypotheses, we determined the sleep-wake phenotype of mice lacking PKR (knockout; PKR-/-) during undisturbed baseline conditions; in responses to six hours of sleep deprivation; and after immune challenge with lipopolysaccharide (LPS). Adult male mice (C57BL/6J, n = 7; PKR-/-, n = 7) were surgically instrumented with EEG recording electrodes and an intraperitoneal microchip to record core body temperature. During undisturbed baseline conditions, PKR -/- mice spent more time in non-rapid eye movement sleep (NREMS) and rapid-eye movement sleep (REMS), and less time awake at the beginning of the dark period of the light:dark cycle. Delta power during NREMS, a measure of sleep depth, was less in PKR-/- mice during the dark period, and core body temperatures were lower during the light period. Both mouse strains responded to sleep deprivation with increased NREMS and REMS, although these changes did not differ substantively between strains. The initial increase in delta power during NREMS after sleep deprivation was greater in PKR-/- mice, suggesting a faster buildup of sleep pressure with prolonged waking. Immune challenge with LPS increased NREMS and inhibited REMS to the same extent in both mouse strains, whereas the initial LPS-induced suppression of delta power during NREMS was greater in PKR-/- mice. Because sleep regulatory and immune responsive systems in brain are redundant and overlapping, other mediators and signaling pathways in addition to PKR are involved in the responses to acute sleep deprivation and LPS immune challenge.
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Affiliation(s)
- S Valencia-Sanchez
- Department of Integrative Physiology, University of Colorado Boulder, USA
| | - M Davis
- Department of Integrative Physiology, University of Colorado Boulder, USA
| | - J Martensen
- Department of Integrative Physiology, University of Colorado Boulder, USA
| | - C Hoeffer
- Institute for Behavioral Genetics, University of Colorado Boulder, USA
| | - C Link
- Department of Integrative Physiology, University of Colorado Boulder, USA
| | - M R Opp
- Department of Integrative Physiology, University of Colorado Boulder, USA.
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3
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Basta M, Bouloukaki I, Skourti E, Zampetakis A, Alexopoulou C, Ganiaris A, Aligizaki M, Zaganas I, Simos ‘P, Vgontzas A. Long Objective Sleep Duration is a Marker of Cognitive Impairment in Older Adults: Findings from the Cretan Aging Cohort. J Alzheimers Dis Rep 2024; 8:927-934. [PMID: 38910938 PMCID: PMC11191628 DOI: 10.3233/adr-230203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/23/2024] [Indexed: 06/25/2024] Open
Abstract
We examined associations between objective sleep duration and cognitive status in older adults initially categorized as cognitively non-impaired (CNI, n = 57) or diagnosed with mild cognitive impairment (MCI, n = 53). On follow-up, 8 years later, all participants underwent neuropsychiatric/neuropsychological evaluation and 7-day 24-h actigraphy. On re-assessment 62.7% of participants were cognitively declined. Patients who developed dementia had significantly longer night total sleep time (TST) than persons with MCI who, in turn, had longer night TST than CNI participants. Objective long sleep duration is a marker of worse cognitive status in elderly with MCI/dementia and this association is very strong in older adults.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Greece
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, USA
- Day Care Center for Alzheimer’s Disease PAGNH “Nefeli”, University Hospital of Heraklion, Heraklion, Greece
| | - Izolde Bouloukaki
- Department of Social and Family Medicine, University of Crete, Heraklion, Greece
| | - Eleni Skourti
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Greece
| | | | - Christina Alexopoulou
- Department of Intensive Care Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Andronikos Ganiaris
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Greece
| | - Marina Aligizaki
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Greece
| | - Ioannis Zaganas
- Department of Neurology, University Hospital of Heraklion, Heraklion, Greece
| | - ‘Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Greece
| | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Greece
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, USA
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4
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Sun H, Adra N, Ayub MA, Ganglberger W, Ye E, Fernandes M, Paixao L, Fan Z, Gupta A, Ghanta M, Moura Junior VF, Rosand J, Westover MB, Thomas RJ. Assessing Risk of Health Outcomes From Brain Activity in Sleep: A Retrospective Cohort Study. Neurol Clin Pract 2024; 14:e200225. [PMID: 38173542 PMCID: PMC10759032 DOI: 10.1212/cpj.0000000000200225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/04/2023] [Indexed: 01/05/2024]
Abstract
Background and Objectives Patterns of electrical activity in the brain (EEG) during sleep are sensitive to various health conditions even at subclinical stages. The objective of this study was to estimate sleep EEG-predicted incidence of future neurologic, cardiovascular, psychiatric, and mortality outcomes. Methods This is a retrospective cohort study with 2 data sets. The Massachusetts General Hospital (MGH) sleep data set is a clinic-based cohort, used for model development. The Sleep Heart Health Study (SHHS) is a community-based cohort, used as the external validation cohort. Exposure is good, average, or poor sleep defined by quartiles of sleep EEG-predicted risk. The outcomes include ischemic stroke, intracranial hemorrhage, mild cognitive impairment, dementia, atrial fibrillation, myocardial infarction, type 2 diabetes, hypertension, bipolar disorder, depression, and mortality. Diagnoses were based on diagnosis codes, brain imaging reports, medications, cognitive scores, and hospital records. We used the Cox survival model with death as the competing risk. Results There were 8673 participants from MGH and 5650 from SHHS. For all outcomes, the model-predicted 10-year risk was within the 95% confidence interval of the ground truth, indicating good prediction performance. When comparing participants with poor, average, and good sleep, except for atrial fibrillation, all other 10-year risk ratios were significant. The model-predicted 10-year risk ratio closely matched the observed event rate in the external validation cohort. Discussion The incidence of health outcomes can be predicted by brain activity during sleep. The findings strengthen the concept of sleep as an accessible biological window into unfavorable brain and general health outcomes.
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Affiliation(s)
- Haoqi Sun
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Noor Adra
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Muhammad Abubakar Ayub
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Wolfgang Ganglberger
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Elissa Ye
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Marta Fernandes
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Luis Paixao
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ziwei Fan
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Aditya Gupta
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Manohar Ghanta
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Valdery F Moura Junior
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan Rosand
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - M Brandon Westover
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robert J Thomas
- Department of Neurology (HS, NA, MAA, WG, EY, MF, LP, ZF, AG, MG, VFMJ, JR, MBW), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health at Mass General (HS, VFMJ, JR, MBW); Department of Neurology (HS, WG, AG, MG, VFMJ, MBW), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (MAA), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (LP), Washington University School of Medicine in St. Louis, MO; and Division of Pulmonary (RJT), Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Hanert A, Schönfeld R, Weber FD, Nowak A, Döhring J, Philippen S, Granert O, Burgalossi A, Born J, Berg D, Göder R, Häussermann P, Bartsch T. Reduced overnight memory consolidation and associated alterations in sleep spindles and slow oscillations in early Alzheimer's disease. Neurobiol Dis 2024; 190:106378. [PMID: 38103701 DOI: 10.1016/j.nbd.2023.106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
Spatial navigation critically underlies hippocampal-entorhinal circuit function that is early affected in Alzheimer's disease (AD). There is growing evidence that AD pathophysiology dynamically interacts with the sleep/wake cycle impairing hippocampal memory. To elucidate sleep-dependent consolidation in a cohort of symptomatic AD patients (n = 12, 71.25 ± 2.16 years), we tested hippocampal place learning by means of a virtual reality task and verbal memory by a word-pair association task before and after a night of sleep. Our results show an impaired overnight memory retention in AD compared with controls in the verbal task, together with a significant reduction of sleep spindle activity (i.e., lower amplitude of fast sleep spindles, p = 0.016) and increased duration of the slow oscillation (SO; p = 0.019). Higher spindle density, faster down-to-upstate transitions within SOs, and the time delay between SOs and nested spindles predicted better memory performance in healthy controls but not in AD patients. Our results show that mnemonic processing and memory consolidation in AD is slightly impaired as reflected by dysfunctional oscillatory dynamics and spindle-SO coupling during NonREM sleep. In this translational study based on experimental paradigms in animals and extending previous work in healthy aging and preclinical disease stages, our results in symptomatic AD further deepen the understanding of the memory decline within a bidirectional relationship of sleep and AD pathology.
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Affiliation(s)
- Annika Hanert
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital of Schleswig Holstein, 24105 Kiel, Germany
| | - Robby Schönfeld
- Institute of Psychology, Division of Clinical Psychology, Martin-Luther-University Halle-Wittenberg, 06099 Halle (Saale), Germany
| | - Frederik D Weber
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72074 Tübingen, Germany; Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, 6525 EN Nijmegen, the Netherlands; Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, 1105 BA Amsterdam, the Netherlands
| | - Alexander Nowak
- Department of Psychiatry and Psychotherapy, Sleep Laboratory, University Hospital of Schleswig Holstein, 24105 Kiel, Germany
| | - Juliane Döhring
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital of Schleswig Holstein, 24105 Kiel, Germany; Institute for General Medicine, University Hospital of Schleswig-Holstein, 24105 Kiel, Germany
| | - Sarah Philippen
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital of Schleswig Holstein, 24105 Kiel, Germany
| | - Oliver Granert
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital of Schleswig Holstein, 24105 Kiel, Germany
| | - Andrea Burgalossi
- Institute of Neurobiology, Werner-Reichardt Center for Integrative Neuroscience, University of Tübingen, 72074 Tübingen, Germany
| | - Jan Born
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72074 Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital of Schleswig Holstein, 24105 Kiel, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, Sleep Laboratory, University Hospital of Schleswig Holstein, 24105 Kiel, Germany
| | - Peter Häussermann
- Department of Geriatric Psychiatry, LVR Klinik Köln, Academic Teaching Hospital, University of Cologne, Köln, Germany
| | - Thorsten Bartsch
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital of Schleswig Holstein, 24105 Kiel, Germany.
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Giri S, Mehta R, Mallick BN. REM Sleep Loss-Induced Elevated Noradrenaline Plays a Significant Role in Neurodegeneration: Synthesis of Findings to Propose a Possible Mechanism of Action from Molecule to Patho-Physiological Changes. Brain Sci 2023; 14:8. [PMID: 38275513 PMCID: PMC10813190 DOI: 10.3390/brainsci14010008] [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: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Wear and tear are natural processes for all living and non-living bodies. All living cells and organisms are metabolically active to generate energy for their routine needs, including for survival. In the process, the cells are exposed to oxidative load, metabolic waste, and bye-products. In an organ, the living non-neuronal cells divide and replenish the lost or damaged cells; however, as neuronal cells normally do not divide, they need special feature(s) for their protection, survival, and sustenance for normal functioning of the brain. The neurons grow and branch as axons and dendrites, which contribute to the formation of synapses with near and far neurons, the basic scaffold for complex brain functions. It is necessary that one or more basic and instinct physiological process(es) (functions) is likely to contribute to the protection of the neurons and maintenance of the synapses. It is known that rapid eye movement sleep (REMS), an autonomic instinct behavior, maintains brain functioning including learning and memory and its loss causes dysfunctions. In this review we correlate the role of REMS and its loss in synaptogenesis, memory consolidation, and neuronal degeneration. Further, as a mechanism of action, we will show that REMS maintains noradrenaline (NA) at a low level, which protects neurons from oxidative damage and maintains neuronal growth and synaptogenesis. However, upon REMS loss, the level of NA increases, which withdraws protection and causes apoptosis and loss of synapses and neurons. We propose that the latter possibly causes REMS loss associated neurodegenerative diseases and associated symptoms.
