Implications of sleep disturbance and inflammation for Alzheimer's disease dementia

Validating the CogSleep Screener in older adults at a memory and cognition clinic

While sleep disturbances are prevalent in older people and are linked with poor health and cognitive outcomes, screening for the range of sleep disturbances is inefficient and therefore not ideal nor routine in memory and cognition clinic settings. We aimed to develop and validate a new brief self-report questionnaire for easy use within memory and cognition clinics. The design for this study was cross-sectional. Older adults (aged ≥50 in Sydney, Australia) were recruited from a memory and cognition research clinic. Participants (N = 497, mean age 67.7 years, range 50-86, 65.0% female) completed a comprehensive medical, neuropsychological, and mental health assessment, alongside self-report instruments, including existing sleep questionnaires and a new 10-item sleep questionnaire, the CogSleep Screener. We examined the factor structure, convergent validity, internal consistency, and discriminant validity of this novel questionnaire. Using exploratory factor analysis, a 3-factor solution was generated highlighting the factors of Insomnia, Rapid Eye Movement (REM) Symptoms and Daytime Sleepiness. Each factor was significantly correlated with currently used sleep questionnaires for each subdomain (all Spearman rho >0.3, all p < 0.001), suggesting good convergent validity. Internal consistency was also good (Revelle's ω = .74). Receiver operating characteristic curves showed good discriminative ability between participants with and without sleep disturbances (all area under curve >0.7, all p < 0.01). The CogSleep Screener has good psychometric properties in older to elderly adults attending a memory and cognition clinic. The instrument has the potential to be used in memory clinics and other clinical settings to provide quick and accurate screening of sleep disturbances. [Correction added on April 2025, after first publication: The number of participants has been updated and associated statistics have been updated].

CSF transport at the brain-meningeal border: effects on neurological health and disease

The existence of specialised structures that allow a continuous exchange of CSF between different anatomical compartments at the brain-meningeal border is challenging conventional notions around molecular transport within the brain. Experimental findings highlight the conduits and cellular structures controlling the transport of CSF and immune cells between the brain parenchyma (via the glymphatic system), the subarachnoid space (enclosed by the meningeal pia and arachnoid layers), and the outmost meningeal dural layer and calvaria (via the so-called arachnoid cuff exit points). Studies in both rodent models and humans show new mechanisms of brain glymphatic molecular transport, meningeal lymphatic vascular drainage, and immune surveillance at the brain-draining skull bone marrow and cervical lymph nodes. Pathological alterations at the brain-meningeal border have been implicated in disorders of diverse causes, from traumatic brain injury to Alzheimer's disease.

The effects of L-theanine consumption on sleep outcomes: A systematic review and meta-analysis

This systematic review ansd meta-analysis aimed to evaluate the effects of L-theanine, a non-proteinogenic amino acid found in tea, on sleep outcomes. Literature searches were conducted in five electronic databases (APA PsycINFO, CINAHL, Medline, Scopus, Web of Science), and one register (Cochrane Central Register of Controlled Trials) from inception until September 2024. Randomised controlled trials investigating the effects of L-theanine supplementation on sleep quality in humans of all ages and health status were included. Nineteen articles (N = 897 participants) were selected and 18 included in the meta-analysis. L-theanine was shown to significantly improve subjective sleep onset latency (SMD = 0.15, 95 % CI [0.01, 0.29], p = 0.04; n = 10 studies), subjective daytime dysfunction (SMD = 0.33, 95 % CI [0.16, 0.49], p < 0.001; n = 9 studies), and overall subjective sleep quality score (SMD = 0.43, 95 % CI [0.04, 0.83], p = 0.03; n = 12 studies). The findings indicate the potential use of L-theanine in the management of sleep disturbances; however, the lack of studies on "pure" L-theanine warrants further investigation. Future studies are needed to determine the adequate dose and duration of L-theanine supplementation for improving and maintaining sleep quality in healthy and clinical populations.

Perioperative sleep disturbances in older adults: a scoping review of epidemiology and treatment

PURPOSE

Perioperative sleep disturbances are prevalent in older adults undergoing surgery, contributing to poor postoperative recovery, increased complications, and prolonged hospitalization. Despite their clinical significance, standardized assessment and management approaches remain insufficient.

METHODS

A scoping review conducted in accordance with PRISMA-ScR guidelines was performed using PubMed, Embase, and Web of Science. Studies focusing on perioperative sleep disturbances in older adults (aged ≥ 65 years) were included, covering prevalence, risk factors, and outcomes. No language restrictions were applied, and studies in English, Chinese, and Japanese were included. Both subjective (e.g., Pittsburgh Sleep Quality Index) and objective (e.g., actigraphy, polysomnography) assessment tools were reviewed, with data synthesized narratively to summarize evidence on prevalence, risk factors, and management strategies.

RESULTS

Preoperative sleep disturbances prevalence ranges from 0 to 91%, while postoperative sleep disturbances affect 6.7% to 93% of patients. Most included studies enrolled participants aged 65-75 years, limiting generalizability to older adults ≥ 80 years. sleep disturbances are associated with increased postoperative pain sensitivity, heightened risk of delirium, cognitive decline, and prolonged recovery. Additionally, sleep disturbances correlate with worsened emotional states, including anxiety and depression, which further impair functional recovery. Key risk factors include pain, anesthesia, hospital environmental factors, and preexisting psychological distress. Management strategies involve multimodal analgesia, psychological interventions, environmental modifications, and pharmacologic treatments (e.g., dexmedetomidine, melatonin).

CONCLUSION

Perioperative sleep disturbances significantly impact postoperative recovery by affecting pain levels, cognitive function, emotional stability, and overall rehabilitation progress. Standardized assessment and targeted interventions are needed to mitigate these effects. Future research should refine diagnostic criteria and explore individualized treatment approaches to optimize perioperative sleep management.

Could self-reporting sleep duration become an important tool in the prediction of dementia?

INTRODUCTION

Optimal sleep duration is increasingly recognized as an important determinant of overall health, including cognitive functioning. Studies often report a U- or J-shaped relationship between sleep duration and incident dementia or cognitive deterioration, whereas long sleep, the extremes of sleep duration, and the transition to long sleep were particularly detrimental. In preclinical studies, partial or complete sleep deprivation produced inflammation, oxidative stress, as well as increased tau hyperphosphorylation and amyloid-β burden. In humans, although the findings are less pronounced, they still highlight that transitioning to an excessive sleep duration is associated with neurodegeneration. Moreover, the association between sleep duration and dementia is complex and modified by genetic, psychosocial and lifestyle factors, along with psychiatric and somatic comorbidities.

AREAS COVERED

The purpose of this perspective is to summarize the current knowledge on the association between sleep duration and dementia. It is based on a literature search for meta-analyses of prospective studies with sleep duration as an exposure and dementia as an outcome.

EXPERT OPINION

Sleep duration is a modifiable risk factor for dementia while long sleep may be an early sign of neurodegeneration. Therefore, self-reported sleep duration is an easy-to-use tool for detecting individuals who may be at risk for cognitive deterioration.

Exploring the nexus: Sleep disorders, circadian dysregulation, and Alzheimer's disease

We reviewed the connections among Alzheimer's disease (AD), sleep deprivation, and circadian rhythm disorders. Evidence is mounting that disrupted sleep and abnormal circadian rhythms are not merely symptoms of AD, but are also involved in accelerating the disease. Amyloid-beta (Aβ) accumulates, a feature of AD, and worsens with sleep deprivation because glymphatic withdrawal is required to clear toxic proteins from the brain. In addition, disturbances in circadian rhythm can contribute to the induction of neuroinflammation and oxidative stress, thereby accelerating neurodegenerative processes. While these interactions are bidirectional, Alzheimer's pathology further disrupts sleep and circadian function in a vicious cycle that worsens cognitive decline, which is emphasized in the review. The evidence that targeting sleep and circadian mechanisms may serve as therapeutic strategies for AD was strengthened by this study through the analysis of the molecular and physiological pathways. Further work on this nexus could help unravel the neurobiological mechanisms common to the onset of Alzheimer's and disrupted sleep and circadian regulation, which could result in earlier intervention to slow or prevent the onset of the disease.

The relationship between multiple chronic diseases and sleep quality among the older people ≥ 60 years in China

BACKGROUND

High-quality sleep is essential for both physical well-being and mental health, particularly in promoting the health and longevity of older adults. However, limited evidence exists regarding the relationship between chronic diseases and sleep quality in this population.

METHODS

The study investigated 35 common chronic diseases among 1186 older individuals aged 60 and above from six rural communities in northwest China. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple logistic regression and interaction analyses were employed to explore the relationship between multiple chronic diseases and sleep quality.

RESULTS

Compared with the first quartile (≤ 1) of the number of chronic diseases, the second (2), third (3-4), and fourth (≥ 5) quartile ORs were 1.771 (95% CI: 1.191-2.631, p = 0.005), 2.434 (95% CI: 1.660-3.567, p < 0.001), and 3.180 (95% CI: 2.039-4.959, p < 0.001), respectively. For the duration of chronic diseases, compared with the first quartile (≤ 4.32 years) of duration of chronic diseases, the second (4.33-7.49 years), third (7.50-11.32 years) and fourth (≥ 11.33 years) quartile ORs were 1.350 (95% CI: 0.931-1.957, p = 0.113), 1.381 (95% CI: 0.953-2.000, p = 0.088), and 1.629 (95% CI: 1.122-2.365, p = 0.010), respectively. Older adults with multimorbidity and a longer duration of chronic diseases (≥ 7.5 years) had poorer sleep quality than those without multimorbidity and shorter duration of chronic diseases.

CONCLUSION

The higher number and longer duration of chronic diseases are associated with poorer sleep quality among older adults, with a stronger correlation observed in females compared to males.

