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Baril AA, Picard C, Labonté A, Sanchez E, Duclos C, Mohammediyan B, Breitner JCS, Villeneuve S, Poirier J. Longer sleep duration and neuroinflammation in at-risk elderly with a parental history of Alzheimer's disease. Sleep 2024; 47:zsae081. [PMID: 38526098 PMCID: PMC11168764 DOI: 10.1093/sleep/zsae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
STUDY OBJECTIVES Although short sleep could promote neurodegeneration, long sleep may be a marker of ongoing neurodegeneration, potentially as a result of neuroinflammation. The objective was to evaluate sleep patterns with age of expected Alzheimer's disease (AD) onset and neuroinflammation. METHODS We tested 203 dementia-free participants (68.5 ± 5.4 years old, 78M). The PREVENT-AD cohort includes older persons with a parental history of AD whose age was nearing their expected AD onset. We estimated expected years to AD onset by subtracting the participants' age from their parent's at AD dementia onset. We extracted actigraphy sleep variables of interest (times of sleep onset and morning awakening, time in bed, sleep efficiency, and sleep duration) and general profiles (sleep fragmentation, phase delay, and hypersomnia). Cerebrospinal fluid (CSF) inflammatory biomarkers were assessed with OLINK multiplex technology. RESULTS Proximity to, or exceeding, expected age of onset was associated with a sleep profile suggestive of hypersomnia (longer sleep and later morning awakening time). This hypersomnia sleep profile was associated with higher CSF neuroinflammatory biomarkers (IL-6, MCP-1, and global score). Interaction analyses revealed that some of these sleep-neuroinflammation associations were present mostly in those closer/exceeding the age of expected AD onset, APOE4 carriers, and those with better memory performance. CONCLUSIONS Proximity to, or exceeding, parental AD dementia onset was associated with a longer sleep pattern, which was related to elevated proinflammatory CSF biomarkers. We speculate that longer sleep may serve a compensatory purpose potentially triggered by neuroinflammation as individuals are approaching AD onset. Further studies should investigate whether neuroinflammatory-triggered long sleep duration could mitigate cognitive deficits.
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Affiliation(s)
- Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM, Montréal, QC, Canada
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Cynthia Picard
- Center for Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Anne Labonté
- Center for Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Erlan Sanchez
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Catherine Duclos
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM, Montréal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, QC, Canada
| | - Béry Mohammediyan
- Center for Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - John C S Breitner
- Center for Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Sylvia Villeneuve
- Center for Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Judes Poirier
- Center for Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
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Li W, Sun L, Yue L, Xiao S. Associations between afternoon napping, left amygdala volume and cognitive performance in elderly with normal cognitive function. Sleep Med 2024; 113:232-237. [PMID: 38064794 DOI: 10.1016/j.sleep.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The relationship between afternoon napping and cognitive function in the elderly is very complex and the mechanism is unknown. METHODS In the current study, 194 community elders with normal cognitive functions were included. All subjects completed baseline clinical assessment, baseline neuropsychological test as well as baseline structural MRI. Based on their napping status, these 194 participants were divided into the napping group (n = 88) and the non-napping group (n = 106). We then compared the differences in cognitive performance and structural magnetic resonance between the two groups. RESULTS In the intergroup analysis, we found that the nappers showed poorer cognitive performance on both overall cognitive function and domain specific cognitive function; while on the whole sample, we found a significant negative association (F = 20.27, p<0.001) between afternoon napping and left amygdala volume. However, we did not find any effect of night sleep length or napping frequency on cognitive performance or left amygdala volume. CONCLUSIONS In community elders with normal cognitive functions, afternoon napping is associated with cognitive performance, and left amygdala may play an important role in this process.