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Affiliation(s)
- Shatrunjai Giri
- Department of Biosciences, Manipal University Jaipur, Jaipur 303007, India;
| | - Rachna Mehta
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida 201301, India;
| | - Birendra Nath Mallick
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida 201301, India;
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7
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Blackman J, Butters A, Oliver C, Coulthard E. Sleep Measurement in Mild Cognitive Impairment and Early Dementia: Is It Time for a Rethink? Sleep 2023; 46:zsad185. [PMID: 37467353 DOI: 10.1093/sleep/zsad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Affiliation(s)
- Jonathan Blackman
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, UK
| | - Anneka Butters
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, UK
| | - Cerys Oliver
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, UK
| | - Elizabeth Coulthard
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, UK
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8
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You S, Lv T, Qin R, Hu Z, Ke Z, Yao W, Zhao H, Bai F. Neuro-Navigated rTMS Improves Sleep and Cognitive Impairment via Regulating Sleep-Related Networks' Spontaneous Activity in AD Spectrum Patients. Clin Interv Aging 2023; 18:1333-1349. [PMID: 37601952 PMCID: PMC10439779 DOI: 10.2147/cia.s416992] [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: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Study Objectives By examining spontaneous activity changes of sleep-related networks in patients with the Alzheimer's disease (AD) spectrum with or without insomnia disorder (ID) over time via neuro-navigated repetitive transcranial magnetic stimulation (rTMS), we revealed the effect and mechanism of rTMS targeting the left-angular gyrus in improving the comorbidity symptoms of the AD spectrum with ID. Methods A total of 34 AD spectrum patients were recruited in this study, including 18 patients with ID and the remaining 16 patients without ID. All of them were measured for cognitive function and sleep by using the cognitive and sleep subscales of the neuropsychiatric inventory. The amplitude of low-frequency fluctuation changes in sleep-related networks was revealed before and after neuro-navigated rTMS treatment between these two groups, and the behavioral significance was further explored. Results Affective auditory processing and sensory-motor collaborative sleep-related networks with hypo-spontaneous activity were observed at baseline in the AD spectrum with ID group, while substantial increases in activity were evident at follow-up in these subjects. In addition, longitudinal affective auditory processing, sensory-motor and default mode collaborative sleep-related networks with hyper-spontaneous activity were also revealed at follow-up in the AD spectrum with ID group. In particular, longitudinal changes in sleep-related networks were associated with improvements in sleep quality and episodic memory scores in AD spectrum with ID patients. Conclusion We speculated that left angular gyrus-navigated rTMS therapy may enhance the memory function of AD spectrum patients by regulating the spontaneous activity of sleep-related networks, and it was associated with memory consolidation in the hippocampus-cortical circuit during sleep. Clinical Trial Registration The study was registered at the Chinese Clinical Trial Registry, registration ID: ChiCTR2100050496, China.
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Affiliation(s)
- Shengqi You
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210008, People’s Republic of China
| | - Tingyu Lv
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210008, People’s Republic of China
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Zheqi Hu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Zhihong Ke
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Weina Yao
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210008, People’s Republic of China
| | - Hui Zhao
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Feng Bai
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
- Geriatric Medicine Center, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
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9
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Liang Y, Liu W, Wang M. Characteristics of macroscopic sleep structure in patients with mild cognitive impairment: a systematic review. Front Psychiatry 2023; 14:1212514. [PMID: 37547222 PMCID: PMC10399242 DOI: 10.3389/fpsyt.2023.1212514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives Conducting a systematic analysis of objective measurement tools to assess the characteristics of macroscopic sleep architecture in patients with mild cognitive impairment (MCI), amnestic MCI (aMCI), and non-amnestic MCI (naMCI) in order to provide sleep disorder guidance for MCI patients. Methods PubMed, EMbase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang Data, and VIP Data were examined to find literature relating to sleep in patients with MCI, aMCI, and naMCI, with a search time frame of build to April 2023. Following independent literature screening, data extraction, and quality evaluation by two researchers, statistical analysis was performed using RevMan 5.4 software. Results Twenty-five papers with 1,165 study subjects were included. Patients with MCI and aMCI were found to have altered total sleep time (TST), reduced sleep efficiency (SE), more wake-time after sleep onset (WASO), longer sleep latency (SL), a higher proportion of N1 stage and a lower proportion of N2 and N3 stage. naMCI was only found to have statistically significant differences in WASO. Conclusions The results of this study provide evidence for macroscopic sleep architecture abnormalities among MCI patients with sleep disorders. Maintaining a normal sleep time, improving SE, and reducing sleep fragmentation may have an association with a slowed development of cognitive impairment. Further exploration is required of the effects each component of macroscopic sleep structure after the intervention has on altered sleep disturbance and cognition in MCI, aMCI, and naMCI. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023401937, identifier: CRD42023401937.
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Affiliation(s)
- Yahui Liang
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Weihua Liu
- School of Chemistry and Pharmaceutical Engineering, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Meizi Wang
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
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10
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Butris N, Tang E, Pivetta B, He D, Saripella A, Yan E, Englesakis M, Boulos MI, Nagappa M, Chung F. The prevalence and risk factors of sleep disturbances in surgical patients: A systematic review and meta-analysis. Sleep Med Rev 2023; 69:101786. [PMID: 37121133 DOI: 10.1016/j.smrv.2023.101786] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023]
Abstract
Determining the prevalence and risk factors related to sleep disturbance in surgical patients would be beneficial for risk stratification and perioperative care planning. The objectives of this systematic review and meta-analysis are to determine the prevalence and risk factors of sleep disturbances and their associated postoperative complications in surgical patients. The inclusion criteria were: (1) patients ≥18 years old undergoing a surgical procedure, (2) in-patient population, and (3) report of sleep disturbances using a validated sleep assessment tool. The systematic search resulted in 21,951 articles. Twelve patient cohorts involving 1497 patients were included. The pooled prevalence of sleep disturbances at preoperative assessment was 60% (95% Confidence Interval (CI): 50%, 69%) and the risk factors for postoperative sleep disturbances were a high preoperative Pittsburgh sleep quality index (PSQI) score indicating preexisting disturbed sleep and anxiety. Notably, patients with postoperative delirium had a higher prevalence of pre- and postoperative sleep disturbances and high preoperative wake after sleep onset percentage (WASO%). The high prevalence of preoperative sleep disturbances in surgical patients has a negative impact on postoperative outcomes and well-being. Further work in this area is warranted.
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Affiliation(s)
- Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada
| | - Evan Tang
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada
| | | | - David He
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University Health Network, University of Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada
| | - Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, ON, Canada
| | - Mark I Boulos
- Division of Neurology, Department of Medicine, University of Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, ON, Canada
| | - Mahesh Nagappa
- Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre and St. Joseph Healthcare, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada.
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11
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Behrens A, Anderberg P, Berglund JS. Sleep disturbance predicts worse cognitive performance in subsequent years: A longitudinal population-based cohort study. Arch Gerontol Geriatr 2023; 106:104899. [PMID: 36512858 DOI: 10.1016/j.archger.2022.104899] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Poor sleep is a potential modifiable risk factor for later life development cognitive impairment. The aim of this study is to examine if subjective measures of sleep duration and sleep disturbance predict future cognitive decline in a population-based cohort of 60, 66, 72 and 78-year-olds with a maximal follow up time of 18 years. METHODS This study included participants from the Swedish National Study on Ageing and Care - Blekinge, with assessments 2001-2021. A cohort of 60 (n = 478), 66 (n = 623), 72 (n = 662) and 78 (n = 548) year-olds, were assessed at baseline and every 6 years until 78 years of age. Longitudinal associations between sleep disturbance (sleep scale), self-reported sleep duration and cognitive tests (Mini Mental State Examination and the Clock drawing test) were examined together with typical confounders (sex, education level, hypertension, hyperlipidemia, smoking status, physical inactivity and depression). RESULTS There was an association between sleep disturbance at age 60 and worse cognitive function at ages 60, 66 and 72 years in fully adjusted models. The association was attenuated after bootstrap-analysis for the 72-year-olds. The items of the sleep scale most predictive of later life cognition regarded nightly awakenings, pain and itching and daytime naps. Long sleep was predictive of future worse cognitive function. CONCLUSION Sleep disturbance was associated with worse future cognitive performance for the 60-year-olds, which suggests poor sleep being a risk factor for later life cognitive decline. Questions regarding long sleep, waking during the night, pain and itching and daytime naps should be further explored in future research and may be targets for intervention.
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Affiliation(s)
- Anders Behrens
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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12
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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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Rosales-Lagarde A, Cubero-Rego L, Menéndez-Conde F, Rodríguez-Torres EE, Itzá-Ortiz B, Martínez-Alcalá C, Vázquez-Tagle G, Vázquez-Mendoza E, Eraña Díaz ML. Dissociation of Arousal Index Between REM and NREM Sleep in Elderly Adults with Cognitive Impairment, No Dementia: A Pilot Study. J Alzheimers Dis 2023; 95:477-491. [PMID: 37574730 DOI: 10.3233/jad-230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Sleep disruption in elderly has been associated with an increased risk of cognitive impairment and its transition into Alzheimer's disease (AD). High arousal indices (AIs) during sleep may serve as an early-stage biomarker of cognitive impairment non-dementia (CIND). OBJECTIVE Using full-night polysomnography (PSG), we investigated whether CIND is related to different AIs between NREM and REM sleep stages. METHODS Fourteen older adults voluntarily participated in this population-based study that included Mini-Mental State Examination, Neuropsi battery, Katz Index of Independence in Activities of Daily Living, and single-night PSG. Subjects were divided into two groups (n = 7 each) according to their results in Neuropsi memory and attention subtests: cognitively unimpaired (CU), with normal results; and CIND, with -2.5 standard deviations in memory and/or attention subtests. AIs per hour of sleep during N1, N2, N3, and REM stages were obtained and correlated with Neuropsi total score (NTS). RESULTS AI (REM) was significantly higher in CU group than in CIND group. For the total sample, a positive correlation between AI (REM) and NTS was found (r = 0.68, p = 0.006), which remained significant when controlling for the effect of age and education. In CIND group, the AI (N2) was significantly higher than the AI (REM) . CONCLUSION In CIND older adults, this attenuation of normal arousal mechanisms in REM sleep are dissociated from the relative excess of arousals observed in stage N2. We propose as probable etiology an early hypoactivity at the locus coeruleus noradrenergic system, associated to its early pathological damage, present in the AD continuum.