A sleep-based risk model for predicting dementia: Development and validation in a Korean cohort

BackgroundDementia is a major public health challenge, yet existing prediction models often overlook sleep-related symptoms, despite their known links to cognitive decline.ObjectiveTo develop and validate a four-year Dementia Risk Score (DRS) incorporating self-reported sleep-related symptoms with demographic and clinical factors to predict all-cause dementia, including Alzheimer's disease.MethodsData from 3082 Korean adults aged 60-79 years were analyzed. Predictors were selected using LASSO regression and included in a multivariate logistic regression model. A point-based scoring system, the DRS, was constructed from the model coefficients. Internal validation was conducted using bootstrapping and a separate dataset.ResultsThe DRS achieved robust predictive performance, with AUC values of 0.824 in the training set and 0.826 in the validation set. Key predictors included sleep disturbance, use of sleep medications, daytime dysfunction, leg discomfort, and urge to move legs.ConclusionsThe DRS provides a practical, scalable tool for predicting dementia risk, supporting community-based screening and early intervention. External validation is needed to confirm its broader applicability.

Impact of age on sleep duration and health outcomes: Evidence from four large cohort studies

BACKGROUND

Sleep duration (SD) is a critical determinant of health, with both short and long SD associated with increased risks of morbidity and mortality. However, distinct ages may exhibit unequal sleep needs. Few studies have addressed the modulation of age on SD associated all-cause mortality (AM). This study aimed to investigate age- and gender-specific associations between SD and AM.

METHODS

Four national cohort studies were conducted: National Health and Nutrition Examination Survey (NHANES), Survey of Health, Ageing and Retirement in Europe (SHARE), Chinese Longitudinal Healthy Longevity Survey (CLHLS), and China Health and Retirement Longitudinal Study (CHARLS). Data pre-processing such as integration, weighting and interpolation was conducted following cohort-specific user manuals. Restricted cubic spline (RCS) was used to test the nonlinear relationship. Kaplan-Meier and Cox regression survival analysis were used to evaluate the association between SD and AM. The moderation of mortality by SD was subsequently investigated in adult, middle-age, elderly and longevity.

RESULTS

RCS analysis showed a nonlinear correlation between SD and AM in the four cohorts(P < 0.001). Survival analysis reveals 6-8 h to be the optimal SD. Subgroup analyses showed a higher risk in adults with ≤5 h than ≥9 h (HR: 2.95 [1.90-4.59] vs 1.83 [1.08-3.12]), and a similar risk in middle age (HR: 2.42 [1.76-3.32] vs 2.44 [1.64-3.61]). In contrast, four datasets suggest a higher risk of the elderly being affected by long SD. Adults (HR = 1.82 [1.14-2.92], P = 0.012) and middle age (NHANES: HR = 1.50 [1.04-2.16], P = 0.029; SHARE: HR = 3.04 [1.10-8.41], P = 0.032) significantly increased the risk of short sleep compared to elderly.

CONCLUSIONS

SD associated mortality risk varies with age. Young adults should avoid poor sleep, while elderly should avoid sleeping too much.

Targeting Sleep Physiology to Modulate Glymphatic Brain Clearance

Sleep has been postulated to play an important role in the removal of potentially neurotoxic molecules, such as amyloid-β, from the brain via the glymphatic system. Disturbed sleep, on the other hand, may contribute to the accumulation of neurotoxins in brain tissue, eventually leading to neuronal death. A bidirectional relationship has been proposed between impaired sleep and neurodegenerative processes, which start years before the onset of clinical symptoms associated with conditions like Alzheimer's and Parkinson's diseases. Given the heavy burden these conditions place on society, it is imperative to develop interventions that promote efficient brain clearance, thereby potentially aiding in the prevention or slowing of neurodegeneration. In this review, we explore whether the metabolic clearance function of sleep can be enhanced through sensory (e.g., auditory, vestibular) or transcranial (e.g., magnetic, ultrasound, infrared light) stimulation, as well as pharmacological (e.g., antiepileptics) and behavioral (e.g., sleeping position, physical exercise, cognitive intervention) modulation of sleep physiology. A particular focus is placed on strategies to enhance slow-wave activity during nonrapid eye movement sleep as a driver of glymphatic brain clearance. Overall, this review provides a comprehensive overview on the potential preventative and therapeutic applications of sleep interventions in combating neurodegeneration, cognitive decline, and dementia.

Data-driven discovery of midlife cardiometabolic profile associated with incident early-onset and late-onset dementia

BACKGROUND

Cardiometabolic risk factors have been associated with the risk of late-onset dementia. However, evidence regarding early-onset dementia was inconsistent, and the impact of clustered cardiometabolic risk factors was unclear. We aimed to investigate the associations of cardiometabolic profiles with incident early-onset and late-onset dementia.

METHODS

Among 289 494 UK Biobank participants, cluster analysis was built on 12 common cardiometabolic markers. Analyses were performed on those aged <65 years at baseline (n = 249 870) for early-onset dementia and those ≥65 at the end of follow-up (n = 191 213) for late-onset dementia.

RESULTS

During a median follow-up of 14.1 years, 279 early-onset dementia cases and 3167 late-onset dementia cases were documented. Among the five clusters of cardiometabolic profiles identified (cluster 1 [obesity-dyslipidemia pattern], cluster 2 [high blood pressure pattern], cluster 3 [high liver enzymes pattern], cluster 4 [inflammation pattern] and cluster 5 [relatively healthy pattern]), cluster 3 was significantly associated with higher risks of both early-onset and late-onset dementia; however, the risk estimate for early-onset dementia (hazard ratio 2.58, 95% CI 1.61-4.14) was larger than that for late-onset dementia (1.36, 1.09-1.71). Cluster 4 was associated with a higher risk of late-onset dementia (hazard ratio 1.39, 95% CI 1.13-1.72). No significant interactions were observed between cardiometabolic clusters and apolipoprotein E ε4 genotype.

CONCLUSIONS

Cardiometabolic patterns characterised by relatively high liver enzyme levels or systemic inflammation were associated with increased risks of early-onset and late-onset dementia. Identification of high-risk subgroups according to distinct cardiometabolic patterns might help develop more precise strategies for dementia prevention regardless of apolipoprotein E (APOE) ε4 status.

Astrocytic GluN2A alleviates sleep deprivation-induced elevation of Aβ through regulating neprilysin and AQP4 via the calcineurin/NFAT pathway

Sleep disorders can increase amyloid beta (Aβ) burden in the brain and are linked to Alzheimer's disease (AD) risk. The precise mechanism by which sleep disturbances elevate Aβ levels is unclear. Our previous study has demonstrated that knocking down encoding gene Grin2a of astrocytic N-methyl-D-aspartate (NMDA) receptors GluN2A subunit could aggravate sleep deprivation (SD)-induced elevation of Aβ, indicating a protective role of astrocytic GluN2A in SD; but the underlying mechanism needs to be further elucidated. In our present study, using rat models of SD combined with specific astrocytic Grin2a knockdown or overexpression in the hippocampus, and a cell model of primary cultured hippocampal astrocytes, we reveal a novel mechanism that astrocytic GluN2A alleviates SD-induced increases in Aβ. We demonstrated that astrocytic GluN2A mainly affected Aβ degradation and clearance through regulating degradation enzyme neprilysin and Aquaporin-4 (AQP4), via the calcineurin/NFAT pathway. Our study provides supportive evidence for the novel role and mechanism of astrocytic GluN2A in Aβ elimination, which would contribute to the discovery of new therapeutic strategies for Aβ-related diseases such as AD.

Longitudinal Proteomic Profiling of Cognition across an Aerobic Exercise Intervention

The physiological basis of cognitive decline remains largely uncharacterized. We identified a protein panel signature, in living humans, that correlates to improvement in neurocognition over a period of 5 years. Our signature is composed of complement proteins, coagulation cascade, and extracellular matrix regulators. In our cohort, SERPINF1 is associated with greater maximal oxygen uptake after an aerobic exercise intervention. Sleep quality is also a key factor in relation to inter-alpha-trypsin inhibitor heavy chain H2, which was associated with greater sleep efficiency. Additionally, we validate that the coagulation profile of decliners' plasma contains procoagulant agonists, leading to greater platelet activation. ANN NEUROL 2025;97:1007-1018.

Sleep quality of college students in Fujian and its influencing factors: A cross-sectional study

AIM

This study aims to investigate college students' sleep quality, explore the factors influencing it, and provide data support for further studies.

METHODS

College students in Fujian Province were chosen as the study sample using snowball sampling. Data was gathered from the participants through the utilization of a self-designed personal questionnaire, the Pittsburgh Sleep Quality Index(PSQI) scale, and the Mobile Phone Addiction Index (MPAI) scale. Binary logistic regression is utilized to assess the sleep quality of college students and identify risk factors.

RESULTS

A total of 971 participants were included in this study. The mean total PSQI score was 4.52 ± 3.17. There were 310 students with poor sleep quality and the detection rate was 32.0%. The multivariate logistic regression analysis showed that smoking (OR(Odds ratio):1.832(1.076,3.118)), electronic product addiction(OR:2.861(1.928,4.246)), personal history of acute illness(OR:2.328(1.671,3.244)) were identified as independent risk factors.In turn, education (OR:0.594(0.456,0,772)) and parents without sleep problems (OR:0.533(0.361,0.787)) were protective factors.

CONCLUSION

College students in Fujian have some sleep problems. We should pay attention to the relationship between smoking, electronic product addiction, personal history of acute illness and sleep quality. Health policymakers should consider these factors to improve college students' sleep quality.

