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Tsapanou A, Gu Y, O’Shea D, Eich T, Tang MX, Schupf N, Manly J, Zimmerman M, Scarmeas N, Stern Y. Daytime somnolence as an early sign of cognitive decline in a community-based study of older people. Int J Geriatr Psychiatry 2016; 31:247-55. [PMID: 26081795 PMCID: PMC5381157 DOI: 10.1002/gps.4318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to examine the association between self-reported sleep problems and cognitive decline in community-dwelling older people. We hypothesized that daytime somnolence predicts subsequent cognitive decline. METHODS This is a longitudinal study in a 3.2-year follow-up, with 18-month intervals. The setting is the Washington Heights-Inwood Community Aging Project. There were 1098 participants, who were over 65 years old and recruited from the community. Sleep problems were estimated using five sleep categories derived from the RAND Medical Outcome Study Sleep Scale: sleep disturbance, snoring, awaken short of breath/with a headache, sleep adequacy, and daytime somnolence. Four distinct cognitive composite scores were calculated: memory, language, speed of processing, and executive functioning. We used generalized estimating equations analyses with cognitive scores as the outcome, and time, sleep categories and their interactions as the main predictors. Models were initially unadjusted and then adjusted for age, gender, education, ethnicity, depression, and apolipoprotein E-ε4 genotype. RESULTS Increased daytime somnolence (including feeling drowsy/sleepy, having trouble staying awake, and taking naps during the day) was linked to slower speed of processing both cross-sectionally (B = -0.143, p = 0.047) and longitudinally (B = -0.003, p = 0.027). After excluding the demented participants at baseline, the results remained significant (B = -0.003, p = 0.021). CONCLUSIONS Our findings suggest that daytime somnolence may be an early sign of cognitive decline in the older population.
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Affiliation(s)
- Angeliki Tsapanou
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Deirdre O’Shea
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Teal Eich
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ming-Xin Tang
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Biostatistics, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicole Schupf
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer Manly
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Molly Zimmerman
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA,National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
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Fridinger SE, Alper G. Defining encephalopathy in acute disseminated encephalomyelitis. J Child Neurol 2014; 29:751-5. [PMID: 23748203 DOI: 10.1177/0883073813489732] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 04/07/2013] [Indexed: 11/15/2022]
Abstract
The International Pediatric Multiple Sclerosis Study Group requires the presence of encephalopathy to diagnose acute disseminated encephalomyelitis. Clinical characteristics of encephalopathy are inadequately delineated in the pediatric demyelinating literature. The authors' purpose was to better define encephalopathy in pediatric acute disseminated encephalomyelitis by describing the details of the mental status change. A retrospective chart review was conducted for 25 children diagnosed with acute disseminated encephalomyelitis according to the International Pediatric Multiple Sclerosis Study Group guidelines. Frequency of encephalopathy-defining features was determined. Clinical characteristics, cerebrospinal fluid findings, and electroencephalography (EEG) findings were compared between patients with different stages of encephalopathy. The authors found irritability (36%), sleepiness (52%), confusion (8%), obtundation (20%), and coma (16%) as encephalopathy-defining features in acute disseminated encephalomyelitis. Twenty-eight percent had seizures, and 65% demonstrated generalized slowing on EEG. Approximately half of the patients in this study were diagnosed with encephalopathy based on the presence of irritability and/or sleepiness only. Such features in young children are often subtle and transient and thus difficult to objectively determine.
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Affiliation(s)
- S E Fridinger
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gulay Alper
- Division of Child Neurology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
Narcolepsy is characterized by excessive daytime sleepiness (EDS), cataplexy and/or other dissociated manifestations of rapid eye movement (REM) sleep (hypnagogic hallucinations and sleep paralysis). Narcolepsy is currently treated with amphetamine-like central nervous system (CNS) stimulants (for EDS) and antidepressants (for cataplexy). Some other classes of compounds such as modafinil (a non-amphetamine wake-promoting compound for EDS) and gamma-hydroxybutyrate (GHB, a short-acting sedative for EDS/fragmented nighttime sleep and cataplexy) given at night are also employed. The major pathophysiology of human narcolepsy has been recently elucidated based on the discovery of narcolepsy genes in animals. Using forward (i.e., positional cloning in canine narcolepsy) and reverse (i.e., mouse gene knockout) genetics, the genes involved in the pathogenesis of narcolepsy (hypocretin/orexin ligand and its receptor) in animals have been identified. Hypocretins/orexins are novel hypothalamic neuropeptides also involved in various hypothalamic functions such as energy homeostasis and neuroendocrine functions. Mutations in hypocretin-related genes are rare in humans, but hypocretin-ligand deficiency is found in many narcolepsy-cataplexy cases. In this review, the clinical, pathophysiological and pharmacological aspects of narcolepsy are discussed.