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Affiliation(s)
- Wei Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Lin Sun
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Yue
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Shifu Xiao
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
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3
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Li J, McPhillips M, Deng Z, Fan F, Spira A. Daytime Napping and Cognitive Health in Older Adults: A Systematic Review. J Gerontol A Biol Sci Med Sci 2023; 78:1853-1860. [PMID: 36472580 PMCID: PMC10562891 DOI: 10.1093/gerona/glac239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Daytime napping may improve cognitive function in older adults. However, the association can be complicated by specific features of napping and the older adult's health. This systematic review aims to synthesize the current literature on napping and cognition in older adults and provide recommendations for future research and daytime sleep practice in older adults. METHODS Systematic searches for relative research published between January 1995 and October 2022 were conducted at PubMed, MEDLINE, PsycINFO, and Google Scholar using keywords individually and in multiple combinations. Manual searches were performed to identify additional studies. All included studies were critically appraised by 2 authors. RESULTS Thirty-five studies, including 23 observational and 12 intervention studies, were reviewed. Findings from observational studies suggest a possible inverted U-shaped association between napping duration and cognitive function: short and moderate duration of naps benefited cognitive health in older adults compared with both non-napping and long or extended napping. Findings from intervention studies suggest one session of afternoon napping might improve psychomotor function and working memory, although with some inconsistency. The effect of multiple nap sessions on cognition was inconclusive due to a limited number of studies. CONCLUSION More rigorous research studies are needed to investigate what causes different patterns of daytime napping, the associations between these distinct patterns and cognitive function, and to determine whether interventions targeting napping patterns can improve cognition in older adults. In addition, future research needs to comprehensively assess daytime napping using a combination of measures such as sleep diary and actigraphy.
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Affiliation(s)
- Junxin Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | | | - Zhongyue Deng
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fangfang Fan
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
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4
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Durães J, Marques P, Novo AM, Facas J, Duro D, Lima M, Leitão MJ, Tábuas-Pereira M, Baldeiras I, Santana I. Associations between self-reported sleep quality and cerebrospinal fluid biomarkers in mild cognitive impairment and Alzheimer's disease. Rev Neurol (Paris) 2023; 179:877-881. [PMID: 36914478 DOI: 10.1016/j.neurol.2022.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/23/2022] [Accepted: 12/06/2022] [Indexed: 03/13/2023]
Abstract
Sleep disorders are very common in mild cognitive impairment (MCI) and Alzheimer's disease (AD). Several parameters of polysomnography seem to correlate with cognitive scores and amyloid biomarkers in the different stages of AD. However, there is limited evidence for the relationship between self-reported sleep impairment and disease biomarkers. In this study, we assessed the relationship between self-reported sleep complaints, with the Pittsburgh Sleep Quality Index, and both cognitive function and cerebrospinal fluid biomarkers in 70 patients with MCI and 78 patients with AD. Sleep duration and daytime dysfunction were higher in AD. Daytime dysfunction had a negative correlation with cognitive scores (Mini-Mental-State Examination and Montreal Cognitive Assessment) and with amyloid-beta1-42 protein, and a positive correlation with total tau protein. However, daytime dysfunction was an independent predictor only of t-tau values (F=57.162; 95% CI: [18.118; 96.207], P=0.004). These findings support a relationship between daytime dysfunction, cognitive scores and neurodegeneration, further expanding recent findings that it may signal a risk of dementia.
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Affiliation(s)
- J Durães
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal.