The association between sleep duration and cognitive function in the U.S. elderly from NHANES 2011-2014: A mediation analysis for inflammatory biomarkers

BACKGROUND

Studies have shown a close association between sleep duration and cognitive function in older adults. However, no studies have explored the underlying mechanisms of this relationship. This study was designed to assess the role of inflammatory markers in the relationship between sleep duration and cognitive function in older Americans.

METHODS

A total of 2502 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the analysis. Cognitive function was assessed using three tests from NHANES. Sleep duration was evaluated through a self-reported sleep time questionnaire. Inflammatory biomarkers examined included leukocytes (WBC) count, neutrophil count (NE), the neutrophil-to-lymphocyte ratio (NLR), and the systemic immune-inflammation index (SII). Mediation models were constructed to clarify the mediating role of inflammatory biomarkers.

RESULTS

Long sleep duration (≥9 h) was associated with lower performance on CERAD (OR: -1.623; 95 % CI: -2.979 to -0.267) and DSST (OR: -3.084; 95 % CI: -5.861 to -0.308) compared to the normal sleep duration group (7-9 h). NE partially and indirectly mediated this association. Meanwhile, WBC moderated the association between long sleep duration (≥9 h) and DSST performance.

LIMITATIONS

The cross-sectional design prevents making causal inferences.

CONCLUSIONS

Long sleep duration is a risk factor for cognitive function. Inflammatory biomarkers based on blood cells present a readily accessible and cost-effective strategy for identifying sleep disorders and also significantly mediate the association between long sleep duration and cognitive function.

Shuangxia Decoction attenuates sleep disruption in 5×FAD mice through neuroinflammation inhibition: An integrative analysis of transcriptomic and molecular biology investigations

ETHNOPHARMACOLOGICAL RELEVANCE

Alzheimer's disease (AD) is a neurodegenerative disease characterized by memory and learning deficits. Circadian rhythm disruption-induced sleep disruption is frequently observed in AD patients. The Shuangxia Decoction (SXD) comprising Pinellia ternata (Thunb.) Breit. (Banxia) and Prunella vulgaris L. (Xiakucao), has been effectively used to treate sleep disruption for thousands of years. However, the mechanisms by which SXD treated AD through circadian rhythm-related pathways remain unexplored.

AIMS OF THE STUDY

This research sought to determine the efficacy, mechanisms, and active compounds of SXD in AD treatment via an integrative approach.

MATERIALS AND METHODS

We conducted a chronic jet lag (CJL) protocol in wild-type (WT) mice and monitored their rest/activity to compare their rest/activity period among WT, CJL, and CJD + SXD groups. In addition, we evaluated the impact of SXD on the cognitive and Aβ burden of 5 × FAD mice by behavioral tests and Thioflavin staining. The underlying pathway analysis of SXD was revealed through transcriptomic and biology experimental validation. The active compounds of SXD were further analyzed using the UPLC-MS, molecular docking, and cellular thermal shift assay (CESTA).

RESULTS

Our study demonstrated a rapid recovery of rest/activity period in CJL mice following SXD treatment. Additionally, SXD treatment alleviated Aβ plaque accumulation, subsequently preserving cognitive behavior and motor ability in 5 × FAD mice. Moreover, SXD significantly enhanced neuronal synaptic plasticity dendritic plasticity in CA1 neurons of 5 × FAD mice. Transcriptomic analysis showed upregulation of the neuroinflammation-related pathway in 5 × FAD mice. Subsequent heatmap analysis indicated a suppression of inflammatory factor secretion (Cd68, Trem2, IL-6, IL-1β, Cxc3r1, Tnf et al.) and an increase of anti-inflammatory factor secretion (IL4, Ccl19, Ccl21a et al.) following SXD treatment in the 5 × FAD mice. Meanwhile, SXD upregulated positive regulators involved in the circadian rhythm like Bmal1 and Clock, and downregulated negative regulators like Nr1d1. Moreover, microglia exhibited an amoeboid morphology characterized by few processes and rounded cell bodies in 5 × FAD mice, whereas the age-matched SXD group maintained microglia with a ramified appearance. Additionally, our study identified 20 major components of SXD and identified 3-(3,4-Dihydroxyphenyl) lactic acid, Salviaflaside, and Ilexhainanoside D for further molecular docking with REV-ERBα (NR1D1), a commonly used circadian target. Salviaflaside further showed a strong bind with REV-ERBα via CESTA.

CONCLUSIONS

Our findings indicate that SXD may rescue circadian rhythm in 5 × FAD mice through specifically binding to REV-ERBα in microglia to activate the BMAL1/CLOCK pathway, thus inhibiting transcription of inflammatory factors, contributing to alleviating neuroinflammation and impeding AD progression. Our results offer a scientific foundation for developing SXD-based therapies in the early stage of AD, where sleep disruption precedes cognitive decline, offering potential leads for clinical trials to improve sleep quality thus delaying neurodegeneration in AD patients.

Insomnia and risk of all-cause dementia: A systematic review and meta-analysis

BACKGROUND

The evidence on the relationship between insomnia and risk of dementia, Alzheimer's disease (AD), and Vascular dementia (VD) is not consistent. We conducted this meta-analysis to examine the evidence for the risk of developing dementia, AD, or VD in patients with all subtypes of insomnia.

METHODS

A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted using the following search strings: 'Insomnia OR Sleep initiation and Maintenance disorders OR Early morning awakening' AND 'Dementia OR Alzheimer's Disease OR Vascular Dementia' AND 'Risk'. Data extraction was done independently by two researchers. Pooled odds ratio (OR) accompanied by 95% confidence interval (CI) were calculated using either a random-effects model or a fixed-effects model. Sensitivity analyses were performed to assess the robustness of the findings. The potential for publication bias was evaluated through Egger's test and Begg's test.

RESULTS

This meta-analysis included 16 studies with a combined sample size of over 9 million individuals. Pooled analyses revealed a significant association between insomnia and dementia risk (OR = 1.36; 95% CI: 1.01-1.84), with increased risks for AD (OR = 1.52; 95% CI: 1.19-1.93) and VD (OR = 2.10; 95% CI = 2.06-2.14). Subgroup analyses showed no evidence of associations between initial insomnia (OR = 1.01; 95% CI = 0.71-1.31), sleep-maintenance insomnia (OR = 0.88; 95% CI = 0.66-1.17), and early morning awakening (OR = 0.94; 95% CI = 0.83-1.07) with dementia risk. Insomnia patients from Europe (OR = 1.24; 95% CI = 1.14-1.35), Asia (OR = 2.19; 95% CI = 2.06-2.32), and the Americas (OR = 1.05; 95% CI =  1.04-1.07) had varying risks of dementia. Subgroups with less than five years of follow-up (OR = 2.16; 95% CI = 1.81-2.60) exhibited higher dementia risks in insomnia patients, while those with more than five years of follow-up (OR = 1.17; 95% CI = 1.03-1.33) showed a lower risk.

CONCLUSION

Our meta-analysis reveals that insomnia is linked to the risk of dementia, AD, and VD. These findings suggest that insomnia may significantly contribute to the risk of all-cause dementia, highlighting the importance of early intervention and management of insomnia. Despite our efforts to minimize and explore the sources of heterogeneity, it still remained, and therefore our results should be interpreted with caution.

The diagnostic and therapeutic value of time in bed extension in Insufficient Sleep Syndrome

BACKGROUND

Insufficient sleep syndrome (ISS) represents an emerging health concern but remains poorly defined as a diagnostic entity, though included in the international classification of sleep disorders. In the present study, we aimed to clarify the longitudinal course of ISS and to identify prognostic factors by comparing remitting and non-remitting patients.

METHODS

A chart-review was realized, retrieving fifty-five patients with ISS (aged 39.8 ± 16.6 years, with 44.6 % of women) who underwent a comprehensive clinical evaluation at baseline and during a follow-up visit after 3-6 months. This evaluation included sleep symptoms, sleep logs, medications, and comorbidities. Additionally, actigraphy, video-polysomnography, and a multiple sleep latency test were conducted at baseline, and at the same moment standard psychoeducation on sleep was provided.

RESULTS

During the follow-up visit, 69 % of patients still met the criteria for a clinical diagnosis of ISS, experiencing symptoms such as daytime sleepiness, disrupted nighttime sleep, unrefreshing sleep, and sleep attacks. Comparing sleep patterns of remitters and non-remitters based on sleep diaries, we observed that remission is associated with not only an increase in total sleep time but also a more regular sleep schedule. This regularity includes a reduction in napping and a lesser difference in sleep timings between weekdays and weekends. However, comparing baseline clinical and instrumental data between remitters and non-remitters revealed no significant differences, hindering the use of these features as prognostic factors.

CONCLUSIONS

Given the low remission rate with standard treatment (i.e. psychoeducation on sleep), we propose the following: (1) Criterion E (extension of total sleep time results in resolution of the symptoms of sleepiness) should be considered as a therapeutic advice, and supportive rather than necessary for the diagnosis; (2) specific cognitive-behavioral therapy protocols targeting the cognitive factors underlying sleep-depriving behaviors are required, as single routine behavioral interventions are insufficient.

Efficacy and Safety of Bilateral Deep Brain Stimulation (DBS) for Severe Alzheimer's Disease: A Comparative Analysis of Fornix Versus Basal Ganglia of Meynert

BACKGROUND

Deep brain stimulation (DBS) is a novel therapy for severe Alzheimer's disease (AD). However, there is an ongoing debate regarding the optimal target for DBS, particularly the fornix and the basal ganglia of Meynert (NBM).

OBJECTIVE

This study aimed to investigate the safety and efficacy of DBS for severe AD and to compare the fornix and the NBM as potential targets.