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Affiliation(s)
- Alejandra Rosales-Lagarde
- CONACyT Chairs, National Council of Science and Technology, Mexico
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico
| | - Lourdes Cubero-Rego
- Neurodevelopmental Research Unit, Institute of Neurobiology, National Autonomous University of Mexico, Campus Juriquilla-Queretaro, Querétaro, México
| | | | | | - Benjamín Itzá-Ortiz
- Mathematics Research Center, Autonomous University of the State of Hidalgo, Mexico
| | - Claudia Martínez-Alcalá
- CONACyT Chairs, National Council of Science and Technology, Mexico
- Institute of Health Sciences, Autonomous University of the State of Hidalgo, Mexico
| | | | | | - Marta L Eraña Díaz
- Center for Research in Engineering and Applied Sciences, Autonomous University of the State of Morelos, Mexico
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Bai W, Zhang J, Smith RD, Cheung T, Su Z, Ng CH, Zhang Q, Xiang YT. Inter-relationship between cognitive performance and depressive symptoms and their association with quality of life in older adults: A network analysis based on the 2017-2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). J Affect Disord 2023; 320:621-627. [PMID: 36206885 DOI: 10.1016/j.jad.2022.09.159] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depressive symptoms and cognitive impairment are common psychiatric conditions and often co-occur in older adults. Network analysis has been widely used in exploring the inter-connections between psychiatric symptoms. The aim of this study was to explore the network model of depressive symptoms and cognitive performance, and their association with quality of life in people aged 65 years or above based on the 2017-2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). METHOD Global cognitive performance, depressive symptoms, and global quality of life (QoL) were measured using the validated Chinese version of the Mini Mental State Examination (MMSE), the 10-item Center for Epidemiologic Studies Short Depression Scale (CES-D), and the World Health Organization Quality of Life-brief version (WHOQOL-BREF), respectively. Central symptoms and bridge symptoms were identified via strength and bridge strength, respectively. The flow network was used to identify symptoms directly related to QoL. Network stability was examined using the case dropping bootstrap method. RESULTS A total of 9023 participants were included in the network analysis. CESD3 "Feeling blue/depressed", CESD4 "Everything was an effort", and At_C "Attention and Calculation" were the central (influential) symptoms that had the highest strength value. Three bridge symptoms (i.e., Nam "Naming", CESD2 "Difficulty with concentrating", and Lan "Language") were also identified. CESD10 "Sleep disturbances" had the strongest direct connection to QoL. CONCLUSIONS This exploratory study highlights the inter-relationships between cognitive performance and depressive symptoms in older adults in the general population. Interventions targeting bridge symptoms have the potential to alleviate depressive and cognitive symptoms in this population. Furthermore, improving sleep quality in older adults may reduce the negative impact of depression and cognition decline on QoL.
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Affiliation(s)
- Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Juan Zhang
- Faculty of Education, University of Macau, Macao SAR, China
| | - Robert D Smith
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, USA
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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15
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Blackman J, Stankeviciute L, Arenaza-Urquijo EM, Suárez-Calvet M, Sánchez-Benavides G, Vilor-Tejedor N, Iranzo A, Molinuevo JL, Gispert JD, Coulthard E, Grau-Rivera O. Cross-sectional and longitudinal association of sleep and Alzheimer biomarkers in cognitively unimpaired adults. Brain Commun 2022; 4:fcac257. [PMID: 36337343 PMCID: PMC9630979 DOI: 10.1093/braincomms/fcac257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Sleep abnormalities are prevalent in Alzheimer’s disease, with sleep quality already impaired at its preclinical stage. Epidemiological and experimental data point to sleep abnormalities contributing to the risk of Alzheimer’s disease. However, previous studies are limited by either a lack of Alzheimer’s disease biomarkers, reduced sample size or cross-sectional design. Understanding if, when, and how poor sleep contributes to Alzheimer’s disease progression is important so that therapies can be targeted to the right phase of the disease. Using the largest cohort to date, the European Prevention of Alzheimer’s Dementia Longitudinal Cohort Study, we test the hypotheses that poor sleep is associated with core Alzheimer’s disease CSF biomarkers cross-sectionally and predicts future increments of Alzheimer’s disease pathology in people without identifiable symptoms of Alzheimer’s disease at baseline. This study included 1168 adults aged over 50 years with CSF core Alzheimer’s disease biomarkers (total tau, phosphorylated tau and amyloid-beta), cognitive performance, and sleep quality (Pittsburgh sleep quality index questionnaire) data. We used multivariate linear regressions to analyse associations between core Alzheimer’s disease biomarkers and the following Pittsburgh sleep quality index measures: total score of sleep quality, binarized score (poor sleep categorized as Pittsburgh sleep quality index > 5), sleep latency, duration, efficiency and disturbance. On a subsample of 332 participants with CSF taken at baseline and after an average period of 1.5 years, we assessed the effect of baseline sleep quality on change in Alzheimer’s disease biomarkers over time. Cross-sectional analyses revealed that poor sleep quality (Pittsburgh sleep quality index total > 5) was significantly associated with higher CSF t-tau; shorter sleep duration (<7 h) was associated with higher CSF p-tau and t-tau; and a higher degree of sleep disturbance (1–9 versus 0 and >9 versus 0) was associated with lower CSF amyloid-beta. Longitudinal analyses showed that greater sleep disturbances (1–9 versus 0 and >9 versus 0) were associated with a decrease in CSF Aβ42 over time. This study demonstrates that self-reported poor sleep quality is associated with greater Alzheimer’s disease-related pathology in cognitively unimpaired individuals, with longitudinal results further strengthening the hypothesis that disrupted sleep may represent a risk factor for Alzheimer’s disease. This highlights the need for future work to test the efficacy of preventive practices, designed to improve sleep at pre-symptomatic stages of disease, on reducing Alzheimer’s disease pathology.
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Affiliation(s)
- Jonathan Blackman
- North Bristol NHS Trust , Bristol BS10 5NB , UK
- Bristol Medical School, University of Bristol , Bristol BS8 1UD , UK
| | - Laura Stankeviciute
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
- Universitat Pompeu Fabra , Barcelona 08005 , Spain
| | - Eider M Arenaza-Urquijo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
- IMIM (Hospital del Mar Medical Research Institute) , Barcelona 08003 , Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES) , Madrid 28029 , Spain
| | - Marc Suárez-Calvet
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
- IMIM (Hospital del Mar Medical Research Institute) , Barcelona 08003 , Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES) , Madrid 28029 , Spain
- Servei de Neurologia, Hospital del Mar , Barcelona 08003 , Spain
| | - Gonzalo Sánchez-Benavides
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
- IMIM (Hospital del Mar Medical Research Institute) , Barcelona 08003 , Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES) , Madrid 28029 , Spain
| | - Natalia Vilor-Tejedor
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
- Universitat Pompeu Fabra , Barcelona 08005 , Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute for Science and Technology , Barcelona 08003 , Spain
- Department of Clinical Genetics, Erasmus University Medical Center , Rotterdam 3015 GD , The Netherlands
| | - Alejandro Iranzo
- Neurology Service, Hospital Clínic de Barcelona and Institut D'Investigacions Biomèdiques , Barcelona 08036 , Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona , Barcelona 28029 , Spain
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
- IMIM (Hospital del Mar Medical Research Institute) , Barcelona 08003 , Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN) , Madrid 28029 , Spain
| | - Elizabeth Coulthard
- North Bristol NHS Trust , Bristol BS10 5NB , UK
- Bristol Medical School, University of Bristol , Bristol BS8 1UD , UK
| | - Oriol Grau-Rivera
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation , Barcelona 08005 , Spain
- IMIM (Hospital del Mar Medical Research Institute) , Barcelona 08003 , Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES) , Madrid 28029 , Spain
- Servei de Neurologia, Hospital del Mar , Barcelona 08003 , Spain
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Tian F, Chen Z, Tang R, Feng Q, Wu F. Impact of the expert consensus on polypharmacy and potentially inappropriate medication use in elderly lung cancer outpatients with multimorbidity: An interrupted time series analysis, 2016–2021. Front Pharmacol 2022; 13:992394. [PMID: 36278193 PMCID: PMC9581179 DOI: 10.3389/fphar.2022.992394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Elderly lung cancer patients often have chronic diseases other than lung cancer. Therefore, this kind of population is often accompanied by polypharmacy. This situation and the resulting potentially inappropriate medication (PIM) use are an increasing global concern. In this context, the Chinese Association of Geriatric Research issued an expert consensus on the safety management of polypharmacy. However, the long- and short-term effects of the expert consensus on polypharmacy and PIM use are not clear.Methods: The study was conducted in Chengdu, a city in southwestern China, consisting of prescriptions for elderly lung cancer outpatients with multimorbidity (cancer with other diseases) from January 2016 to December 2021. The 2019 Beers criteria were used to evaluate PIM use, and interrupted time series analysis was used to evaluate the longitudinal effectiveness of expert consensus by measuring the prevalence of polypharmacy and PIM use. We used R software version 4.2.0 for data analysis.Results: A total of 7,238 elderly lung cancer outpatient prescriptions were included in the study. After the publication of the expert consensus, the level (β = -10.273, P < 0.001) of the prevalence of polypharmacy decreased, but the trend (β = 0.158, p = 0.855) of polypharmacy increased. The prevalence of PIM use decreased abruptly (β = -22.828, p < 0.001) after the intervention, but the long-term trend was still upward (β = 0.907, p = 0.916).Conclusion: The long-term effects of the publication of the expert consensus on the prevalence of polypharmacy and PIM use in hospitals in Chengdu were not optimal. Future research on interventions rationing polypharmacy and PIM use is needed.
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Affiliation(s)
- Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- *Correspondence: Fangyuan Tian, ; Fengbo Wu,
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Tang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyi Feng
- Precision Medicine Research Center, Sichuan Provincial Key Laboratory of Precision Medicine and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fengbo Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Fangyuan Tian, ; Fengbo Wu,
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Tian F, Chen Z, Chen X, Zhao M. Increasing Trends of Polypharmacy and Potentially Inappropriate Medication Use in Older Lung Cancer Patients in China: A Repeated Cross-Sectional Study. Front Pharmacol 2022; 13:935764. [PMID: 35924052 PMCID: PMC9340379 DOI: 10.3389/fphar.2022.935764] [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: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023] Open
Abstract
Objectives: Polypharmacy and potentially inappropriate medication (PIM) use are frequent in older lung cancer patients. This study aimed to examine the trends of polypharmacy and PIM use and explore risk factors for PIM use based on the 2019 Beers criteria in older Chinese lung cancer outpatients with multimorbidity. Methods: A repeated cross-sectional study was conducted using electronic medical data consisting of the prescriptions of older lung cancer outpatients in China from January 2016 to December 2018. Polypharmacy was defined as the use of five or more medications. The 2019 Beers criteria were used to evaluate the PIM use of older cancer outpatients (age ≥65 years), and multivariate logistic regression was used to identify the risk factors for PIM use. Results: A total of 3,286 older lung cancer outpatients and their prescriptions were included in the study. The prevalence of polypharmacy was 14.27% in 2016, 16.55% in 2017, and 18.04% in 2018. The prevalence of PIM use, according to the 2019 Beers criteria, was 31.94% in 2016, 35.78% in 2017, and 42.67% in 2018. The two most frequently used PIMs in older lung cancer outpatients were estazolam and tramadol. The logistic regression demonstrated that age 75 to 79, polypharmacy, irrational use of drugs, and lung cancer accompanied by sleep disorders, anxiety or depression, or pain were positively associated with PIM use in older lung cancer outpatients. Conclusion: The prevalence of polypharmacy and PIM use in older lung cancer outpatients with multimorbidity was high in China, and polypharmacy and PIM use increased over time. Further research on interventions rationing PIM use in the older lung cancer patient population is needed.