| | - P Marques
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal
| | - A M Novo
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal
| | - J Facas
- Department of Medical Imaging, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal
| | - D Duro
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - M Lima
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal; Faculty of Psychology and Educational Sciences, University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), 3000-115 Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - M J Leitão
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - M Tábuas-Pereira
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - I Baldeiras
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - I Santana
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, 3000-045 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
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Salari N, Moradi S, Bagheri R, Talebi S, Wong A, Babavaisi B, Kermani MAH, Hemati N. Daytime napping and coronary heart disease risk in adults: a systematic review and dose-response meta-analysis. Sleep Breath 2023; 27:1255-1267. [PMID: 36480117 DOI: 10.1007/s11325-022-02759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/19/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The present study investigated the association between daytime napping and coronary heart disease (CHD) risk among adults. METHODS Articles were detected by using PubMed, ISI Web of Science, and Scopus databases until November 8th, 2021. The relevant data were found among the eight included articles and were pooled for meta-analysis in adult participants via a random-effects model. RESULTS Among 167,025 adults, the results revealed that daytime napping was associated with an enhanced risk of CHD (risk ratios [RR] = 1.30; 95% CI: 1.06, 1.60; p < 0.001). Subgroup analysis by daytime napping duration also indicated that daytime napping for at least 1 h had three times higher influence on the enhanced risk of CHD (RR = 1.34; 95% CI: 1.14, 1.58; p < 0.001) than that of daytime napping for less than 1 h (RR = 1.10; 95% CI: 1.02, 1.19; p = 0.014). In addition, subgroup analysis by region illustrated that daytime napping was linked with an enhanced risk of CHD in Chinese (RR = 1.41; 95% CI: 1.19, 1.66; p < 0.001), but not in European or American populations. Furthermore, the subgroup analysis of napping duration and risk of CHD suggested that their relation was significant just in those studies that controlled for depressive symptoms (RR = 1.52; 95% CI: 1.29, 1.80; p < 0.001, n = 3) and night sleep duration (RR = 1.42; 95% CI: 1.21, 1.66; p < 0.001, n = 5). The linear dose-response meta-analysis revealed that each 15-min increase in daytime napping was related with a 5% higher risk of CHD (RR = 1.05; 95% CI: 1.02, 1.08; I2 = 58.7%; p < 0.001). Furthermore, nonlinear dose-response meta-analysis revealed a positive linear relationship between daytime napping and CHD risk in adults (p nonlinearity = 0.484, p dose-response = 0.003). CONCLUSION Results showed that daytime napping was related with an increased risk of CHD in adults. The evidence from this study suggests that the public should be made conscious of the adverse outcomes of long daytime napping for CHD, notably among the Chinese population. Additional studies are required to confirm potential links between CHD risk and daytime napping.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajjad Moradi
- Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Science, Tehran University of Medical Science, Tehran, Iran
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Basir Babavaisi
- Internal Medicine Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Ali Hojjati Kermani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Hemati
- Internal Medicine Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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6
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Zhou R, Chen HW, Huang YN, Zhong Q, Li FR, Huang RD, Liu HM, Zheng JZ, Xu JW, Wu XB. The association between daytime napping and risk of type 2 diabetes is modulated by inflammation and adiposity: Evidence from 435 342 UK-Biobank participants. J Diabetes 2023. [PMID: 37052293 DOI: 10.1111/1753-0407.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/07/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Existing evidence concerning the relationship between daytime napping and type 2 diabetes (T2D) is inconsistent, and whether the effects of napping differ by body fat percentage (BFP) and C-reactive protein (CRP) is unclear. We aimed to investigate the association between daytime napping frequency and T2D risk and whether such an association was modified by BFP and CRP. METHODS We included 435 342 participants free of diabetes from the UK Biobank. Participants were categorized as nonnappers, occasional nappers, and frequent nappers based on napping frequency, and BFP/CRP was divided into quartiles. Cox proportional hazards models were used. RESULTS During a median follow-up of 9.2 years, 17 592 T2D cases occurred. Higher frequency of daytime napping was significantly associated with an increased risk of T2D. Compared with nonnappers, the adjusted hazard ratios (HRs) for occasional nappers and habitual nappers were 1.28 (95% confidence interval [CI]: 1.24-1.32) and 1.49 (95% CI: 1.41-1.57), respectively. There was a significant additive and multiplicative interaction (relative excess risk due to interaction [RERI] = 0.490, 95% CI 0.307-0.673; p for multiplicative interaction <.001) between napping and BFP, whereby a higher hazard of T2D associated with more frequent napping was greatest among participants in the highest BFP quartile (HR = 4.45, 95% CI: 3.92-5.06). The results for CRP were similar (RERI = 0.266, 95% CI: 0.094-0.439; p for multiplicative interaction <.001). CONCLUSIONS Higher daytime napping frequency is associated with an increased T2D risk, and such relationships are modified by BFP and CRP. These findings underscore the importance of adiposity and inflammation control to mitigate diabetes risk.