METHODS

We conducted a prospective, nonrandomized clinical study involving 20 patients with severe AD (MMSE score 0 to 10, CDR level 3) from January 2015 to August 2022, comprising 12 males and eight females, with a mean age of 59.05 ± 6.45 years. All patients underwent DBS treatment, among which 14 received bilateral fornix implantation, while six received bilateral implantation in the NBM. Electrical stimulation commenced 1 month postoperatively. We assessed the patients before surgery, followed by evaluations at 1 month, 3 months, 6 months, and 12 months poststimulation. Primary outcome measures focused on changes in cognitive function, assessed using the MMSE, MoCA, ADAS-Cog, and CDR scales. Secondary measures encompassed quality of life, caregiver burden, neuropsychiatric symptoms, and sleep disturbances, evaluated through the BI, FAQ, FIM, ZBI, NPI, HAMA, HAMD, and PSQI scales.

RESULTS

All patients tolerated DBS well, with no serious adverse effects reported. Early on, DBS significantly improved cognitive function and quality of life. Long-term benefits include the improvement of neuropsychiatric symptoms and sleep disorders and the alleviation of caregiver burden. Comparison between DBS targeting the NBM and fornix revealed no significant differences in overall scale scores. However, upon deeper analysis, NBM-DBS exhibited a more pronounced improvement in neuropsychiatric symptoms, particularly in NPI scores.

CONCLUSION

DBS is a potential therapeutic approach for severe AD, capable of improving patients' cognitive function, quality of life, and neuropsychiatric symptoms. Notably, NBM-DBS showed distinct advantages in ameliorating neuropsychiatric symptoms, providing valuable insights for clinically selecting the optimal DBS target.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03115814.

Tauopathy after long-term cervical lymphadenectomy

INTRODUCTION

This study examined the effects of long-term cervical lymphadenectomy (cLE) on cognitive and Alzheimer's disease (AD)-like tauopathy changes.

METHODS

Male C57BL/6 mice were used to assess cLE impacts on sleep, brain pathways, and pathologies. RNA sequencing and proteomics analyzed gene/protein changes, with results verified by western blotting and immunofluorescence.

RESULTS

CLE led to sleep and psychiatric disorders, linked to mitogen-activated protein kinase/extracellular signal-regulated kinase (ERK) pathway activation. Activation of ERK may interfere with autophagy and is associated with phosphorylated tau accumulation. Peripheral blood analysis shows decreased brain waste in the peripheral blood post-cLE, implicating impaired lymphatic drainage and brain waste build-up.

DISCUSSION

These findings suggest a potential connection between cLE and AD-like tauopathy, potentially influencing surgical decisions.

HIGHLIGHTS

Cervical lymphadenectomy (cLE) is the cornerstone of head and neck cancers, affecting millions of people each year. We provide the first evidence of mildly impaired cognitive functioning with significant anxiety-depressive disorders in mice after long-term cLE. Long-term cLE not only directly impairs brain wastes (amyloid beta, phosphorylated tau [p-tau]) drainage, but also activates the Erk1/2 signaling pathway leading to attenuation of autophagy. We found for the first time that long-term cLE accelerated the deposition of p-tau in young mice. Patients after clinical cervical lymph node dissection showed reduced brain waste in peripheral blood consistent with mouse models. This study suggests the need for further evaluation of the neurologic effects of cervical lymph node dissection, a procedure that affects millions of people each year.

Real-world datasets for the International Registry for Alzheimer's Disease and Other Dementias (InRAD) and other registries: An international consensus

BACKGROUND

Many dementia and Alzheimer's disease (AD) registries operate at local or national levels without standardization or comprehensive real-world data (RWD) collection. This initiative sought to achieve consensus among experts on priority outcomes and measures for clinical practice in caring for patients with symptomatic AD, particularly in the mild cognitive impairment and mild to moderate dementia stages.

OBJECTIVE

The primary aim was to define a minimum dataset (MDS) and extended dataset (EDS) to collect RWD in the new International Registry for AD and Other Dementias (InRAD) and other AD registries. The MDS and EDS focus on informing routine clinical practice, covering relevant comorbidities and safety, and are designed to be easily integrated into existing data capture systems.

METHODS AND RESULTS

An international steering committee (ISC) of AD clinician experts lead the initiative. The first drafts of the MDS and EDS were developed based on a previous global inter-societal Delphi consensus on outcome measures for AD. Based on the ISC discussions, a survey was devised and sent to a wider stakeholder group. The ISC discussed the survey results, resulting in a consensus MDS and EDS covering: patient profile and demographics; lifestyle and anthropometrics; co-morbidities and diagnostics; imaging; treatment; clinical characterization; safety; discontinuation; laboratory tests; patient and care partner outcomes; and interface functionality.

CONCLUSION

By learning from successful examples in other clinical areas, addressing current limitations, and proactively enhancing data quality and analytical rigor, the InRAD registry will be a foundation to contribute to improving patient care and outcomes in neurodegenerative diseases.

Choline alleviates cognitive impairment in sleep-deprived young mice via reducing neuroinflammation and altering phospholipidomic profile

Cognitive impairment resulting from insufficient sleep poses a significant public health concern, particularly in children. The effects and mechanisms of choline on cognitive impairment caused by sleep deprivation are unknown. Chronic sleep deprivation is induced in young mice in this study, followed by feeding diet containing 11.36 g/kg choline bitartrate. Choline supplementation significantly improves spatial learning ability. Functional MRI results reveal the hippocampus as a key region affected by sleep deprivation, where choline supplementation notably preserves hippocampal structural integrity and enhanced connectivity. Additionally, choline ameliorates hippocampal pathological injury, reduces blood-brain barrier permeability and serum brain injury biomarkers. Choline also reduces inflammation and oxidative stress biomarkers, and mitigates microglial activation in the hippocampus, which preserves synaptic plasticity. A key finding is the changes of hippocampal phospholipidomic profile along with cognitive function, and a total of 313 phospholipid molecules are identified. Choline increases the levels of total phospholipid and sub-classes (particularly PC), which are strongly correlated with reduced neuroinflammation and oxidative stress biomarkers, as well as improved cognitive outcomes. Furthermore, there are similar findings in some phospholipid molecules such as PC 36:1, PC O-33:0, PC p-38:3, PE 36:3, PE p-42:4 and PS 44:12. These findings highlight that choline alleviates cognitive impairment in sleep deprivation via reducing neuroinflammation and oxidative stress as well as altering phospholipidomic profile. This study suggests that choline could develop into functional food or medicine ingredient to prevent and treat cognitive impairment by sleep disturbances, particularly children and adolescents.

The up-regulation of PTBP1 expression level in patients with Insomnia by senile dementia and promote cuproptosis of nerve cell by SLC31A1

Alzheimer's disease (AD), often referred to as the modern-day scourge, stands as a significant health challenge characterized by high rates of disability and mortality, particularly among the geriatric population. Thus, the present study investigated the precise details of PTBP1 involvement in cuproptosis of nerve cell of patients with Insomnia by senile dementia (ISD). Patients with ISD, early mild cognitive impairment (EMCI) and Normal healthy volunteers were obtained. In the context of ISD, the elevated PTBP1 mRNA expressions were observed in patient samples, correlating positively with diminished cognitive function as measured by the Mini-Mental State Examination (MMSE) and increased geriatric depression scale scores. The pivotal role of PTBP1 was further underscored by its inhibitory effects in a mice model, which prevented the development of senile dementia, and its influence on neuronal cell proliferation and ROS-induced oxidative stress in vitro. Additionally, PTBP1's regulatory capacity on the cuproptosis of nerve cells and its modulation of SLC31A1 expression, through effects on ubiquitination, were revealed. The stability of PTBP1, critical for its function, was enhanced by the m6A modification mediated by METTL3, highlighting a complex regulatory network in the pathogenesis of ISD. These data confirmed that PTBP1 plays a pivotal role in promoting the oxidative response and cuproptosis in Alzheimer's disease models via the SLC31A1 pathway. The findings suggest that PTBP1 could serve as a potential biomarker for the diagnosis and prognostic evaluation of ISD and AD, paving the way for the development of novel therapeutic strategies targeting this protein.

Association between sleep quality and mild cognitive impairment in Chinese patients with type 2 diabetes mellitus: a cross-sectional study

BACKGROUND

Globally, the number of individuals with type 2 diabetes mellitus (T2DM) is increasing, and they are at a higher risk of developing mild cognitive impairment (MCI) than the general population. Sleep quality is thought to be a modifiable factor that may contribute to MCI, as previous studies have linked it to cognitive function in older adults. However, evidence concerning the association between sleep quality and MCI among patients with T2DM in China is limited. Therefore, this study aims to identify the association between sleep quality and MCI among patients with T2DM in China.

METHODS

This cross-sectional study was conducted among patients with T2DM who were referred to the Endocrinology Department of Xiangya Hospital, Central South University. Data regarding sociodemographic characteristics, lifestyle factors, T2DM-related information, and biochemical indicators were collected. Sleep quality and MCI were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Mini-Mental State Examination (MMSE) scale, respectively. The association between sleep quality and MCI was analyzed using univariate and multivariate analyses.

RESULTS

This study included 1,001 patients with T2DM, with a mean age of 60.2 (standard deviation: 10.1) years. Pearson's correlation analysis showed that the total PSQI score was negatively associated with the MMSE score (r=-0.27, P < 0.05). Multivariate analyses based on four models consistently showed that those with higher total PSQI score (aOR = 1.09-1.11, P < 0.05), as well as higher scores on the subjective sleep quality (aOR = 1.32-1.46, P < 0.05), sleep latency (aOR = 1.25-1.32, P < 0.05), sleep duration (aOR = 1.30-1.32, P < 0.05), sleep efficiency (aOR = 1.36-1.41, P < 0.05), sleep disturbance (aOR = 1.66-1.86, P < 0.05), and daily dysfunction (aOR = 1.38-1.48, P < 0.05) were associated with higher rates of MCI.