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Affiliation(s)
- Seiji Nishino
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Sleep and Circadian, Neurobiology Laboratory, Center for Narcolepsy, 1201 Welch Road, P213, Palo Alto, CA 94304, USA.
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Nishino S, Kanbayashi T. Symptomatic narcolepsy, cataplexy and hypersomnia, and their implications in the hypothalamic hypocretin/orexin system. Sleep Med Rev 2005; 9:269-310. [PMID: 16006155 DOI: 10.1016/j.smrv.2005.03.004] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Human narcolepsy is a chronic sleep disorder affecting 1:2000 individuals. The disease is characterized by excessive daytime sleepiness, cataplexy and other abnormal manifestations of REM sleep, such as sleep paralysis and hypnagogic hallucinations. Recently, it was discovered that the pathophysiology of (idiopathic) narcolepsy-cataplexy is linked to hypocretin ligand deficiency in the brain and cerebrospinal fluid (CSF), as well as the positivity of the human leukocyte antigen (HLA) DR2/DQ6 (DQB1*0602). The symptoms of narcolepsy can also occur during the course of other neurological conditions (i.e. symptomatic narcolepsy). We define symptomatic narcolepsy as those cases that meet the International Sleep Disorders Narcolepsy Criteria, and which are also associated with a significant underlying neurological disorder that accounts for excessive daytime sleepiness (EDS) and temporal associations. To date, we have counted 116 symptomatic cases of narcolepsy reported in literature. As, several authors previously reported, inherited disorders (n=38), tumors (n=33), and head trauma (n=19) are the three most frequent causes for symptomatic narcolepsy. Of the 116 cases, 10 are associated with multiple sclerosis, one case of acute disseminated encephalomyelitis, and relatively rare cases were reported with vascular disorders (n=6), encephalitis (n=4) and degeneration (n=1), and hererodegenerative disorder (three cases in a family). EDS without cataplexy or any REM sleep abnormalities is also often associated with these neurological conditions, and defined as symptomatic cases of EDS. Although it is difficult to rule out the comorbidity of idiopathic narcolepsy in some cases, review of the literature reveals numerous unquestionable cases of symptomatic narcolepsy. These include cases with HLA negative and/or late onset, and cases in which the occurrences of the narcoleptic symptoms are parallel with the rise and fall of the causative disease. A review of these cases (especially those with brain tumors), illustrates a clear picture that the hypothalamus is most often involved. Several cases of symptomatic cataplexy (without EDS) were also reported and in contrast, these cases appear to be often associated with non-hypothalamic structures. CSF hypocretin-1 measurement were also carried out in a limited number of symptomatic cases of narcolepsy/EDS, including narcolepsy/EDS associated with tumors (n=5), head trauma (n=3), vascular disorders (n=5), encephalopathies (n=3), degeneration (n=30), demyelinating disorder (n=7), genetic/congenital disorders (n=11) and others (n=2). Reduced CSF hypocretin-1 levels were seen in most symptomatic narcolepsy cases of EDS with various etiologies and EDS in these cases is sometimes reversible with an improvement of the causative neurological disorder and an improvement of the hypocretin status. It is also noted that some symptomatic EDS cases (with Parkinson diseases and the thalamic infarction) appeared, but they are not linked with hypocretin ligand deficiency. In contrast to idiopathic narcolepsy cases, an occurrence of cataplexy is not tightly associated with hypocretin ligand deficiency in symptomatic cases. Since CSF hypocretin measures are still experimental, cases with sleep abnormalities/cataplexy are habitually selected for CSF hypocretin measures. Therefore, it is still not known whether all or a large majority of cases with low CSF hypocretin-1 levels with CNS interventions, exhibit EDS/cataplexy. It appears that further studies of the involvement of the hypocretin system in symptomatic narcolepsy and EDS are helpful to understand the pathophysiological mechanisms for the occurrence of EDS and cataplexy.
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Affiliation(s)
- Seiji Nishino
- Center for Narcolepsy, Stanford University, Palo Alto, CA 94304, USA.
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