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Affiliation(s)
- Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Hao-Wen Chen
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Yi-Ning Huang
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Qi Zhong
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Fu-Rong Li
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Rui-Dian Huang
- Public Health Division, Hospital of Zhongluotan Town Baiyun District, Guangzhou, China
| | - Hua-Min Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia-Zhen Zheng
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, China
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Jia-Wen Xu
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
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Koutentaki E, Basta M, Antypa D, Zaganas I, Panagiotakis S, Simos P, Vgontzas AN. IL-6 Enhances the Negative Impact of Cortisol on Cognition among Community-Dwelling Older People without Dementia. Healthcare (Basel) 2023; 11:healthcare11070951. [PMID: 37046878 PMCID: PMC10094120 DOI: 10.3390/healthcare11070951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
There is growing evidence that high basal cortisol levels and systemic inflammation independently contribute to cognitive decline among older people without dementia. The present cross-sectional study examined (a) the potential synergistic effect of cortisol levels and systemic inflammation on executive function and (b) whether this effect is more prominent among older people with mild cognitive impairment (MCI). A sub-sample of 99 patients with MCI and 84 older people without cognitive impairment (CNI) (aged 73.8 ± 7.0 years) were recruited from a large population-based cohort in Crete, Greece, and underwent comprehensive neuropsychiatric and neuropsychological evaluation and a single morning measurement of cortisol and IL-6 plasma levels. Using moderated regression models, we found that the relation between cortisol and executive function in the total sample was moderated by IL-6 levels (b = −0.994, p = 0.044) and diagnostic group separately (b = −0.632, p < 0.001). Moreover, the interaction between cortisol and IL-6 levels was significant only among persons with MCI (b = −0.562, p < 0.001). The synergistic effect of stress hormones and systemic inflammation on cognitive status appears to be stronger among older people who already display signs of cognitive decline. Targeting hypercortisolemia and inflammation may be a promising strategy toward improving the course of cognitive decline.
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8
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Mathioudakis L, Dimovasili C, Bourbouli M, Latsoudis H, Kokosali E, Gouna G, Vogiatzi E, Basta M, Kapetanaki S, Panagiotakis S, Kanterakis A, Boumpas D, Lionis C, Plaitakis A, Simos P, Vgontzas A, Kafetzopoulos D, Zaganas I. Study of Alzheimer's disease- and frontotemporal dementia-associated genes in the Cretan Aging Cohort. Neurobiol Aging 2023; 123:111-128. [PMID: 36117051 DOI: 10.1016/j.neurobiolaging.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/02/2023]
Abstract
Using exome sequencing, we analyzed 196 participants of the Cretan Aging Cohort (CAC; 95 with Alzheimer's disease [AD], 20 with mild cognitive impairment [MCI], and 81 cognitively normal controls). The APOE ε4 allele was more common in AD patients (23.2%) than in controls (7.4%; p < 0.01) and the PSEN2 p.Arg29His and p.Cys391Arg variants were found in 3 AD and 1 MCI patient, respectively. Also, we found the frontotemporal dementia (FTD)-associated TARDBP gene p.Ile383Val variant in 2 elderly patients diagnosed with AD and in 2 patients, non CAC members, with the amyotrophic lateral sclerosis/FTD phenotype. Furthermore, the p.Ser498Ala variant in the positively selected GLUD2 gene was less frequent in AD patients (2.11%) than in controls (16%; p < 0.01), suggesting a possible protective effect. While the same trend was found in another local replication cohort (n = 406) and in section of the ADNI cohort (n = 808), this finding did not reach statistical significance and therefore it should be considered preliminary. Our results attest to the value of genetic testing to study aged adults with AD phenotype.