CONCLUSIONS

Among Chinese patients with T2DM, poor overall sleep quality, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, and daily dysfunction were associated with higher rates of MCI. Future studies are needed to examine whether sleep intervention could improve cognitive function in patients with T2DM. It is also suggested for clinicians working with T2DM patients to raise the awareness of cognitive impairment and sleep problems.

The Potential Role of Neurogranin in Alzheimer's Disease

Alzheimer's disease (AD) is the most common form of dementia and is characterized by the excessive deposition of amyloid-β (Aβ) plaques and the formation of neurofibrillary tangles. Numerous new studies also indicate that synaptic damage and loss play crucial roles in AD and form the basis of cognitive impairment. In recent years, synaptic-related proteins have emerged as important biomarkers for the early diagnosis of AD. Among these proteins, neurogranin (Ng), a postsynaptic protein widely present in the dendritic spines of the associative cortex in the brain, plays a significant role in memory, learning, synaptic plasticity, and long-term potentiation (LTP). This review aims to reveal the link between Ng and AD, as well as the potential for the diagnosis of AD, the prediction of the development of the disease, and the identification of a therapeutic target for AD.

Red blood cell distribution width to albumin ratio (RAR) is associated with low cognitive performance in American older adults: NHANES 2011-2014

BACKGROUND

The red blood cell distribution width to albumin ratio (RAR) is a novel comprehensive biomarker of inflammation and nutrition, which has emerged as a reliable prognostic indicator for adverse outcomes and mortality in patients with various diseases. However, the association between RAR and low cognitive performance in older adults remains unclear. This study aims to investigate the relationship between RAR and low cognitive performance among older adults in the United States.

METHODS

This study, a retrospective analysis, included 2,765 participants aged 60 years and older from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2014. Low cognitive performance was assessed using word learning subset from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Digit Symbol Substitution Test (DSST), and the Animal Fluency Test (AFT). Low cognitive performance was defined as scores below the lowest quartile in each cognitive test. The association between RAR and low cognitive performance was evaluated using weighted multivariable logistic regression, restricted cubic splines (RCS), and subgroup analyses.

RESULTS

After adjusting for all potential confounders, RAR was independently and linearly positively associated with both low DSST performance and low AFT performance. Specifically, compared to participants in the first quartile of RAR, those in the fourth quartile had adjusted ORs (95% CIs) of 1.81 (1.03, 3.20) for low DSST performance and 1.68 (1.05, 2.67) for low AFT performance. Subgroup analysis did not reveal significant interactions between stratification variables.

CONCLUSION

RAR is significantly linearly positively associated with low cognitive performance. Maintaining a lower RAR may be a crucial strategy for mitigating the risk of cognitive decline in the elderly population.

Structural insights into human ABCA7-mediated lipid transport

The human ATP-binding cassette (ABC) transporter ABCA7 participates in the lipidation of apolipoprotein ApoE, a commonly recognized risk factor for Alzheimer's disease (AD). How ABCA7 is involved in the molecular pathogenesis of AD remains poorly understood. Using cryoelectron microscopy (cryo-EM), we determined ABCA7 structures in the apo and substrate-bound forms, respectively. Combined with activity assays, we assigned the residues that specifically bind two molecules of phosphatidylserine (PS) that are arranged in a "tail-to-tail" manner. Pull-down assays confirmed that ApoE directly interacts with ABCA7; and moreover, both ATPase and lipid transport activities of ABCA7 were significantly enhanced in the presence of ApoE. We also measured the activities of a familial AD variant and a protective clinically reported variant in the ABCA7 gene. Our findings not only give structural insights into ABCA7-mediated PS translocation, but we also provide first biochemical evidence for its link to AD by forwarding lipids to ApoE.

The effectiveness of exercise interventions in the improvement of sleep in older adult people: a meta-analysis

Background

Sleep problems are prevalent among the older adult population, with a significant impact on their health and overall well-being. Several randomized controlled trials (RCTs) have yielded controversial results regarding the efficacy of exercise interventions in the improvement of sleep among older adult people. This systematic review and meta-analysis aim to assess the influence of exercise interventions on sleep quality within this demographic.

Methods

A search was conducted across four databases, namely Web of Science, PubMed, Embase, and SportDiscus, in order to identify randomized controlled trials investigating exercise interventions and sleep in the older adult. The quality of the studies included was evaluated by two researchers according to the PEDro scale. Meta-analysis and sensitivity analysis were performed utilizing RevMan 5.4 and Stata 17 software.

Result

A total of fifty studies encompassing 3,937 participants were included in the analysis. Regarding patient-reported sleep parameters, exercise interventions exhibited enhancements in sleep quality (WMD = -2.18, 95%CI: -2.83 to -1.53, p < 0.01) and reductions in insomnia severity (SMD = -0.52, 95%CI: -0.79 to -0.25, p < 0.01), albeit without significant improvements in daytime sleepiness (SMD = -0.66, 95%CI: -1.41 to 0.09, p = 0.09). In terms of clinician-reported sleep parameters, exercise interventions resulted in increased total sleep time (WMD = 8.98, 95%CI: 1.19 to 16.78, p < 0.05) and sleep efficiency (WMD = 3.66, 95%CI: 2.46 to 4.85, p < 0.01), and reduced wake time after sleep onset (WMD = -11.85, 95%CI: -15.58 to -8.11, p < 0.01), but did not decrease sleep onset latency (WMD = -3.05, 95%CI: -6.23 to 0.13, p = 0.06) or the number of awakenings during sleep (WMD = -0.73, 95%CI: -1.98 to 0.52, p = 0.25).

Conclusion

Exercise interventions have demonstrated positive effects on enhancing sleep quality among the older adult population. This study lends support to the utilization of exercise interventions as a safe, feasible, and effective non-pharmacological treatment approach for enhancing sleep among older individuals.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024530227, Identifier CRD42024530227.

Association between pain, sleep and intrinsic capacity in Chinese older adults: Evidence from CHARLS

OBJECTIVES

To examine the relationship between pain, sleep, and intrinsic capacity (IC).

DESIGN

A cohort study.

SETTING AND PARTICIPANTS

Data were obtained from participants in China Health and Retirement Longitudinal Study (CHARLS) 2011-2015. The study population consisted of older adults who completed assessments on pain, sleep duration, sleep quality and IC at baseline.

MEASUREMENTS

Pain, sleep duration, and sleep quality were assessed through self-reports from participants. The total IC score was derived from five domains: psychological, sensory, cognitive, locomotor, and vitality. The relationships between pain, sleep duration, sleep quality and IC were analyzed using linear mixed models. The relationship between sleep duration and IC was analyzed using quadratic analysis. Stratified analyses by gender and age were also performed.

RESULTS

A total of 3517 participants were included in the analysis. After adjusting for all covariates, single-site pain (β = -0.29, 95% confidence interval [CI] = -0.38 to -0.20) and multisite pain (β = -0.41, 95% CI = -0.48 to -0.34) were significantly associated with a decrease in IC compared with older adults without pain; long sleep duration (β = -0.15, 95% CI = -0.24 to -0.06) was significantly associated with a decrease in IC compared with older adults with moderate sleep duration; and poor sleep quality (β = -0.63, 95% CI = -0.71 to -0.55) and fair sleep quality (β = -0.33, 95% CI = -0.40 to -0.27) were significantly associated with a decrease in IC compared with older adults with good sleep quality.

CONCLUSION

To maintain IC, it is important to ensure approximately 7.5 h of sleep duration, improve sleep quality, and manage pain. Interventions should begin as early as possible.

Circadian rhythm, microglia-mediated neuroinflammation, and Alzheimer's disease

Microglia, the brain's resident macrophages, are key mediators of neuroinflammation, responding to immune pathogens and toxins. They play a crucial role in clearing cellular debris, regulating synaptic plasticity, and phagocytosing amyloid-β (Aβ) plaques in Alzheimer's disease (AD). Recent studies indicate that microglia not only exhibit intrinsic circadian rhythms but are also regulated by circadian clock genes, influencing specific functions such as phagocytosis and the modulation of neuroinflammation. Disruption of the circadian rhythm is closely associated with AD pathology. In this review, we will provide an overview of how circadian rhythms regulate microglia-mediated neuroinflammation in the progression of AD, focusing on the pathway from the central nervous system (CNS) and the peripheral immune system. We also discuss potential therapeutic targets, including hormone modulation, lifestyle interventions, and anti-inflammatory therapies, aimed at maintaining brain health in AD. This will shed light on the involvement of circadian rhythm in AD and explore new avenues for AD treatment.

Advanced nano delivery system for stem cell therapy for Alzheimer's disease

Alzheimer's Disease (AD) represents one of the most significant neurodegenerative challenges of our time, with its increasing prevalence and the lack of curative treatments underscoring an urgent need for innovative therapeutic strategies. Stem cells (SCs) therapy emerges as a promising frontier, offering potential mechanisms for neuroregeneration, neuroprotection, and disease modification in AD. This article provides a comprehensive overview of the current landscape and future directions of stem cell therapy in AD treatment, addressing key aspects such as stem cell migration, differentiation, paracrine effects, and mitochondrial translocation. Despite the promising therapeutic mechanisms of SCs, translating these findings into clinical applications faces substantial hurdles, including production scalability, quality control, ethical concerns, immunogenicity, and regulatory challenges. Furthermore, we delve into emerging trends in stem cell modification and application, highlighting the roles of genetic engineering, biomaterials, and advanced delivery systems. Potential solutions to overcome translational barriers are discussed, emphasizing the importance of interdisciplinary collaboration, regulatory harmonization, and adaptive clinical trial designs. The article concludes with reflections on the future of stem cell therapy in AD, balancing optimism with a pragmatic recognition of the challenges ahead. As we navigate these complexities, the ultimate goal remains to translate stem cell research into safe, effective, and accessible treatments for AD, heralding a new era in the fight against this devastating disease.