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Affiliation(s)
- Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- *Correspondence: Fangyuan Tian,
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Chen
- Department of Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mengnan Zhao
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
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18
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Casagrande M, Forte G, Favieri F, Corbo I. Sleep Quality and Aging: A Systematic Review on Healthy Older People, Mild Cognitive Impairment and Alzheimer’s Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148457. [PMID: 35886309 PMCID: PMC9325170 DOI: 10.3390/ijerph19148457] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
Aging is characterized by changes in the structure and quality of sleep. When the alterations in sleep become substantial, they can generate or accelerate cognitive decline, even in the absence of overt pathology. In fact, impaired sleep represents one of the earliest symptoms of Alzheimer’s disease (AD). This systematic review aimed to analyze the studies on sleep quality in aging, also considering mild cognitive impairment (MCI) and AD. The review process was conducted according to the PRISMA statement. A total of 71 studies were included, and the whole sample had a mean age that ranged from 58.3 to 93.7 years (62.8–93.7 healthy participants and 61.8–86.7 pathological populations). Of these selected studies, 33 adopt subjective measurements, 31 adopt objective measures, and 10 studies used both. Pathological aging showed a worse impoverishment of sleep than older adults, in both subjective and objective measurements. The most common aspect compromised in AD and MCI were REM sleep, sleep efficiency, sleep latency, and sleep duration. These results underline that sleep alterations are associated with cognitive impairment. In conclusion, the frequency and severity of sleep disturbance appear to follow the evolution of cognitive impairment. The overall results of objective measures seem more consistent than those highlighted by subjective measurements.
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Affiliation(s)
- Maria Casagrande
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00185 Roma, Italy;
- Correspondence: (M.C.); (I.C.)
| | - Giuseppe Forte
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00185 Roma, Italy;
- Body and Action Laboratory, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy;
| | - Francesca Favieri
- Body and Action Laboratory, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy;
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Roma, Italy
| | - Ilaria Corbo
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Roma, Italy
- Correspondence: (M.C.); (I.C.)
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19
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Grigg-Damberger MM, Foldvary-Schaefer N. Sleep Biomarkers Help Predict the Development of Alzheimer Disease. J Clin Neurophysiol 2022; 39:327-334. [PMID: 35239558 DOI: 10.1097/wnp.0000000000000818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Middle-aged or older adults who self-report sleep-wake disorders are at an increased risk for incident dementia, mild cognitive impairment, and Alzheimer disease. Dementia in people with mild cognitive impairment and Alzheimer disease who complain of sleep-wake disorders progress faster than those without sleep-wake disorders. Removal of amyloid-beta and tau tangles occurs preferentially in non-rapid eye movement 3 sleep and fragmented or insufficient sleep may lead to accumulation of these neurotoxins even in preclinical stages. Selective atrophy in the medial temporal lobe on brain MRI has been shown to predict impaired coupling of slow oscillations and sleep spindles. Impaired slow wave-spindle coupling has been shown to correlate with impaired overnight memory consolidation. Whereas, a decrease in the amplitude of 0.6 to 1 Hz slow wave activity predicts higher cortical Aβ burden on amyloid PET scans. Overexpression of the wake-promoting neurotransmitter orexin may predispose patients with mild cognitive impairment and Alzheimer disease to increased wakefulness, decreasing time they need to clear from the brain the neurotoxic accumulation of amyloid-beta and especially tau. More research exploring these relationships is needed and continuing.
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20
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Costa AN, McCrae CS, Cowan N, Curtis AF. Paradoxical relationship between subjective and objective cognition: the role of sleep. J Clin Sleep Med 2022; 18:2009-2022. [PMID: 35638120 PMCID: PMC9340592 DOI: 10.5664/jcsm.10070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Subjective memory complaints and objective cognitive dysfunction are common in aging populations, however research investigating the associations between them is inconclusive. Given the high prevalence of sleep complaints in middle-aged/older adults, this research tested whether objective cognition interacted with sleep parameters in its associations with subjective cognition. METHODS Cognitively healthy adults aged 50+ completed the Pittsburgh Sleep Quality Index, Cognitive Failures Questionnaire (CFQ) and cognitive tasks: Stroop, Sternberg, and Posner cueing. Multiple regression and simple slope analyses examined whether objective cognition interacted with sleep parameters in its associations with subjective memory. RESULTS Stroop performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, better Stroop performance (faster reaction time, RT-control trials) was associated with more memory complaints at worst and average, but not best sleep efficiency. Additionally, faster RT was associated with more memory complaints only for worst sleep disturbance. Similarly, Sternberg performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, higher proportion correct was associated with more memory complaints only at worst sleep efficiency and sleep disturbance. Finally, Posner performance and sleep disturbance had an interactive association with CFQ-memory. Faster exogenous orienting was associated with more memory complaints only for worst sleep disturbance. CONCLUSIONS Objective cognition interacts with sleep efficiency and sleep disturbances in its associations with subjective memory in mid-to-late life. Findings suggest sleep fragmentation plays a role in the discrepant relationship between objective and subjective cognition. Future studies should investigate this relationship in aging populations with sleep disorders and/or cognitive impairments.
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Affiliation(s)
- Amy N Costa
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO
| | | | - Nelson Cowan
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO.,Department of Psychiatry, University of Missouri-Columbia, Columbia, MO
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21
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A New Perspective on the Treatment of Alzheimer's Disease and Sleep Deprivation-Related Consequences: Can Curcumin Help? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6168199. [PMID: 35069976 PMCID: PMC8769857 DOI: 10.1155/2022/6168199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 01/09/2023]
Abstract
Sleep disturbances, as well as sleep-wake rhythm disorders, are characteristic symptoms of Alzheimer's disease (AD) that may head the other clinical signs of this neurodegenerative disease. Age-related structural and physiological changes in the brain lead to changes in sleep patterns. Conditions such as AD affect the cerebral cortex, basal forebrain, locus coeruleus, and the hypothalamus, thus changing the sleep-wake cycle. Sleep disorders likewise adversely affect the course of the disease. Since the sleep quality is important for the proper functioning of the memory, impaired sleep is associated with problems in the related areas of the brain that play a key role in learning and memory functions. In addition to synthetic drugs, utilization of medicinal plants has become popular in the treatment of neurological diseases. Curcuminoids, which are in a diarylheptanoid structure, are the main components of turmeric. Amongst them, curcumin has multiple applications in treatment regimens of various diseases such as cardiovascular diseases, obesity, cancer, inflammatory diseases, and aging. Besides, curcumin has been reported to be effective in different types of neurodegenerative diseases. Scientific studies exclusively showed that curcumin leads significant improvements in the pathological process of AD. Yet, its low solubility hence low bioavailability is the main therapeutic limitation of curcumin. Although previous studies have focused different types of advanced nanoformulations of curcumin, new approaches are needed to solve the solubility problem. This review summarizes the available scientific data, as reported by the most recent studies describing the utilization of curcumin in the treatment of AD and sleep deprivation-related consequences.
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22
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Arapova Y, Popov I, Shikhliarova A, Rostorguev E, Kuznetsova N, Protasova T. The study of cognitive functions and the brain electrical activity in wakefulness and night sleep in patients with lobe tumors. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:106-111. [DOI: 10.17116/jnevro2022122031106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Bubu OM, Williams ET, Umasabor-Bubu OQ, Kaur SS, Turner AD, Blanc J, Cejudo JR, Mullins AE, Parekh A, Kam K, Osakwe ZT, Nguyen AW, Trammell AR, Mbah AK, de Leon M, Rapoport DM, Ayappa I, Ogedegbe G, Jean-Louis G, Masurkar AV, Varga AW, Osorio RS. Interactive Associations of Neuropsychiatry Inventory-Questionnaire Assessed Sleep Disturbance and Vascular Risk on Alzheimer's Disease Stage Progression in Clinically Normal Older Adults. Front Aging Neurosci 2021; 13:763264. [PMID: 34955813 PMCID: PMC8704133 DOI: 10.3389/fnagi.2021.763264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To determine whether sleep disturbance (SD) and vascular-risk interact to promote Alzheimer's disease (AD) stage-progression in normal, community-dwelling older adults and evaluate their combined risk beyond that of established AD biomarkers. Methods: Longitudinal data from the National Alzheimer's Coordinating Center Uniform-Dataset. SD data (i.e., SD+ vs. SD-), as characterized by the Neuropsychiatric Inventory-Questionnaire, were derived from 10,600 participants at baseline, with at-least one follow-up visit. A subset (n = 361) had baseline cerebrospinal fluid (CSF) biomarkers and MRI data. The Framingham heart study general cardiovascular disease (FHS-CVD) risk-score was used to quantify vascular risk. Amnestic mild cognitive impairment (aMCI) diagnosis during follow-up characterized AD stage-progression. Logistic mixed-effects models with random intercept and slope examined the interaction of SD and vascular risk on prospective aMCI diagnosis. Results: Of the 10,600 participants, 1,017 (9.6%) reported SD and 6,572 (62%) were female. The overall mean (SD) age was 70.5 (6.5), and follow-up time was 5.1 (2.7) years. SD and the FHS-CVD risk-score were each associated with incident aMCI (aOR: 1.42 and aOR: 2.11, p < 0.01 for both). The interaction of SD and FHS-CVD risk-score with time was significant (aOR: 2.87, p < 0.01), suggesting a synergistic effect. SD and FHS-CVD risk-score estimates remained significantly associated with incident aMCI even after adjusting for CSF (Aβ, T-tau, P-tau) and hippocampal volume (n = 361) (aOR: 2.55, p < 0.01), and approximated risk-estimates of each biomarker in the sample where data was available. Conclusions: Clinical measures of sleep and vascular risk may complement current AD biomarkers in assessing risk of cognitive decline in older adults.
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Affiliation(s)
- Omonigho M Bubu
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Population Health, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, United States
| | - Ellita T Williams
- Department of Population Health, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, United States
| | - Ogie Q Umasabor-Bubu
- Division of Epidemiology and Infection Control, State University New York (SUNY) Downstate Medical Center, Brooklyn, NY, United States
| | - Sonya S Kaur
- Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Arlener D Turner
- Department of Psychiatry and Behavioral Sciences, Center for Translational Sleep and Circadian Sciences (TSCS), University of Miami Miller School of Medicine, Miami, FL, United States
| | - Judite Blanc
- Department of Psychiatry and Behavioral Sciences, Center for Translational Sleep and Circadian Sciences (TSCS), University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jaime Ramos Cejudo
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Anna E Mullins
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zainab T Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, United States
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Antoine R Trammell
- Division of General Medicine and Geriatrics, Department of Medicine, Emory Brain Health Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Mony de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - David M Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, United States
| | - Girardin Jean-Louis
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry and Behavioral Sciences, Center for Translational Sleep and Circadian Sciences (TSCS), University of Miami Miller School of Medicine, Miami, FL, United States
| | - Arjun V Masurkar
- Department of Neurology, Center for Cognitive Neurology, New York University School of Medicine, New York, NY, United States
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ricardo S Osorio
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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24
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Beck J, Loretz E, Rasch B. Exposure to relaxing words during sleep promotes slow-wave sleep and subjective sleep quality. Sleep 2021; 44:zsab148. [PMID: 34115139 PMCID: PMC8598180 DOI: 10.1093/sleep/zsab148] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/07/2021] [Indexed: 12/14/2022] Open
Abstract
Our thoughts alter our sleep, but the underlying mechanisms are still unknown. We propose that mental processes are active to a greater or lesser extent during sleep and that this degree of activation affects our sleep depth. We examined this notion by activating the concept of "relaxation" during sleep using relaxation-related words in 50 healthy participants. In support of our hypothesis, playing relaxing words during non-rapid eye movement sleep extended the time spent in slow-wave sleep, increased power in the slow-wave activity band after the word cue, and abolished an asymmetrical sleep depth during the word presentation period. In addition, participants reported a higher sleep quality and elevated subjective alertness. Our results support the notion that the activation of mental concepts during sleep can influence sleep depth. They provide a basis for interventions using targeted activations to promote sleep depth and sleep quality to foster well-being and health.