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Affiliation(s)
- Lambros Mathioudakis
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Christina Dimovasili
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Mara Bourbouli
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Helen Latsoudis
- Minotech Genomics Facility, Institute of Molecular Biology and Biotechnology (IMBB-FORTH), Heraklion, Crete, Greece
| | - Evgenia Kokosali
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Garyfallia Gouna
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Emmanouella Vogiatzi
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Maria Basta
- University of Crete, Medical School, Psychiatry Department, Heraklion, Crete, Greece
| | - Stefania Kapetanaki
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Simeon Panagiotakis
- University of Crete, Medical School, Internal Medicine Department, Heraklion, Crete, Greece
| | - Alexandros Kanterakis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas (ICS-FORTH), Heraklion, Crete, Greece
| | - Dimitrios Boumpas
- University of Crete, Medical School, Internal Medicine Department, Heraklion, Crete, Greece
| | - Christos Lionis
- University of Crete, Medical School, Clinic of Social and Family Medicine, Heraklion, Crete, Greece
| | - Andreas Plaitakis
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece
| | - Panagiotis Simos
- University of Crete, Medical School, Psychiatry Department, Heraklion, Crete, Greece
| | - Alexandros Vgontzas
- University of Crete, Medical School, Psychiatry Department, Heraklion, Crete, Greece
| | - Dimitrios Kafetzopoulos
- Minotech Genomics Facility, Institute of Molecular Biology and Biotechnology (IMBB-FORTH), Heraklion, Crete, Greece
| | - Ioannis Zaganas
- University of Crete, Medical School, Neurology/Neurogenetics Laboratory, Heraklion, Crete, Greece.
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Associations between objectively measured sleep parameters and cognition in healthy older adults: A meta-analysis. Sleep Med Rev 2023; 67:101734. [PMID: 36577339 DOI: 10.1016/j.smrv.2022.101734] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Multiple studies have examined associations between sleep and cognition in older adults, but a majority of these depend on self-reports on sleep and utilize cognitive tests that assess overall cognitive function. The current meta-analysis involved 72 independent studies and sought to quantify associations between objectively measured sleep parameters and cognitive performance in healthy older adults. Both sleep macrostructure (e.g., sleep duration, continuity, and stages) and microstructure (e.g., slow wave activity and spindle activity) were evaluated. For macrostructure, lower restlessness at night was associated with better memory performance (r = 0.43, p = 0.02), while lower sleep onset latency was associated with better executive functioning (r = 0.28, p = 0.03). Greater relative amount of N2 and REM sleep, but not N3, positively correlated with cognitive performance. The association between microstructure and cognition in older adults was marginally significant. This relationship was moderated by age (z = 0.07, p < 0.01), education (z = 0.26, p = 0.03), and percentage of female participants (z = 0.01, p < 0.01). The current meta-analysis emphasizes the importance of considering objective sleep measures to understand the relationship between sleep and cognition in healthy older adults. These results also form a base from which researchers using wearable sleep technology and measuring behavior through computerized testing tools can evaluate their findings.
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Liu Y, Leggett AN, Kim K, Polenick CA, McCurry SM, Zarit SH. Daily sleep, well-being, and adult day services use among dementia care dyads. Aging Ment Health 2022; 26:2472-2480. [PMID: 34761966 PMCID: PMC9109303 DOI: 10.1080/13607863.2021.1998354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/17/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The study aimed to describe daily sleep characteristics for dementia care dyads in the context of adult day services (ADS) use and examine the associations with sleep quality and daytime functioning (fatigue, affect, and behavior problems). METHODS Caregivers (CG; N = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons living with dementia (PLWD) across 8 consecutive days (N = 1359), where PLWD attended ADS at least 2 days of the week. On each day, caregivers also reported their own fatigue and affect and PLWD's daytime behavior problems and nighttime sleep problems. Considering the context of ADS use, we compared mean differences in bedtime, wake time, and total time in bed on nights before versus after ADS use. We estimated multilevel models to examine daily sleep-well-being associations. RESULTS On nights before an upcoming ADS day, care dyads went to bed and woke up earlier, and spent less time in bed. Further, PLWD had better sleep quality the night before an upcoming ADS day. Using ADS during the day buffered the negative impact of PLWD's sleep problems in the previous night, reducing daytime negative affect for caregivers. For caregivers, using ADS yesterday attenuated the association between shorter than typical time in bed and daytime fatigue; it also attenuated the association between PLWD's nighttime sleep problems and lowered daytime positive affect. CONCLUSIONS Regular ADS use may promote earlier sleep timing and protect against the adverse impact of sleep disturbances on daytime functioning for dementia care dyads.