A pathway study of factors influencing anxiety in patients with gestational diabetes mellitus

BACKGROUND

This study aims to assess anxiety severity among patients with and to elucidate the predominant psychological factors, informing the development of targeted anxiety management strategies.

METHODS

The cross-sectional study recruited 421 GDM patients via convenience sampling from Guangdong Province, China. Self-administered questionnaires, including the Pregnancy-related Anxiety Scale, Simplified Coping Style Questionnaire, Type D Personality Scale, Perceived Social Support Scale, and General Self-Efficacy Scale, were utilized to gather data. Data analysis was performed using Structural Equation Modeling (SEM) in AMOS 25.0 and SPSS 25.0.

RESULTS

Among patients with GDM, anxiety was significantly and positively associated with negative coping styles (β = 0.190, P < 0.01) and Type D personality (β = 0.167, P < 0.01), indicating their roles in exacerbating anxiety. In contrast, positive coping (β=-0.136, P < 0.01), perceived social support (β=-0.206, P < 0.01) and general self efficacy (β=-0.49, P < 0.01) had direct negative impacts on anxiety, suggesting their protective influence. Mediation analysis revealed that negative coping and Type D personality exerted significant mediating effects on anxiety, with the pathway from negative coping through Type D personality explaining 16% of the indirect effect (β = 2.302, 95% CI: 1.411 ~ 3.350) and the pathway from Type D personality through perceived social support explaining 32% of the indirect effect (β = 4.528, 95% CI: 3.231 ~ 5.913).

CONCLUSION

The study identifies key psychological modifiers of anxiety in GDM, suggesting that targeted psychological support could mitigate anxiety and improve pregnancy outcomes.

Chronic sleep curtailment expediates brain aging by activating the complement and coagulation cascades in mice

Chronic sleep insufficiency is prevalent in modern society and has been associated with age-related neurodegenerative diseases. Loss of sleep accelerates the progression of neurodegeneration in animal models of neurological diseases. Here, we study whether chronic sleep curtailment leads to brain aging in wild-type animals without a genetic predisposition. We used a wild-type mouse model to simulate modern-day conditions of restricted sleep and compared the brain (cortex) proteome of young sleep-restricted animals with different aged control groups. We report the alteration of 149 proteins related to sleep and 1269 related to age with 96 proteins common between them. Through pathway analysis of proteins common to sleep restriction and aging, we discovered that the complement and coagulation cascade pathways were enriched by alterations of complement component 3 (C3), alpha-2-macroglobulin (A2M), fibrinogen alfa and beta chain (FGA and FGB). This is the first study indicating the possible role of the complement and coagulation pathways in brain aging and by chronic sleep restriction (CSR) in mice.

Advancing Alzheimer's disease risk prediction: development and validation of a machine learning-based preclinical screening model in a cross-sectional study

OBJECTIVES

Alzheimer's disease (AD) poses a significant challenge for individuals aged 65 and older, being the most prevalent form of dementia. Although existing AD risk prediction tools demonstrate high accuracy, their complexity and limited accessibility restrict practical application. This study aimed to develop a convenience, efficient prediction model for AD risk using machine learning techniques.

DESIGN AND SETTING

We conducted a cross-sectional study with participants aged 60 and older from the National Alzheimer's Coordinating Center. We selected personal characteristics, clinical data and psychosocial factors as baseline predictors for AD (March 2015 to December 2021). The study utilised Random Forest and Extreme Gradient Boosting (XGBoost) algorithms alongside traditional logistic regression for modelling. An oversampling method was applied to balance the data set.

INTERVENTIONS

This study has no interventions.

PARTICIPANTS

The study included 2379 participants, of whom 507 were diagnosed with AD.

PRIMARY AND SECONDARY OUTCOME MEASURES

Including accuracy, precision, recall, F1 score, etc. RESULTS: 11 variables were critical in the training phase, including educational level, depression, insomnia, age, Body Mass Index (BMI), medication count, gender, stenting, systolic blood pressure (sbp), neurosis and rapid eye movement. The XGBoost model exhibited superior performance compared with other models, achieving area under the curve of 0.915, sensitivity of 76.2% and specificity of 92.9%. The most influential predictors were educational level, total medication count, age, sbp and BMI.

CONCLUSIONS

The proposed classifier can help guide preclinical screening of AD in the elderly population.

Characterization of gene expression profiles in Alzheimer's disease and osteoarthritis: A bioinformatics study

BACKGROUND

Alzheimer's disease (AD) and Osteoarthritis (OA) have been shown to have a close association in previous studies, but the pathogenesis of both diseases are unclear. This study explores the potential common molecular mechanisms between AD and OA through bioinformatics analysis, providing new insights for clinical treatment strategies.

METHODS

The AD and OA-related datasets were downloaded from the gene expression database GEO. The datasets were analyzed to obtain differentially expressed gene (DEG) datasets for OA and AD, respectively. The intersection of these DEGs was analyzed to identify common DEGs (Co-DEGs). Subsequently, the Co-DEGs were enriched, and a protein-protein interaction network was constructed to identify core genes. The expression of these genes was validated in a separate dataset, and their diagnostic value for the diseases was analyzed. In addition, the core genes were analyzed using gene set enrichment analysis and single-gene genome variation analysis.

RESULTS

Analysis of DEGs on gene chips from OA and AD patients revealed significant changes in gene expression patterns. Notably, EFEMP2 and TSPO, genes associated with inflammatory responses, showed lower expression levels in both AD and OA patients, suggesting a downregulation in the pathological backgrounds of these diseases. Additionally, GABARAPL1, which is crucial for the maturation of autophagosomes, was found to be upregulated in both conditions. These findings suggest the potential of these genes as diagnostic biomarkers and potential therapeutic targets. However, to confirm the effectiveness of these genes as therapeutic targets, more in-depth mechanistic studies are needed in the future, particularly to explore the feasibility and specific mechanisms of combating disease progression by regulating the expression of these genes.

CONCLUSIONS

This study suggests that AD and OA shares common molecular mechanisms. The identification of EFEMP2, GABARAPL1, and TSPO as key target genes highlights potential common factors in both diseases. Further investigation into these findings could lead to new candidate targets and treatment directions for AD and OA, offering promising avenues for developing more effective and targeted therapeutic interventions.

Intermittent Vibration Induces Sleep via an Allatostatin A-GABA Signaling Pathway and Provides Broad Benefits in Alzheimer's Disease Models

While animals across species typically experience suppressed consciousness and an increased arousal threshold during sleep, the responsiveness to specific sensory inputs persists. Previous studies have demonstrated that rhythmic and continuous vibration can enhance sleep in both animals and humans. However, the neural circuits underlying vibration-induced sleep (VIS) and its potential therapeutic benefits on neuropathological processes in disease models remain unclear. Here, it is shown that intermittent vibration, such as cycles of 30 s on followed by 30 s off, is more effective in inducing sleep compared to continuous vibration. A clear evidence is further provided that allatostatin A (AstA)-GABA signaling mediates short-term intermittent vibration-induced sleep (iVIS) by inhibiting octopaminergic arousal neurons through activating GABAA receptors. The existence of iVIS in mice is corroborated, implicating the GABAergic system in this process. Finally, intermittent vibration not only enhances sleep but also reduces amyloid-β (Aβ) deposition and reverses memory defects in Alzheimer's disease models. In conclusion, the study defines a central neural circuit involved in mediating short-term iVIS and the potential implications of vibration in treating sleep-related brain disorders.

The potential molecular markers of inflammatory response in KOA with AD based on single-cell transcriptome sequencing analysis and identification of ligands by virtual screening

Alzheimer's disease (AD) and osteoarthritis (OA) are both senile degenerative diseases. Clinical studies have found that OA patients have a significantly increased risk of AD in their later life. This study hypothesized that chronic aseptic inflammation might lead to AD in KOA patients. However, current research has not yet clarified the potential mechanism between AD and KOA. Therefore, this study intends to use KOA transcriptional profiling and single-cell sequencing analysis technology to explore the molecular mechanism of KOA affecting AD development, and screen potential molecular biomarkers and drugs for the prediction, diagnosis, and prognosis of AD in KOA patients. It was found that the higher the expression of TXNIP, MMP3, and MMP13, the higher the risk coefficient of AD was. In addition, the AUC of TXNIP, MMP3, and MMP13 were all greater than 0.70, which had good diagnostic significance for AD. Finally, through the virtual screening of core proteins in FDA drugs and molecular dynamics simulation, it was found that compound Cobicistat could be targeted to TXNIP, Itc could be targeted to MMP3, and Isavuconazonium could be targeted to MMP13. To sum up, TXNIP, MMP3, and MMP13 are prospective molecular markers in KOA with AD, which could be used to predict, diagnose, and prognosis.