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Affiliation(s)
- Jonas Beck
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Erna Loretz
- The Siesta Group Schlafanalyse GmbH, Vienna, Austria
| | - Björn Rasch
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
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25
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Dhillon VS, Deo P, Chua A, Thomas P, Fenech M. Sleep duration, Health Promotion Index (HPI), sRAGE and ApoE-ε4 genotype are associated with telomere length (TL) in healthy elderly Australians. J Gerontol A Biol Sci Med Sci 2021; 77:243-249. [PMID: 34508574 DOI: 10.1093/gerona/glab264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 12/18/2022] Open
Abstract
Significant alterations in sleep duration and/or quality of sleep become more pronounced as people get older. Poor sleep in elderly people is associated with adverse health outcomes and cellular ageing. We examined the relationship between TL and sleep duration, Health Promotion Index (HPI), and tested whether the presence of ApoE-ε4 allele impacts both sleep and TL. The present study was carried out in 174 healthy elderly subjects (21% male; mean age 53.79 years) from South Australia. Lymphocyte telomere length (TL) was measured by real-time qPCR and ApoE genotype was determined by TaqMan assay. HPI was calculated from a questionnaire regarding 8 lifestyle habits, including sleeping hours. Multivariate regression analysis was used to establish these associations adjusted for specified confounders. TL was found to be inversely associated with age (r = - 0.199; p = 0.008) and BMI (r = - 0.121; p = 0.11), and was significantly shorter in participants who slept for <7 hours (p = 0.001) relative to those sleeping ≥7 hours. TL was positively correlated with HPI (r = 0.195; p = 0.009). ApoE-ε4 allele carriers who slept for less than 7 hours had shortest TL (p = 0.01) compared to non-carriers. Plasma sRAGE level was significantly (p = 0.001) lower in individuals who sleep <7 hours and ApoE-ϵ4 carriers. Our results suggest that inadequate sleep duration or poor HPI is associated with shorter TL in cognitively normal elderly people and that carriage of APOE-ε4 genotype may influence the extent of these effects.
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Affiliation(s)
- Varinderpal S Dhillon
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Permal Deo
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Ann Chua
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Phil Thomas
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Michael Fenech
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5000, Australia.,Centre of Healthy Ageing and Wellness, Faculty of Health Sciences Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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26
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Price BR, Johnson LA, Norris CM. Reactive astrocytes: The nexus of pathological and clinical hallmarks of Alzheimer's disease. Ageing Res Rev 2021; 68:101335. [PMID: 33812051 PMCID: PMC8168445 DOI: 10.1016/j.arr.2021.101335] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/21/2021] [Accepted: 03/20/2021] [Indexed: 02/06/2023]
Abstract
Astrocyte reactivity is a hallmark of neuroinflammation that arises with Alzheimer’s disease (AD) and nearly every other neurodegenerative condition. While astrocytes certainly contribute to classic inflammatory processes (e.g. cytokine release, waste clearance, and tissue repair), newly emerging technologies for measuring and targeting cell specific activities in the brain have uncovered essential roles for astrocytes in synapse function, brain metabolism, neurovascular coupling, and sleep/wake patterns. In this review, we use a holistic approach to incorporate, and expand upon, classic neuroinflammatory concepts to consider how astrocyte dysfunction/reactivity modulates multiple pathological and clinical hallmarks of AD. Our ever-evolving understanding of astrocyte signaling in neurodegeneration is not only revealing new drug targets and treatments for dementia but is suggesting we reimagine AD pathophysiological mechanisms.
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Affiliation(s)
- Brittani R Price
- Department of Neuroscience, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA, 02111, USA
| | - Lance A Johnson
- Sanders-Brown Center on Aging, University of Kentucky, 800 S. Limestone St., Lexington, KY, 40356, USA; Department of Physiology, University of Kentucky, College of Medicine, UK Medical Center MN 150, Lexington, KY, 40536, USA
| | - Christopher M Norris
- Sanders-Brown Center on Aging, University of Kentucky, 800 S. Limestone St., Lexington, KY, 40356, USA; Department of Pharmacology and Nutritional Sciences, University of Kentucky, College of Medicine, UK Medical Center MN 150, Lexington, KY, 40536, USA.
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27
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Ahnaou A, Drinkenburg WHIM. Sleep, neuronal hyperexcitability, inflammation and neurodegeneration: Does early chronic short sleep trigger and is it the key to overcoming Alzheimer's disease? Neurosci Biobehav Rev 2021; 129:157-179. [PMID: 34214513 DOI: 10.1016/j.neubiorev.2021.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/13/2021] [Accepted: 06/25/2021] [Indexed: 01/13/2023]
Abstract
Evidence links neuroinflammation to Alzheimer's disease (AD); however, its exact contribution to the onset and progression of the disease is poorly understood. Symptoms of AD can be seen as the tip of an iceberg, consisting of a neuropathological build-up in the brain of extracellular amyloid-β (Aβ) plaques and intraneuronal hyperphosphorylated aggregates of Tau (pTau), which are thought to stem from an imbalance between its production and clearance resulting in loss of synaptic health and dysfunctional cortical connectivity. The glymphatic drainage system, which is particularly active during sleep, plays a key role in the clearance of proteinopathies. Poor sleep can cause hyperexcitability and promote Aβ and tau pathology leading to systemic inflammation. The early neuronal hyperexcitability of γ-aminobutyric acid (GABA)-ergic inhibitory interneurons and impaired inhibitory control of cortical pyramidal neurons lie at the crossroads of excitatory/inhibitory imbalance and inflammation. We outline, with a prospective framework, a possible vicious spiral linking early chronic short sleep, neuronal hyperexcitability, inflammation and neurodegeneration. Understanding the early predictors of AD, through an integrative approach, may hold promise for reducing attrition in the late stages of neuroprotective drug development.
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Affiliation(s)
- A Ahnaou
- Dept. of Neuroscience Discovery, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse, B-2340, Belgium.
| | - W H I M Drinkenburg
- Dept. of Neuroscience Discovery, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse, B-2340, Belgium
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28
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Zhang L, Li T, Lei Y, Cheng G, Liu B, Yu Y, Yin H, Song L, La Q, Li B, Bao W, Guo Z, Rong S. Association between sleep structure and amnesic mild cognitive impairment in patients with insomnia disorder: a case-control study. J Clin Sleep Med 2021; 17:37-43. [PMID: 32946373 DOI: 10.5664/jcsm.8804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVES To examine the association between sleep structure and amnesic mild cognitive impairment (aMCI) in patients with insomnia disorder. METHODS A total of 256 patients with insomnia disorder were diagnosed by neurologists, 45 of whom were diagnosed with aMCI according to the Petersen criteria, and 45 participants with intact cognition were chosen as controls matched for age and education. A case-control study was conducted to compare sleep structure between aMCI and control patients with insomnia disorder. We evaluated self-reported sleep problems by the Insomnia Severity Index and objective sleep features by polysomnography. Logistic regression models were used to estimate the associations between sleep parameters and aMCI in patients with insomnia disorder. RESULTS There was no significant difference in Insomnia Severity Index scores between the aMCI and control groups. In the logistic regression after adjustment for covariates, people with a longer sleep duration (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI]: 0.36-0.89), greater sleep efficiency (aOR = 0.50, 95% CI: 0.32-0.77), and a higher percentage of total sleep time in stage 3 of non-rapid eye movement sleep (N3%) (aOR = 0.02, 95% CI: 0.01-0.15) have a lower relative probability of having aMCI. By contrast, higher N1% (aOR = 2.28, 95% CI: 1.36-3.82) and wake after sleep onset (aOR = 1.31, 95% CI: 1.11-1.55) may be risk factors for aMCI in patients with insomnia. CONCLUSIONS In patients with insomnia disorder, sleep duration, sleep fragmentation, sleep efficiency, N1% and N3% were independently associated with the presence of aMCI. In the clinical setting, if patients with insomnia show much more serious abnormalities in these sleep indices, clinicians should pay attention to their cognitive function. In-depth research would also be worthwhile to elaborate the causality between sleep and cognitive decline.
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Affiliation(s)
- Li Zhang
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Tingting Li
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Yuhua Lei
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Guangwen Cheng
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - YongFei Yu
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - HongXiang Yin
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Lin Song
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Qiong La
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Benchao Li
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - ZhenLi Guo
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Shuang Rong
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
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29
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Mc Carthy CE. Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person. Med Sci (Basel) 2021; 9:medsci9020031. [PMID: 34063838 PMCID: PMC8162526 DOI: 10.3390/medsci9020031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson's disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.
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Affiliation(s)
- Christine E. Mc Carthy
- Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland;
- HRB-Clinical Research Facility, National University of Ireland, Galway, Co., Galway, Ireland
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Cordone S, Scarpelli S, Alfonsi V, De Gennaro L, Gorgoni M. Sleep-Based Interventions in Alzheimer's Disease: Promising Approaches from Prevention to Treatment along the Disease Trajectory. Pharmaceuticals (Basel) 2021; 14:ph14040383. [PMID: 33921870 PMCID: PMC8073746 DOI: 10.3390/ph14040383] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
The multifactorial nature of Alzheimer’s disease (AD) has led scientific researchers to focus on the modifiable and treatable risk factors of AD. Sleep fits into this context, given the bidirectional relationship with AD confirmed by several studies over the last years. Sleep disorders appear at an early stage of AD and continue throughout the entire course of the pathology. Specifically, sleep abnormalities, such as more fragmented sleep, increase in time of awakenings, worsening of sleep quality and primary sleep disorders raise with the severity and progression of AD. Intervening on sleep, therefore, means acting both with prevention strategies in the pre-clinical phase and with treatments during the course of the disease. This review explores sleep disturbances in the different stages of AD, starting from the pre-clinical stage. Particular attention is given to the empirical evidence investigating obstructive sleep apnea (OSA) disorder and the mechanisms overlapping and sharing with AD. Next, we discuss sleep-based intervention strategies in the healthy elderly population, mild cognitive impairment (MCI) and AD patients. We mention interventions related to behavioral strategies, combination therapies, and bright light therapy, leaving extensive space for new and raising evidence on continuous positive air pressure (CPAP) treatment effectiveness. Finally, we clarify the role of NREM sleep across the AD trajectory and consider the most recent studies based on the promising results of NREM sleep enhancement, which use innovative experimental designs and techniques.
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Affiliation(s)
- Susanna Cordone
- UniCamillus, Saint Camillus International University of Health Sciences, 00131 Rome, Italy;
| | - Serena Scarpelli
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
| | | | - Luigi De Gennaro
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy;
- Correspondence:
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
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Giri S, Ranjan A, Kumar A, Amar M, Mallick BN. Rapid eye movement sleep deprivation impairs neuronal plasticity and reduces hippocampal neuronal arborization in male albino rats: Noradrenaline is involved in the process. J Neurosci Res 2021; 99:1815-1834. [PMID: 33819353 DOI: 10.1002/jnr.24838] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 12/22/2022]
Abstract
Rapid eye movement sleep (REMS) favors brain development and memory, while it is decreased in neurodegenerative diseases. REMS deprivation (REMSD) affects several physiological processes including memory consolidation; however, its detailed mechanism(s) of action was unknown. REMS reduces, while REMSD elevates noradrenaline (NA) level in the brain; the latter induces several deficiencies and disorders, including changes in neuronal cytomorphology and apoptosis. Therefore, we proposed that REMS- and REMSD-associated modulation of NA level might affect neuronal plasticity and affect brain functions. Male albino rats were REMS deprived by flower-pot method for 6 days, and its effects were compared with home cage and large platform controls as well as post-REMSD recovered and REMS-deprived prazosin (α1-adrenoceptor antagonist)-treated rats. We observed that REMSD reduced CA1 and CA3 neuronal dendritic length, branching, arborization, and spine density, while length of active zone and expressions of pre- as well as post-synaptic proteins were increased as compared to controls; interestingly, prazosin prevented most of the effects in vivo. Studies on primary culture of neurons from chick embryo brain confirmed that NA at lower concentration(s) induced neuronal branching and arborization, while higher doses were destructive. The findings support our contention that REMSD adversely affects neuronal plasticity, branching, and synaptic scaffold, which explain the underlying cytoarchitectural basis of REMSD-associated patho-physio-behavioral changes. Consolidation of findings of this study along with that of our previous reports suggest that the neuronal disintegration could be due to either withdrawal of direct protective and proliferative role of low dose of NA or indirect effect of high dose of NA or both.