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Affiliation(s)
- Yin Liu
- Department of Human Development and Family Studies, Utah State University
| | | | - Kyungmin Kim
- Department of Child Development and Family Studies, Seoul National University
| | | | - Susan M. McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Steven H. Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University
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Álvarez-Bueno C, Mesas AE, Reina-Gutierrez S, Saz-Lara A, Jimenez-Lopez E, Martinez-Vizcaino V. Napping and cognitive decline: a systematic review and meta-analysis of observational studies. BMC Geriatr 2022; 22:756. [PMID: 36109701 PMCID: PMC9479293 DOI: 10.1186/s12877-022-03436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/31/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND No clear evidence is available for the influence of napping on cognitive function in older adults. This systematic review and meta-analysis aimed to elucidate the cross-sectional and longitudinal relationships between napping and cognitive function (global cognition and memory) and to explore whether some individual characteristics and sleep characteristics can modify this relationship. METHODS We systematically searched Medline (via PubMed), Web of Science, and Scopus. DerSimonian and Lair and Hartung-Knapp-Sidik-Jonkman random effects methods were used to compute pooled estimates of odds ratios (ORs) and their respective 95% confidence intervals (95% CIs) for the association of global cognition and memory with napping. The mean age, the night sleep time (hours), and the percentage of women, no nappers, and people in the less night-time sleep duration category were used for meta-regressions. RESULTS Twenty-five studies were included in this systematic review and meta-analysis, 18 cross-sectional and seven longitudinal studies, including 95,719 participants older than 60 years. The pooled ORs from the cross-sectional analyses were 1.03 (95% CI: 1.01 to 1.06) for global cognition and 1.06 (95%: 0.90 to 1.26) for memory. The pooled ORs from the longitudinal analyses were 1.00 (95% 0.85 to 1.18) for global cognition and 1.08 (95% 0.98 to 1.19) for memory. These associations were not modified by individual or sleep characteristics. CONCLUSION Our data confirm the absence of association between napping and global cognition and memory regardless of the characteristics of the population. This information might be considered when providing lifestyle recommendations to adults with and without cognitive complaints.