Sleep deprivation alters hepatic UGT1A9 and propofol metabolism in mice

Sleep deprivation (SD) causes circadian misalignment, and circadian clock disruption is associated with metabolic diseases such as obesity, insulin resistance, and diabetes. However, the underlying mechanism for SD-induced circadian clock disruption as well as metabolic enzyme changes is still lacking. Here, we developed SD sensitizes mice with disrupted circadian rhythms to demonstrate the regulation role and mechanism of SD in UDP-glucuronosyltransferases (UGTs) expression and the metabolism of corresponding substrates. We found that UGT Family 1 Member A9 (UGT1A9) expression was significantly decreased in the liver of SD mice, which led to an elevation exposure and prolonged anesthesia effect of propofol, which was attributed to the decreased metabolism. Meanwhile, SD down-regulated basic helix-loop-helix ARNT like 1 (BMAL1) and its target clock genes period circadian clock (Per), cryptochrome circadian regulator (Cry), and nuclear receptor subfamily 1 group D member 1 (Rev-erb) expression in mice. Furthermore, the positive regulation of UGTIA9 mRNA and protein levels by Bmal1 was confirmed in hepatocyte-specific Bmal1-knockout mice (Bmal1-hkO) and Bmal1-overexpressed AML-12 cells. At last, through a combination of promoter analysis, luciferase reporter assay, and chromatin immunoprecipitation (ChIP) assay, it was conducted that Bmal1 regulates Ugtla9 expression by directly binding the -864 bp E-box in Ugtla9 promotor or indirectly acting on the Rev-erbα- differentiated embryo chondrocyte 2 (Dec2) axis. In conclusion, our findings suggested that SD can lead to altered drug disposition and effects in vivo, and Bmal1 plays a crucial role in the crosstalk between SD-induced circadian clock disruption and drug metabolism. It initiates a new direction for the understanding of drug efficacy and toxicity changes in SD conditions and provides a scientific basis for improving the rationality of drug use.

Automated remote sleep monitoring needs uncertainty quantification

Wearable electroencephalography devices emerge as a cost-effective and ergonomic alternative to gold-standard polysomnography, paving the way for better health monitoring and sleep disorder screening. Machine learning allows to automate sleep stage classification, but trust and reliability issues have hampered its adoption in clinical applications. Estimating uncertainty is a crucial factor in enhancing reliability by identifying regions of heightened and diminished confidence. In this study, we used an uncertainty-centred machine learning pipeline, U-PASS, to automate sleep staging in a challenging real-world dataset of single-channel electroencephalography and accelerometry collected with a wearable device from an elderly population. We were able to effectively limit the uncertainty of our machine learning model and to reliably inform clinical experts of which predictions were uncertain to improve the machine learning model's reliability. This increased the five-stage sleep-scoring accuracy of a state-of-the-art machine learning model from 63.9% to 71.2% on our dataset. Remarkably, the machine learning approach outperformed the human expert in interpreting these wearable data. Manual review by sleep specialists, without specific training for sleep staging on wearable electroencephalography, proved ineffective. The clinical utility of this automated remote monitoring system was also demonstrated, establishing a strong correlation between the predicted sleep parameters and the reference polysomnography parameters, and reproducing known correlations with the apnea-hypopnea index. In essence, this work presents a promising avenue to revolutionize remote patient care through the power of machine learning by the use of an automated data-processing pipeline enhanced with uncertainty estimation.

Impact of sleep characteristics on IVF/ICSI outcomes: A prospective cohort study

BACKGROUND

Infertility affects millions of individuals worldwide, imposing significant personal and societal burdens. Assisted reproductive technologies (ART), such as IVF and ICSI, provide hope for many, yet clinical pregnancy rate per embryo transfer remains around 35 %. Modifiable lifestyle factors, including sleep, may influence ART outcomes. However, the relationship between specific sleep characteristics and IVF/ICSI success is unclear. This study aims to explore the associations between sleep characteristics and various IVF/ICSI outcomes. Additionally, we investigated if perceived stress mediates these relationships.

METHODS

This prospective cohort study enrolled 174 women undergoing IVF/ICSI at Zhongnan Hospital of Wuhan University from December 2021 to December 2023. Prior to initial ART treatment, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10). IVF/ICSI outcomes such as the number of retrieved oocytes, matured oocytes, number of fertilized oocytes, fertilization rate, good-quality embryos, blastocyst formation rate and early pregnancy outcome (implantation and clinical pregnancy) were obtained from medical records. We employed multivariate generalized linear models to assess the associations between sleep characteristics and IVF/ICSI outcomes. Dose-response relationships between napping duration and maturation rate were analyzed using generalized additive models. Mediation analysis was used to assess the role of stress in the relationship between sleep characteristics and IVF/ICSI outcomes.

RESULTS

Women reporting poor sleep quality had significantly fewer retrieved oocytes (-22.89 %, 95%CI: 37.82 %, -4.00 %) and matured oocytes (-22.01 %, 95%CI: 37.54 %, -2.62 %). Those sleeping ≥10 h per night had fewer retrieved oocytes (-30.68 %, 95%CI: 48.88 %, -6.00 %), matured oocytes (-27.17 %, 95%CI: 46.57 %, -0.73 %), and good-quality embryos (-45.64 %, 95%CI: 65.43 %, -14.51 %). Women experiencing difficulty falling asleep more than three times a week had a significant reduction in blastocyst rates (-64.40 %, 95 % CI: 85.55 %, -12.30 %). Those reporting difficulty falling asleep less than once a week had fewer retrieved oocytes (-28.89 %, 95%CI: 47.34 %, -3.98 %), and matured oocytes (-27.77 %, 95%CI: 46.90 %, -1.73 %). Napping exceeding 1 h daily was associated with a significantly lower oocyte maturation rate (-73.8 %, 95%CI: 88.91 %, -38.06 %). A significant non-linear dose-response relationship was observed between napping duration and maturation rate (p < 0.001), with maturation rates initially increasing slightly with short naps but declining significantly with longer naps, particularly beyond 1 h. This relationship was significant among women with good sleep quality (PSQI ≤5) (p < 0.001) and those with normal BMI (p = 0.0005). Perceived stress did not significantly mediate these associations.

CONCLUSION

Our findings suggest that sleep characteristics, particularly poor quality, difficulty falling asleep, long sleep durations, negatively impact various IVF/ICSI outcomes. Longer daytime napping is inversely associated with oocyte maturation rates, especially among women with good sleep quality and normal BMI. Perceived stress did not appear to influence the relationship between sleep and IVF outcome. While optimizing sleep patterns may hold promise for improving IVF/ICSI success rates, it is essential to approach lifestyle guidance with caution, given the current limitations in confirming causative roles. Further studies are needed to clarify the extent and nature of the relationship between sleep characteristics and IVF/ICSI outcomes.

Enhancing sleep quality in synucleinopathies through physical exercise

During sleep, several crucial processes for brain homeostasis occur, including the rearrangement of synaptic connections, which is essential for memory formation and updating. Sleep also facilitates the removal of neurotoxic waste products, the accumulation of which plays a key role in neurodegeneration. Various neural components and environmental factors regulate and influence the physiological transition between wakefulness and sleep. Disruptions in this complex system form the basis of sleep disorders, as commonly observed in synucleinopathies. Synucleinopathies are neurodegenerative disorders characterized by abnormal build-up of α-synuclein protein aggregates in the brain. This accumulation in different brain regions leads to a spectrum of clinical manifestations, including hypokinesia, cognitive impairment, psychiatric symptoms, and neurovegetative disturbances. Sleep disorders are highly prevalent in individuals with synucleinopathies, and they not only affect the overall well-being of patients but also directly contribute to disease severity and progression. Therefore, it is crucial to develop effective therapeutic strategies to improve sleep quality in these patients. Adequate sleep is vital for brain health, and the role of synucleinopathies in disrupting sleep patterns must be taken into account. In this context, it is essential to explore the role of physical exercise as a potential non-pharmacological intervention to manage sleep disorders in individuals with synucleinopathies. The current evidence on the efficacy of exercise programs to enhance sleep quality in this patient population is discussed.

Mechanism of Panax notoginseng saponins in improving cognitive impairment induced by chronic sleep deprivation based on the integrative analysis of serum metabolomics and network pharmacology

ETHNOPHARMACOLOGICAL RELEVANCE

Panax notoginseng saponin (PNS) has a variety of biological activities, such as improvement of myocardial ischemia, improvement of learning and memory, hypolipidemia, and immunomodulation. However, its protective mechanism on the central nervous system (CNS) is not clear.

AIM OF THE STUDY

The present study initially evaluated the possible mechanism of PNS to improve cognitive dysfunction due to chronic sleep deprivation (CSD).

MATERIALS AND METHODS

In the present study, we used a modified multi-platform aquatic environment sleep deprivation method to induce a cognitively impaired rat model, and explored the mechanism of action of PNS by integrating serum metabolomics and network pharmacology, which was further verified by molecular docking and experiments.

RESULTS

The results showed that PNS significantly shortened the escape latency, increased the target quadrant time and the number of traversing platforms, and attenuated the inflammatory damage in the hippocampal Cornu Ammonis 1 (CA1) region in CSD rats. The non-targeted metabolomics results indicated that 35 biomarkers significantly altered following PNS therapy intervention, with metabolic pathways enriched for the effects of One carbon pool by folate, Riboflavin metabolism, Glycerophospholipid metabolism, Sphingolipid metabolism, Glycerolipid metabolism, Arachidonic acid metabolism, and Tryptophan metabolism. In addition, network pharmacology identified 234 potential targets for PNS intervention in CSD with cognitive impairment. Metabolite-response-enzyme-gene network was constructed by MetaScape and matched with the network pharmacology results to identify a total of five shared targets (LPL, GPAM, HSD11B1, HSD11B2, and SULT2A1) and two metabolic pathways (Sphingolipid metabolism and Steroid hormone biosynthesis). The results of molecular docking revealed that the five active ingredients had good binding ability with the five core targets. qPCR analysis confirmed the ability of PNS to modulate the above five targets.

CONCLUSIONS

The combination of metabolomics and network analysis provides a scientific basis for promoting the clinical application of PNS in cognitive impairment.