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Affiliation(s)
- Shatrunjai Giri
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Amit Ranjan
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India.,Mahatma Gandhi Central University, Motihari, Bihar, India
| | - Awanish Kumar
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Megha Amar
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Kent BA, Feldman HH, Nygaard HB. Sleep and its regulation: An emerging pathogenic and treatment frontier in Alzheimer's disease. Prog Neurobiol 2021; 197:101902. [PMID: 32877742 PMCID: PMC7855222 DOI: 10.1016/j.pneurobio.2020.101902] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/19/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023]
Abstract
A majority of patients with Alzheimer's disease (AD) experience some form of sleep disruption, including nocturnal sleep fragmentation, increased daytime napping, decreased slow-wave sleep (SWS, stage N3), and decreased rapid-eye-movement sleep (REM). Clinical studies are investigating whether such sleep disturbances are a consequence of the underlying disease, and whether they also contribute to the clinical and pathological manifestations of AD. Emerging research has provided a direct link between several of these sleep disruptions and AD pathophysiology, suggesting that treating sleep disorders in this population may target basic mechanisms of the disease. Here, we provide a comprehensive review of sleep disturbances associated with the spectrum of AD, ranging from the preclinical stages through dementia. We discuss how sleep interacts with AD pathophysiology and, critically, whether sleep impairments can be targeted to modify the disease course in a subgroup of affected AD patients. Ultimately, larger studies that fully utilize new diagnostic and experimental tools will be required to better define the most relevant sleep disturbance to target in AD, the interventions that best modulate this target symptom, and whether successful early intervention can modify AD risk and prevent dementia.
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Affiliation(s)
- Brianne A Kent
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Division of Neurology, University of British Columbia, Vancouver, Canada.
| | - Howard H Feldman
- Division of Neurology, University of British Columbia, Vancouver, Canada; Department of Neurosciences, University of California, San Diego, La Jolla, USA
| | - Haakon B Nygaard
- Division of Neurology, University of British Columbia, Vancouver, Canada
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Torossian M, Fiske SM, Jacelon CS. Sleep, Mild Cognitive Impairment, and Interventions for Sleep Improvement: An Integrative Review. West J Nurs Res 2021:193945920986907. [PMID: 33455559 PMCID: PMC8282804 DOI: 10.1177/0193945920986907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbance in mild cognitive impairment (MCI) is associated with progression to Alzheimer's disease (AD), more severe AD symptoms, and worse health outcomes. The aim of this review was to examine the relationship between sleep and MCI, and the effectiveness of sleep improvement interventions for older adults with MCI or AD. An integrative review was conducted using four databases, and findings were analyzed using an iterative process. Findings from 24 studies showed that alterations in sleep increased the risk of MCI and that the sleep quality of individuals with MCI or AD was poorer than healthy controls. Changes in brain anatomy were also observed in healthy older adults with sleep disturbances. Examined interventions were shown to be effective in improving sleep. Screening for sleep disturbances in individuals with MCI/AD is crucial to mitigate neurodegenerative or neurobehavioral risks in this population.
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Romanella SM, Roe D, Tatti E, Cappon D, Paciorek R, Testani E, Rossi A, Rossi S, Santarnecchi E. The Sleep Side of Aging and Alzheimer's Disease. Sleep Med 2021; 77:209-225. [PMID: 32912799 PMCID: PMC8364256 DOI: 10.1016/j.sleep.2020.05.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 01/23/2023]
Abstract
As we age, sleep patterns undergo significant modifications in micro and macrostructure, worsening cognition and quality of life. These are associated with remarkable brain changes, like deterioration in synaptic plasticity, gray and white matter, and significant modifications in hormone levels. Sleep alterations are also a core component of mild cognitive impairment (MCI) and Alzheimer's Disease (AD). AD night time is characterized by a gradual decrease in slow-wave activity and a substantial reduction of REM sleep. Sleep abnormalities can accelerate AD pathophysiology, promoting the accumulation of amyloid-β (Aβ) and phosphorylated tau. Thus, interventions that target sleep disturbances in elderly people and MCI patients have been suggested as a possible strategy to prevent or decelerate conversion to dementia. Although cognitive-behavioral therapy and pharmacological medications are still first-line treatments, despite being scarcely effective, new interventions have been proposed, such as sensory stimulation and Noninvasive Brain Stimulation (NiBS). The present review outlines the current state of the art of the relationship between sleep modifications in healthy aging and the neurobiological mechanisms underlying age-related changes. Furthermore, we provide a critical analysis showing how sleep abnormalities influence the prognosis of AD pathology by intensifying Aβ and tau protein accumulation. We discuss potential therapeutic strategies to target sleep disruptions and conclude that there is an urgent need for testing new therapeutic sleep interventions.
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Affiliation(s)
- S M Romanella
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - D Roe
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Tatti
- Department of Molecular, Cellular & Biomedical Sciences, CUNY, School of Medicine, New York, NY, USA
| | - D Cappon
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - R Paciorek
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - E Testani
- Sleep Medicine Center, Department of Neurology, Policlinico Santa Maria Le Scotte, Siena, Italy
| | - A Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - S Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - E Santarnecchi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Borges CR, Piovezan RD, Poyares DR, Busatto Filho G, Studart-Neto A, Coutinho AM, Tufik S, Nitrini R, Brucki SM. Subjective sleep parameters in prodromal Alzheimer's disease: a case-control study. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:510-513. [PMID: 33331534 PMCID: PMC8555634 DOI: 10.1590/1516-4446-2020-1503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/28/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE People with Alzheimer's disease (AD) dementia have impaired sleep. However, the characteristics of sleep in the early stages of AD are not well known, and studies with the aid of biomarkers are lacking. We assessed the subjective sleep characteristics of non-demented older adults and compared their amyloid profiles. METHODS We enrolled 30 participants aged ≥ 60 years, with no dementia or major clinical and psychiatric diseases. They underwent [11C]PiB-PET-CT, neuropsychological evaluations, and completed two standardized sleep assessments (Pittsburgh Sleep Quality Inventory and Epworth Sleep Scale). RESULTS Comparative analysis of subjective sleep parameters across the two groups showed longer times in bed (p = 0.024) and reduced sleep efficiency (p = 0.05) in individuals with positive amyloid. No differences in other subjective sleep parameters were observed. We also found that people with multiple-domain mild cognitive impairment (MCI) had shorter self-reported total sleep times (p = 0.034) and worse overall sleep quality (p = 0.027) compared to those with single-domain MCI. CONCLUSIONS Older adults testing positive for amyloid had a longer time in bed and lower sleep efficiency, regardless of cognitive status. In parallel, individuals with multiple-domain MCI reported shorter sleep duration and lower overall sleep quality.
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Affiliation(s)
- Conrado R Borges
- Departamento de Neurologia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ronaldo D Piovezan
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Dalva R Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | | | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Sonia M Brucki
- Departamento de Neurologia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Guarnieri B, Maestri M, Cucchiara F, Lo Gerfo A, Schirru A, Arnaldi D, Mattioli P, Nobili F, Lombardi G, Cerroni G, Bartoli A, Manni R, Sinforiani E, Terzaghi M, Arena MG, Silvestri R, La Morgia C, Di Perri MC, Franzoni F, Tognoni G, Mancuso M, Sorbi S, Bonuccelli U, Siciliano G, Faraguna U, Bonanni E. Multicenter Study on Sleep and Circadian Alterations as Objective Markers of Mild Cognitive Impairment and Alzheimer’s Disease Reveals Sex Differences. J Alzheimers Dis 2020; 78:1707-1719. [DOI: 10.3233/jad-200632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Circadian and sleep disturbances are associated with increased risk of mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Wearable activity trackers could provide a new approach in diagnosis and prevention. Objective: To evaluate sleep and circadian rhythm parameters, through wearable activity trackers, in MCI and AD patients as compared to controls, focusing on sex dissimilarities. Methods: Based on minute level data from consumer wearable devices, we analyzed actigraphic sleep parameters by applying an electromedical type I registered algorithm, and the corresponding circadian variables in 158 subjects: 86 females and 72 males (42 AD, 28 MCI, and 88 controls). Moreover, we used a confusion-matrix chart method to assess accuracy, precision, sensitivity, and specificity of two decision-tree models based on actigraphic data in predicting disease or health status. Results: Wake after sleep onset (WASO) was higher (p < 0.001) and sleep efficiency (SE) lower (p = 0.003) in MCI, and Sleep Regularity Index (SRI) was lower in AD patients compared to controls (p = 0.004). SE was lower in male AD compared to female AD (p = 0.038) and SRI lower in male AD compared to male controls (p = 0.008), male MCI (p = 0.047), but also female AD subjects (p = 0.046). Mesor was significantly lower in males in the overall population. Age reduced the dissimilarities for WASO and SE but demonstrated sex differences for amplitude (p = 0.009) in the overall population, controls (p = 0.005), and AD subjects (p = 0.034). The confusion-matrices showed good predictive power of actigraphic data. Conclusion: Actigraphic data could help identify disease or health status. Sex (possibly gender) differences could impact on neurodegeneration and disease trajectory with potential clinical applications.