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Affiliation(s)
- Celia Álvarez-Bueno
- grid.8048.40000 0001 2194 2329Universidad de Castilla-La Mancha, Health and Social Care Research Center, 16071 Cuenca, Spain ,grid.441660.10000 0004 0418 6711Universidad Politécnica Y Artística del Paraguay, Asunción, 001518 Paraguay
| | - Arthur Eumann Mesas
- grid.8048.40000 0001 2194 2329Universidad de Castilla-La Mancha, Health and Social Care Research Center, 16071 Cuenca, Spain ,grid.411400.00000 0001 2193 3537Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Parana, Brasil
| | - Sara Reina-Gutierrez
- grid.8048.40000 0001 2194 2329Universidad de Castilla-La Mancha, Health and Social Care Research Center, 16071 Cuenca, Spain
| | - Alicia Saz-Lara
- grid.8048.40000 0001 2194 2329Universidad de Castilla-La Mancha, Health and Social Care Research Center, 16071 Cuenca, Spain
| | - Estela Jimenez-Lopez
- Department of Psychiatry Hospital, Virgen de La Luz, Cuenca, Spain ,grid.469673.90000 0004 5901 7501CIBERSAM (Biomedical Research, Networking Centre in Mental Health), Barcelona, Spain
| | - Vicente Martinez-Vizcaino
- grid.8048.40000 0001 2194 2329Universidad de Castilla-La Mancha, Health and Social Care Research Center, 16071 Cuenca, Spain ,grid.441837.d0000 0001 0765 9762Faculty of Health Sciences, Universidad Autónoma de Chile, 1670 Talca, Chile
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12
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Li M, Wang N, Dupre ME. Association between the self-reported duration and quality of sleep and cognitive function among middle-aged and older adults in China. J Affect Disord 2022; 304:20-27. [PMID: 35176346 DOI: 10.1016/j.jad.2022.02.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 02/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The World Alzheimer Report showed that 46.8 million people suffered from dementia in 2015. This study examined how the duration and quality of sleep are associated with cognition among older adults in China. METHOD Data were drawn from waves 2011, 2013, and 2015 of the China Health and Retirement Longitudinal Study (CHARLS), including noninstitutionalized adults aged 45 and older (n=10,768). Cognition was measured by interview-based assessments of mental status (TICS-10), episodic memory, and visuospatial abilities. Sleep duration was categorized as long, medium, or short and sleep quality was categorized as good, fair, or poor. RESULTS Sleep duration had an inverted U-shape relationship with cognitive scores (P <.001); and sleep quality had a positive linear relationship with cognitive scores (P <.001). Short and long sleep durations were associated with consistently lower cognition scores with increasing age (both P <.001); and fair and poor quality of sleep were associated with consistently lower levels of cognition (both P <.001). Tests of interactions between sleep duration and sleep quality showed that participants reporting long durations of sleep with poor quality of sleep had the lowest overall cognitive scores. LIMITATIONS Self-reported methods were used to measure sleep quality and duration and thus our findings underscore the need for more evidence-based research to improve prevention efforts and tailor interventions to reduce cognitive decline among Chinese older adults. CONCLUSIONS Suboptimal sleep duration and quality were associated with poor cognition. Cognitive scores were lowest among those who reported long durations of sleep that were of poor quality.
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Affiliation(s)
- Minchao Li
- Center for Disease Control and Prevention of Haining County, Jiaxing, Zhejiang, China
| | - Nan Wang
- Department of Global Health Sciences, School of Medicine, University of California at Davis, CA, United States.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Sociology, Duke University, Durham, NC, United States; Duke Clinical Research Institute, Duke University, Durham, NC, United States
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13
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Basta M, Belogianni C, Yannakoulia M, Zaganas I, Panagiotakis S, Simos P, Vgontzas AN. Poor Diet, Long Sleep, and Lack of Physical Activity Are Associated with Inflammation among Non-Demented Community-Dwelling Elderly. Healthcare (Basel) 2022; 10:healthcare10010143. [PMID: 35052306 PMCID: PMC8775386 DOI: 10.3390/healthcare10010143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
Inflammation in elderly is associated with physical and cognitive morbidity and mortality. We aimed to explore the association of modifiable lifestyle parameters with inflammation among non-demented, community-dwelling elderly. A sub-sample of 117 patients with mild cognitive impairment (MCI, n = 63) and cognitively non-impaired controls (CNI, n = 54) were recruited from a large, population-based cohort in Crete, Greece, of 3140 elders (>60 years old). All participants underwent assessment of medical history/physical examination, extensive neuropsychiatric/neuropsychological evaluation, diet, three-day 24-h actigraphy, subjective sleep, physical activity, and measurement of IL-6 and TNFα plasma levels. Associations between inflammatory markers and diet, objective sleep duration, subjective sleep quality, and lack of physical activity were assessed using multivariate models. Regression analyses in the total group revealed significant associations between TNF-α and low vegetable consumption (p = 0.003), and marginally with objective long nighttime sleep duration (p = 0.04). In addition, IL-6 was associated with low vegetable consumption (p = 0.001) and lack of physical activity (p = 0.001). Poor diet and lack of physical activity appear to be modifiable risk factors of inflammation, whereas long sleep appears to be a marker of increased inflammatory response in elderly. Our findings may have clinical implications given the association of inflammatory response with morbidity, including cognitive decline, and mortality in elderly.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.B.); (P.S.); (A.N.V.)