A review of the application of exercise intervention on improving cognition in patients with Alzheimer's disease: mechanisms and clinical studies

Alzheimer's disease (AD) is the most common form of dementia, leading to sustained cognitive decline. An increasing number of studies suggest that exercise is an effective strategy to promote the improvement of cognition in AD. Mechanisms of the benefits of exercise intervention on cognitive function may include modulation of vascular factors by affecting cardiovascular risk factors, regulating cardiorespiratory health, and enhancing cerebral blood flow. Exercise also promotes neurogenesis by stimulating neurotrophic factors, affecting neuroplasticity in the brain. Additionally, regular exercise improves the neuropathological characteristics of AD by improving mitochondrial function, and the brain redox status. More and more attention has been paid to the effect of Aβ and tau pathology as well as sleep disorders on cognitive function in persons diagnosed with AD. Besides, there are various forms of exercise intervention in cognitive improvement in patients with AD, including aerobic exercise, resistance exercise, and multi-component exercise. Consequently, the purpose of this review is to summarize the findings of the mechanisms of exercise intervention on cognitive function in patients with AD, and also discuss the application of different exercise interventions in cognitive impairment in AD to provide a theoretical basis and reference for the selection of exercise intervention in cognitive rehabilitation in AD.

Association between post-COVID-19 sleep disturbance and neurocognitive function: a comparative study based on propensity score matching

Despite that sleep disturbance and poor neurocognitive performance are common complaints among coronavirus disease 2019 (COVID-19) survivors, few studies have focused on the effect of post-COVID-19 sleep disturbance (PCSD) on cognitive function. This study aimed to identify the impact of PCSD on neurocognitive function and explore the associated risk factors for the worsening of this condition. This cross-sectional study was conducted via the web-based assessment in Chinese mainland. Neurocognitive function was evaluated by the modified online Integrated Cognitive Assessment (ICA) and the Number Ordering Test (NOT). Propensity score matching (PSM) was utilized to match the confounding factors between individuals with and without PCSD. Univariate analyses were performed to evaluate the effect of PCSD on neurocognitive function. The risk factors associated with worsened neurocognitive performance in PCSD individuals were explored using binary logistic regression. A total of 8692 individuals with COVID-19 diagnosis were selected for this study. Nearly half (48.80%) of the COVID-19 survivors reported sleep disturbance. After matching by PSM, a total of 3977 pairs (7954 individuals in total) were obtained. Univariate analyses revealed that PCSD was related to worse ICA and NOT performance (P<0.05). Underlying disease, upper respiratory infection, loss of smell or taste, severe pneumonia, and self-reported cognitive complaints were associated with worsened neurocognitive performance among PCSD individuals (P<0.05). Furthermore, aging, ethnicity (minority), and lower education level were found to be independent risk factors for worsened neurocognitive performance in PCSD individuals (P<0.05). PCSD was related to impaired neurocognitive performance. Therefore, appropriate prevention and intervention measures should be taken to minimize or prevent PCSD and eliminate its potential adverse effect on neurocognitive function.

Explainable machine learning models for identifying mild cognitive impairment in older patients with chronic pain

BACKGROUND

Mild cognitive impairment (MCI) is prevalent in older adults with chronic pain, making early detection crucial for dementia prevention and healthy aging. This study aimed to determine MCI risk factors in older patients with chronic pain and to develop 9 machine learning models to identify MCI risk.

METHODS

A total of 612 older patients with chronic pain were recruited between October 2023 and July 2024. Data collected included patients' general information, cognitive function, pain level, depression, and sleep quality. The dataset was randomly divided into training set and testing set, and processed by Min-Max Normalization and SMOTETomek comprehensive sampling. SVM-RFE and LASSO regression were used for variable selection. We then developed machine learning models and interpreted them by SHAP.

RESULTS

Age, education level, number of pain sites, pain duration, pain level, depression and sleep quality were risk factors of MCI in older patients with chronic pain. The Extreme Gradient Boosting (XGBoost) model performed best (AUC 0.925), with pain level, age, and depression as the most important variables.

CONCLUSIONS

We successfully developed 9 machine learning models to identify MCI risk. These models provide a tool for nurses to detect MCI risk early. We recommend that nurses integrate machine learning techniques into clinical nursing practice for managing MCI. However, these findings require validation with longitudinal data to confirm predictive validity for MCI progression.

Sleep structure of short-term insomnia disorder with mild cognitive impairment in older adults and their correlation with cognitive function: a case-control study

Objectives

This study seeks to delineate the sleep architecture characteristics in older adults with short-term insomnia and mild cognitive impairment (MCI) and to explore their association with cognitive performance.

Methods

Ninety elderly individuals with short-term insomnia were enrolled and stratified into two cohorts based on their Montreal Cognitive Assessment (MoCA) scores: the Short-Term Insomnia Group (STID) comprising 35 participants and the Short-Term Insomnia with Cognitive Impairment Group (STID-MCI) with 55 participants. Demographic data, Pittsburgh Sleep Quality Index (PSQI), MoCA, Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), and polysomnography (PSG) parameters were compared between groups. Correlations between MoCA scores and PSG metrics were also analyzed.

Results

No significant disparities were noted between groups in terms of HAMD-17, HAMA, and PSQI scores (p > 0.05). However, marked differences were identified in MoCA scores and its subdomains (p < 0.05). Significant variations were also observed in the duration and proportion of slow-wave sleep (N3) between groups (p < 0.05). In STID-MCI patients, memory scores correlated positively with N3 duration and percentage (p < 0.05), while verbal functions and attention were positively associated with rapid eye movement (REM) sleep duration.

Conclusion

This study highlights the potential of PSG in the clinical assessment of cognitive function and underscores the need for targeted interventions to improve sleep quality in this vulnerable population.

The combined effects of sleep and extreme heat exposure on cognitive function among older adults

BACKGROUND

Extreme heat is linked to cognitive impairment. Normal sleep duration and good sleep quality can reduce cognitive impairment risks. However, the combined impact of sleep (duration and quality) and extreme heat on cognitive impairment is unclear. This study tests whether normal sleep duration and good sleep quality during a heatwave reduce cognitive impairment compared to poor sleep quality and long sleep duration in older adults.

METHODS

This study used cohort data from 9153 older adults. Extreme heat was defined as periods ≥ 3 days with daily minimum temperatures above the 92.5th percentile during the warm season. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). Sleep duration was categorized as long, normal, or short, and sleep quality as good or poor. Six and four categories were used for combinations of heatwave exposure with sleep duration and quality, respectively. Cox regression models were applied for analysis.

RESULTS

Compared to those with long sleep duration during heatwaves, participants exposed to heatwaves with normal sleep duration had lower cognitive impairment risk (HR: 0.86, 95 %CI: 0.76-0.97). Those exposed to extreme heat with short sleep duration also showed lower cognitive risks (HR: 0.74, 95 %CI: 0.62-0.88). Compared to those with poor sleep quality during heatwave, participants with good sleep quality during heatwaves did not show significantly lower cognitive impairment risk (HR: 1.10, 95 %CI: 0.98-1.23).

CONCLUSION

Older adults with normal or short sleep duration during heatwaves may face lower cognitive impairment risks, highlighting the importance of sleep guidance to protect cognitive health during extreme heat.

A Comprehensive Review on Preclinical Alzheimer's Disease Models: Evaluating their Clinical Relevance

Alzheimer's disease (AD) is a neurological disorder that increases with age and must be treated immediately by worldwide healthcare systems. Internal neurofibrillary tau tangles and extracellular amyloid accumulation have been widely recognized as the primary causes of Alzheimer's disease. These degenerative age-related ailments are expected to proliferate exponentially as life expectancy rises. Experimental models of AD are essential for acquiring a deep knowledge of its pathogenesis and determining the viability of novel therapy options. Although there isn't a model that encompasses all the characteristics of real AD, these models are nonetheless highly helpful for the research of various modifications associated with it, even though they are only partially indicative of the disease circumstances being studied. Better knowledge of the advantages and disadvantages of each of the different models, as well as the use of more than one model to evaluate potential medications, would increase the effectiveness of therapy translation from preclinical research to patients. We outline the pathogenic characteristics and limitations of the main experimental models of AD in this review, including transgenic mice, transgenic rats, primates and non-primate models along with in-vitro cell culture models in humans. Additionally, it highlights the possible future of experimental modeling of AD and includes the co-morbid models.

Non-Drug and Non-Invasive Therapeutic Options in Alzheimer's Disease

Despite the massive efforts of modern medicine to stop the evolution of Alzheimer's disease (AD), it affects an increasing number of people, changing individual lives and imposing itself as a burden on families and the health systems. Considering that the vast majority of conventional drug therapies did not lead to the expected results, this review will discuss the newly developing therapies as an alternative in the effort to stop or slow AD. Focused Ultrasound (FUS) and its derived Transcranial Pulse Stimulation (TPS) are non-invasive therapeutic approaches. Singly or as an applied technique to change the permeability of the blood-brain-barrier (BBB), FUS and TPS have demonstrated the benefits of use in treating AD in animal and human studies. Adipose-derived stem Cells (ADSCs), gene therapy, and many other alternative methods (diet, sleep pattern, physical exercise, nanoparticle delivery) are also new potential treatments since multimodal approaches represent the modern trend in this disorder research therapies.

Circadian Clocks, Daily Stress, and Neurodegenerative Disease

Disrupted circadian or 24-h rhythms are among the most common early findings in a wide range of neurodegenerative disorders. Once thought to be a mere consequence of the disease process, increasing evidence points toward a causal or contributory role of the circadian clock in neurodegenerative disease. Circadian clocks control many aspects of cellular biochemistry, including stress pathways implicated in neuronal survival and death. Given the dearth of disease-modifying therapies for these increasingly prevalent disorders, this understanding may lead to breakthroughs in the development of new treatments. In this review, we provide a background on circadian clocks and focus on some potential mechanisms that may be pivotal in neurodegeneration.