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Affiliation(s)
- Biancamaria Guarnieri
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo, Pescara, Italy
- Villaserena Foundation for the Research, Città S. Angelo, Pescara, Italy
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federico Cucchiara
- SONNOLab, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Annalisa Lo Gerfo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Schirru
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dario Arnaldi
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale San Martino, Genoa, Italy
| | - Pietro Mattioli
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale San Martino, Genoa, Italy
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale San Martino, Genoa, Italy
| | | | - Gianluigi Cerroni
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo, Pescara, Italy
- Villaserena Foundation for the Research, Città S. Angelo, Pescara, Italy
| | - Antonella Bartoli
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo, Pescara, Italy
- Villaserena Foundation for the Research, Città S. Angelo, Pescara, Italy
| | - Raffaele Manni
- Sleep and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Sinforiani
- Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Michele Terzaghi
- Sleep and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Maria Grazia Arena
- Center for Cognitive Disorders and Dementias, Alzheimer's Disease Assessment Unit, UOC of Neurology and Neuromuscular Disorders, AOU Policlinico, ``G. Martino'', University of Messina, Messina, Italy
| | - Rosalia Silvestri
- Sleep Medicine Center, UOSD of Neurophysiopathology and Movement Disorders, AOU Policlinico ``G.~Martino'', Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Chiara La Morgia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna Bologna, Italy
| | - Maria Caterina Di Perri
- Sleep Medicine Center, UOSD of Neurophysiopathology and Movement Disorders, AOU Policlinico ``G.~Martino'', Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Ferdinando Franzoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gloria Tognoni
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Ubaldo Bonuccelli
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ugo Faraguna
- SONNOLab, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Enrica Bonanni
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Suh SW, Han JW, Han JH, Bae JB, Moon W, Kim HS, Oh DJ, Kwak KP, Kim BJ, Kim SG, Kim JL, Kim TH, Ryu SH, Moon SW, Park JH, Byun S, Seo J, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW. Sex differences in subjective age-associated changes in sleep: a prospective elderly cohort study. Aging (Albany NY) 2020; 12:21942-21958. [PMID: 33170149 PMCID: PMC7695390 DOI: 10.18632/aging.104016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/22/2020] [Indexed: 01/16/2023]
Abstract
Subjective age-associated changes in sleep (AACS) and sex differences in AACS have never been prospectively investigated in elderly populations. We compared the AACS every 2 years over a total of 6 years between 4,686 community-dwelling healthy men and women aged 60 years or older who participated in the Korean Longitudinal Study on Cognitive Aging and Dementia. Sleep parameters including sleep duration, latency, and efficiency, mid-sleep time, daytime dysfunction, and overall subjective sleep quality were measured using the Pittsburgh Sleep Quality Index at baseline and at each follow-up. The effects of time and sex on subjective sleep parameters were analyzed using linear mixed-effects models. During the 6 years of follow-up, we observed that overall, sleep latency increased, while daytime dysfunction and sleep quality worsened. Significant sex differences in AACS was found, with women showing shortened sleep duration, delayed mid-sleep time, and decreased sleep efficiency over 6 years. Sleep quality worsened in both groups but a more pronounced change was observed in women. Clinicians should be cautious in determining when to treat declared sleep disturbances in this population.
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Affiliation(s)
- Seung Wan Suh
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woori Moon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dae Jong Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jiyeong Seo
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Sciences, Seoul, Korea
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Pini L, Wennberg A, Mitolo M, Meneghello F, Burgio F, Semenza C, Venneri A, Mantini D, Vallesi A. Quality of sleep predicts increased frontoparietal network connectivity in patients with mild cognitive impairment. Neurobiol Aging 2020; 95:205-213. [DOI: 10.1016/j.neurobiolaging.2020.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 11/27/2022]
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Chou CA, Toedebusch CD, Redrick T, Freund D, McLeland JS, Morris JC, Holtzman DM, Lucey BP. Comparison of single-channel EEG, actigraphy, and sleep diary in cognitively normal and mildly impaired older adults. ACTA ACUST UNITED AC 2020; 1:zpaa006. [PMID: 33644758 PMCID: PMC7898727 DOI: 10.1093/sleepadvances/zpaa006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Study Objectives Multiple methods for monitoring sleep-wake activity have identified sleep disturbances as risk factors for Alzheimer disease (AD). In order to identify the level of agreement between different methods, we compared sleep parameters derived from single-channel EEG (scEEG), actigraphy, and sleep diaries in cognitively normal and mildly impaired older adults. Methods Two hundred ninety-three participants were monitored at home for up to six nights with scEEG, actigraphy, and sleep diaries. Total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO) were calculated using each of these methods. In 109 of the 293 participants, the ratio of cerebrospinal fluid concentrations of phosphorylated tau (p-tau) and amyloid-β-42 (Aβ42) was used as a biomarker for AD pathology. Results Agreement was highest for TST across instruments, especially in cognitively normal older adults. Overall, scEEG and actigraphy appeared to have greater agreement for multiple sleep parameters than for scEEG and diary or actigraphy and diary. Levels of agreement between scEEG and actigraphy overall decreased in mildly impaired participants and those with biomarker evidence of AD pathology, especially for measurements of TST. Conclusions Caution should be exercised when comparing scEEG and actigraphy in individuals with mild cognitive impairment or with AD pathology. Sleep diaries may capture different aspects of sleep compared to scEEG and actigraphy. Additional studies comparing different methods of measuring sleep-wake activity in older adults are necessary to allow for comparison between studies using different methods.
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Affiliation(s)
- Chris A Chou
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | | | - Tiara Redrick
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - David Freund
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Jennifer S McLeland
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St Louis, MO.,Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO.,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO
| | - David M Holtzman
- Department of Neurology, Washington University School of Medicine, St Louis, MO.,Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO.,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO
| | - Brendan P Lucey
- Department of Neurology, Washington University School of Medicine, St Louis, MO.,Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO
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40
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Mander BA. Local Sleep and Alzheimer's Disease Pathophysiology. Front Neurosci 2020; 14:525970. [PMID: 33071726 PMCID: PMC7538792 DOI: 10.3389/fnins.2020.525970] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Even prior to the onset of the prodromal stages of Alzheimer's disease (AD), a constellation of sleep disturbances are apparent. A series of epidemiological studies indicate that multiple forms of these sleep disturbances are associated with increased risk for developing mild cognitive impairment (MCI) and AD, even triggering disease onset at an earlier age. Through the combination of causal manipulation studies in humans and rodents, as well as targeted examination of sleep disturbance with respect to AD biomarkers, mechanisms linking sleep disturbance to AD are beginning to emerge. In this review, we explore recent evidence linking local deficits in brain oscillatory function during sleep with local AD pathological burden and circuit-level dysfunction and degeneration. In short, three deficits in the local expression of sleep oscillations have been identified in relation to AD pathophysiology: (1) frequency-specific frontal deficits in slow wave expression during non-rapid eye movement (NREM) sleep, (2) deficits in parietal sleep spindle expression, and (3) deficits in the quality of electroencephalographic (EEG) desynchrony characteristic of REM sleep. These deficits are noteworthy since they differ from that seen in normal aging, indicating the potential presence of an abnormal aging process. How each of these are associated with β-amyloid (Aβ) and tau pathology, as well as neurodegeneration of circuits sensitive to AD pathophysiology, are examined in the present review, with a focus on the role of dysfunction within fronto-hippocampal and subcortical sleep-wake circuits. It is hypothesized that each of these local sleep deficits arise from distinct network-specific dysfunctions driven by regionally-specific accumulation of AD pathologies, as well as their associated neurodegeneration. Overall, the evolution of these local sleep deficits offer unique windows into the circuit-specific progression of distinct AD pathophysiological processes prior to AD onset, as well as their impact on brain function. This includes the potential erosion of sleep-dependent memory mechanisms, which may contribute to memory decline in AD. This review closes with a discussion of the remaining critical knowledge gaps and implications of this work for future mechanistic studies and studies implementing sleep-based treatment interventions.
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Affiliation(s)
- Bryce A. Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, United States
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41
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Romanella SM, Roe D, Paciorek R, Cappon D, Ruffini G, Menardi A, Rossi A, Rossi S, Santarnecchi E. Sleep, Noninvasive Brain Stimulation, and the Aging Brain: Challenges and Opportunities. Ageing Res Rev 2020; 61:101067. [PMID: 32380212 PMCID: PMC8363192 DOI: 10.1016/j.arr.2020.101067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/26/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023]
Abstract
As we age, sleep patterns undergo severe modifications of their micro and macrostructure, with an overall lighter and more fragmented sleep structure. In general, interventions targeting sleep represent an excellent opportunity not only to maintain life quality in the healthy aging population, but also to enhance cognitive performance and, when pathology arises, to potentially prevent/slow down conversion from e.g. Mild Cognitive Impairment (MCI) to Alzheimer's Disease (AD). Sleep abnormalities are, in fact, one of the earliest recognizable biomarkers of dementia, being also partially responsible for a cascade of cortical events that worsen dementia pathophysiology, including impaired clearance systems leading to build-up of extracellular amyloid-β (Aβ) peptide and intracellular hyperphosphorylated tau proteins. In this context, Noninvasive Brain Stimulation (NiBS) techniques, such as transcranial electrical stimulation (tES) and transcranial magnetic stimulation (TMS), may help investigate the neural substrates of sleep, identify sleep-related pathology biomarkers, and ultimately help patients and healthy elderly individuals to restore sleep quality and cognitive performance. However, brain stimulation applications during sleep have so far not been fully investigated in healthy elderly cohorts, nor tested in AD patients or other related dementias. The manuscript discusses the role of sleep in normal and pathological aging, reviewing available evidence of NiBS applications during both wakefulness and sleep in healthy elderly individuals as well as in MCI/AD patients. Rationale and details for potential future brain stimulation studies targeting sleep alterations in the aging brain are discussed, including enhancement of cognitive performance, overall quality of life as well as protein clearance.
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Affiliation(s)
- Sara M Romanella
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Daniel Roe
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rachel Paciorek
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Davide Cappon
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Arianna Menardi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Padova Neuroscience Center, Department of Neuroscience, University of Padova, Padova, Italy
| | - Alessandro Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; Siena Robotics and Systems Lab (SIRS-Lab), Engineering and Mathematics Department, University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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It's complicated: The relationship between sleep and Alzheimer's disease in humans. Neurobiol Dis 2020; 144:105031. [PMID: 32738506 DOI: 10.1016/j.nbd.2020.105031] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 01/01/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by an asymptomatic period of amyloid-β (Aβ) deposition as insoluble extracellular plaque, intracellular tau aggregation, neuronal and synaptic loss, and subsequent cognitive dysfunction and dementia. A growing public health crisis, the worldwide prevalence of AD is expected to rise from 46.8 million individuals affected in 2015 to 131.5 million in 2050. Sleep disturbances have been associated with increased future risk of AD. A bi-directional relationship is hypothesized between sleep and AD with sleep disturbances as either markers for AD pathology and/or a mechanism mediating increased risk of AD. In this review, the evidence in humans supporting this complex relationship between sleep and AD will be discussed as well as the therapeutic potential and challenges of treating sleep disturbances to prevent or delay the onset of AD.
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43
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Scholes S, Santisteban JA, Zhang Y, Bertone A, Gruber R. Modulation of Slow-Wave Sleep: Implications for Psychiatry. Curr Psychiatry Rep 2020; 22:52. [PMID: 32710222 DOI: 10.1007/s11920-020-01175-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The objectives of this review are to examine and integrate existing empirical evidence regarding the impact of slow-wave sleep (SWS) modulation on memory and executive function performance in individuals with psychiatric disorders, and to examine the feasibility of integrating SWS modulation into psychiatric care. RECENT FINDINGS SWS modulation in individuals with psychiatric disorders resulted in changes to SWS across multiple psychiatric disorders, using all stimulation methods. SWS stimulation was associated with improved cognitive performance. SWS modulation using acoustic stimulation resulted in improved cognitive performance in children with ADHD, and the use of transcranial stimulation was associated with improved cognitive performance in individuals with mild cognitive impairment. Significant relationships between changes in SWS and cognitive improvement were found for individual with mild cognitive impairment following the use of acoustic or transcranial stimulation night. Our review reveals partial support to the potential efficacy of SWS modulation as a transdiagnostic intervention that uses sleep to improve cognitive functions of individuals diagnosed with psychiatric disorders and cognitive deficits. It further highlights multiple barriers pertaining to the feasibility of integrating SWS modulation into clinical practice and proposes ways to improve it.
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Affiliation(s)
- Samantha Scholes
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Verdun, Montréal, QC, H4H 1R3, Canada.,Perceptual Neuroscience Lab (PNLab) for Autism, Development Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
| | - J A Santisteban
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Verdun, Montréal, QC, H4H 1R3, Canada
| | - Yujie Zhang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Armando Bertone
- Perceptual Neuroscience Lab (PNLab) for Autism, Development Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Reut Gruber
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Verdun, Montréal, QC, H4H 1R3, Canada. .,Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada.
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44
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Neurostimulation techniques to enhance sleep and improve cognition in aging. Neurobiol Dis 2020; 141:104865. [DOI: 10.1016/j.nbd.2020.104865] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/16/2020] [Accepted: 04/02/2020] [Indexed: 01/09/2023] Open
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45
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Cavuoto MG, Kinsella GJ, Ong B, Pike KE, Nicholas CL. Naturalistic Measurement of Sleep in Older Adults with Amnestic Mild Cognitive Impairment: Anxiety Symptoms Do Not Explain Sleep Disturbance. Curr Alzheimer Res 2020; 16:233-242. [PMID: 30827241 DOI: 10.2174/1567205016666190301104645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/14/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep disturbance is prevalent in Alzheimer's disease (AD). In amnestic mild cognitive impairment (aMCI), the preclinical stage of AD, deterioration in sleep quality has also been reported. Consensus is lacking, however, regarding what aspects of sleep are characteristically affected, whether the setting of the sleep recordings impacts these findings, and whether anxiety may account for the differences. OBJECTIVE The current study aimed to address these knowledge gaps by obtaining comprehensive sleep measurement in aMCI within a naturalistic environment using in-home sleep recordings. METHODS 17 healthy older adults and twelve participants with aMCI wore an actiwatch for two weeks to objectively record habitual sleeping patterns and completed two nights of in-home polysomnography. RESULTS In aMCI, habitual sleep disturbances were evident on actigraphy including greater wake after sleep onset (p = .012, d = 0.99), fragmentation (p = .010, d = 1.03), and time in bed (p = .046, d = .76). Although not statistically significant, there was a large group effect on polysomnography with aMCI demonstrating less slow-wave-sleep than controls (p >.05, d = .0.83). Anxiety did not mediate the relationship between the group and sleep in this small study. CONCLUSIONS The results indicate that people with aMCI have poorer quality sleep than healthy controls, as indicated by greater sleep disruption and less slow-wave sleep, even in naturalistic settings. Additionally, anxiety symptoms do not mediate the relationship. Therefore, this research supports the view that sleep disturbance is likely to be indicative of neuropathological changes in aMCI rather than being attributed to psychological factors.
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Affiliation(s)
- Marina G Cavuoto
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia.,Department of Psychology, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Glynda J Kinsella
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia.,Department of Psychology, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Ben Ong
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kerryn E Pike
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Breathing & Sleep, Heidelberg, Victoria, Australia
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46
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Salfi F, D'Atri A, Tempesta D, De Gennaro L, Ferrara M. Boosting Slow Oscillations during Sleep to Improve Memory Function in Elderly People: A Review of the Literature. Brain Sci 2020; 10:E300. [PMID: 32429181 PMCID: PMC7287854 DOI: 10.3390/brainsci10050300] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 02/05/2023] Open
Abstract
Sleep represents a crucial time window for the consolidation of memory traces. In this view, some brain rhythms play a pivotal role, first of all the sleep slow waves. In particular, the neocortical slow oscillations (SOs), in coordination with the hippocampal ripples and the thalamocortical spindles, support the long-term storage of the declarative memories. The aging brain is characterized by a disruption of this complex system with outcomes on the related cognitive functions. In recent years, the advancement of the comprehension of the sleep-dependent memory consolidation mechanisms has encouraged the development of techniques of SO enhancement during sleep to induce cognitive benefits. In this review, we focused on the studies reporting on the application of acoustic or electric stimulation procedures in order to improve sleep-dependent memory consolidation in older subjects. Although the current literature is limited and presents inconsistencies, there is promising evidence supporting the perspective to non-invasively manipulate the sleeping brain electrophysiology to improve cognition in the elderly, also shedding light on the mechanisms underlying the sleep-memory relations during healthy and pathological aging.
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Affiliation(s)
- Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Aurora D'Atri
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
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47
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Borges CR, Poyares D, Piovezan R, Nitrini R, Brucki S. Alzheimer's disease and sleep disturbances: a review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:815-824. [PMID: 31826138 DOI: 10.1590/0004-282x20190149] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/23/2019] [Indexed: 01/19/2023]
Abstract
The association between Alzheimer's disease (AD) and sleep disturbances has received increasing scientific attention in the last decades. However, little is known about the impact of sleep and its disturbances on the development of preclinical AD stages, such as mild cognitive impairment. This review describes the evolution of knowledge about the potential bidirectional relationships between AD and sleep disturbances exploring recent large prospective studies and meta-analyses and studies of the possible mechanisms through which sleep and the neurodegenerative process could be associated. The review also makes a comprehensive exploration of the sleep characteristics of older people, ranging from cognitively normal individuals, through patients with mild cognitive impairment, up to the those with dementia with AD.
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Affiliation(s)
- Conrado Regis Borges
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Dalva Poyares
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Instituto do Sono, São Paulo SP, Brasil
| | - Ronaldo Piovezan
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Instituto do Sono, São Paulo SP, Brasil
| | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Sonia Brucki
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
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48
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D'Rozario AL, Chapman JL, Phillips CL, Palmer JR, Hoyos CM, Mowszowski L, Duffy SL, Marshall NS, Benca R, Mander B, Grunstein RR, Naismith SL. Objective measurement of sleep in mild cognitive impairment: A systematic review and meta-analysis. Sleep Med Rev 2020; 52:101308. [PMID: 32302775 DOI: 10.1016/j.smrv.2020.101308] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/23/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
Older adults with mild cognitive impairment (MCI) are at-risk of developing dementia, particularly Alzheimer's disease. While some research suggests that alterations in sleep architecture may mediate cognitive decline, the nature and magnitude of changes to sleep macro- (sleep stages) and micro-architecture (electroencephalography (EEG) oscillations) in MCI is not yet clear. This study aimed to systematically review and meta-analyse case-control studies objectively measuring sleep in MCI. A systematic search was conducted using PubMed, Scopus, Web of Science, Embase and Psycinfo databases and after review, a total of 10 studies met inclusion criteria. Of these, all reported sleep macro-architecture and four reported micro-architecture outcomes. A combined total of 430 participants (209 with and 221 without MCI) underwent objective sleep assessments in the included full text articles. Findings show that compared to healthy controls, those with MCI have pronounced changes in sleep macro-architecture with greater wake after sleep onset, reduced total sleep time, lower sleep efficiency, longer sleep onset latency, longer rapid eye movement sleep (REM) latency, reduced REM sleep, greater N1 sleep, and worse severity of hypoxemia. Pooling of sleep micro-architecture EEG measures was not possible due to limited studies, however reduced spindles in non-REM sleep and greater EEG slowing in REM sleep were reported.
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Affiliation(s)
- Angela L D'Rozario
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.
| | - Julia L Chapman
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Craig L Phillips
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jake R Palmer
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Loren Mowszowski
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Shantel L Duffy
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ruth Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Bryce Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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49
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Cabanel N, Speier C, Müller MJ, Kundermann B. Actigraphic, but not subjective, sleep measures are associated with cognitive impairment in memory clinic patients. Psychogeriatrics 2020; 20:133-139. [PMID: 31264318 DOI: 10.1111/psyg.12474] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 04/02/2019] [Accepted: 05/20/2019] [Indexed: 01/23/2023]
Abstract
AIM Sleep disturbances are prevalent in various dementia subtypes but rarely investigated in early clinical stages. Although memory clinics have become an established institution for the early diagnosis of dementia, sleep assessment is not part of their routine diagnostics. This study aimed to examine whether subjective and objective sleep variables are related to cognitive impairment in patients referred to a memory clinic. METHODS On two consecutive days, patients underwent routine diagnostic procedures, including a neuropsychological examination (consortium to establish a registry for alzheimer's disease), and had their sleep quality evaluated by the Pittsburgh Sleep Quality Index and overnight hand-wrist actigraphy. RESULTS Data of 31 patients (age, M ± SEM: 74.1 ± 1.5; 18 women, 13 men; Clinical Dementia Rating: 0-1) were analysed. One had been diagnosed with subjective cognitive impairment, 13 with mild cognitive impairment with or without depression, and 17 with dementia syndrome due to Alzheimer's and/or cerebrovascular disease. Compared to patients with subjective or mild cognitive impairment, dementia patients showed a significantly increased nocturnal acceleration magnitude; other differences in subjective and objective sleep measures were not significant. Comparing patients with subjectively poor (Pittsburgh Sleep Quality Index > 5: n = 9) and good sleep (Pittsburgh Sleep Quality Index ≤ 5: n = 22) yielded no differences in any neuropsychological and clinical variables. In contrast, patients with low actigraphically recorded sleep efficiency (<85%: n = 11) exhibited a significantly more impaired cognitive performance than those in the high sleep efficiency group (≥85%: n = 20). Correlation analyses demonstrated that actigraphically assessed disturbed sleep continuity accompanied by increased night-time motor activity was substantially associated with cognitive impairment. CONCLUSION This study highlights that objectively assessed, but not self-reported, parameters of disturbed sleep are closely related to cognitive dysfunction in the early stages of dementia of different aetiologies. Possible diagnostic and treatment implications are discussed.
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Affiliation(s)
- Nicole Cabanel
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Germany.,Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
| | - Christa Speier
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Germany
| | - Matthias J Müller
- Oberberg Group, Berlin, Germany.,Justus-Liebig University of Giessen, Germany
| | - Bernd Kundermann
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Germany.,Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
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50
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Pulopulos MM, Hidalgo V, Puig-Perez S, Montoliu T, Salvador A. Relationship between Cortisol Changes during the Night and Subjective and Objective Sleep Quality in Healthy Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1264. [PMID: 32079109 PMCID: PMC7068538 DOI: 10.3390/ijerph17041264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 01/09/2023]
Abstract
The aim of this study was to investigate whether the nighttime cortisol release was associated with subjective and objective sleep quality and the discrepancy between them. Forty-five healthy older adults (age range from 56 to 75 years) collected salivary samples immediately before sleep and immediately after awakening on two consecutive nights. Actigraphy was used to assess objective sleep quality and quantity. A sleep diary was used to assess subjective sleep quality. Linear mixed models were performed using subjective and objective sleep quality data from 76 nights to investigate between-subject associations. We observed that larger changes in cortisol levels between sleep onset and awakening, reflecting a healthier circadian rhythm of the Hypothalamic-Pituitary-Adrenal (HPA) axis, were associated with better subjective sleep quality, but not with objective sleep quality. Moreover, smaller changes in nighttime cortisol were associated with lower subjective sleep quality relative to objective sleep quality. All these results were observed even after controlling for important confounders such as sleep quantity, age, sex, subjective socioeconomic status, stress perception, depression, physical activity, and adherence to the salivary sampling protocol. This study demonstrates that subjective sleep quality in older people may be explained, to some extent, by the activity of the HPA axis.
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Affiliation(s)
- Matias M. Pulopulos
- Department of Experimental Clinical and Health Psychology, Ghent University, 9000 Gent, Belgium
| | - Vanesa Hidalgo
- Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, 44003 Teruel, Spain
- Department of Psychobiology and IDOCAL, University of Valencia, 46010 Valencia, Spain
| | - Sara Puig-Perez
- Area of Health Sciences, Valencian International University, 46002 Valencia, Spain
| | - Teresa Montoliu
- Department of Psychobiology and IDOCAL, University of Valencia, 46010 Valencia, Spain
| | - Alicia Salvador
- Department of Psychobiology and IDOCAL, University of Valencia, 46010 Valencia, Spain
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