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, State College, PA 16802, USA
- Correspondence: ; Tel.: +30-2810392402; Fax: +30-2810392859
| | - Christina Belogianni
- Department of Psychiatry, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.B.); (P.S.); (A.N.V.)
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University of Athens, 17671 Athens, Greece;
| | - Ioannis Zaganas
- Department of Neurology, University Hospital of Heraklion, 71500 Heraklion, Greece;
| | - Symeon Panagiotakis
- Department of Internal Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece;
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.B.); (P.S.); (A.N.V.)
| | - Alexandros N. Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, 71500 Heraklion, Greece; (C.B.); (P.S.); (A.N.V.)
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, State College, PA 16802, USA
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14
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Zhao J, Kong Q, Wang M, Huang H, Zhou X, Guo Y, Zhang Y, Wu L, Yu Z, Luo X. Association of Excessive Daytime Sleepiness with Cerebral Small Vessel Disease in Community-Dwelling Older Adults. Nat Sci Sleep 2022; 14:765-773. [PMID: 35478722 PMCID: PMC9037722 DOI: 10.2147/nss.s357586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Excessive daytime sleepiness (EDS) and cerebral small vessel disease (CSVD) are common problems among older adults; however, their association is not clear. The present study aimed to investigate the frequency of EDS in CSVD patients and the relationship between EDS and neuroimaging markers of CSVD. PATIENTS AND METHODS We conducted a cross-sectional study among 1076 community-dwelling older adults aged 55-85 years. EDS was measured using the Epworth Sleepiness Scale (ESS), and EDS was defined as an ESS score greater than 10. Binary logistic regression was performed to assess the association between EDS and neuroimaging markers of CSVD. RESULTS Of the 1076 participants (mean age: 65.58 ± 6.46 years, 60.5% female), the prevalence of EDS was 10.0%. EDS was more frequent in participants with CSVD than in the total sample (20.0% vs 10.0%, p <0.001). In fully adjusted models, EDS was significantly correlated with CSVD burden (OR = 1.39, 95% CI 1.16 to 1.68, p <0.001), the severity of white matter hyperintensities (WMH) (OR = 1.33, 95% CI 1.14 to 1.54, p <0.001), and presence of lacunes (OR = 2.47, 95% CI 1.53 to 4.00, p <0.001) but not with the presence of cerebral microbleeds (CMBs) (OR=1.54, 95% CI 0.92 to 2.56, p = 0.099) or severity of enlarged perivascular spaces (EPVS) in basal ganglia (OR = 1.16, 95% CI 0.70 to 1.92, p = 0.564). CONCLUSION We found a high frequency of EDS symptoms in CSVD individuals. Further, EDS was significantly associated with WMH, lacunes, and CSVD burden. Our findings further suggest patients with CSVD may exhibit abnormal sleep-wake patterns.
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Affiliation(s)
- Jing Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Qianqian Kong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xirui Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yinping Guo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yi Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lingshan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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15
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Basta M, Vgontzas AN, Fernandez-Mendoza J, Antypa D, Li Y, Zaganas I, Panagiotakis S, Karagkouni E, Simos P. Basal Cortisol Levels Are Increased in Patients with Mild Cognitive Impairment: Role of Insomnia and Short Sleep Duration. J Alzheimers Dis 2022; 87:933-944. [PMID: 35404277 DOI: 10.3233/jad-215523] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is frequent in elderly and a risk factor for dementia. Both insomnia and increased cortisol levels are risk factors for MCI. OBJECTIVE We examined cross-sectionally whether increased cortisol levels are associated with short sleep duration (SSD) and/or the insomnia short sleep duration (ISS) phenotype, in elderly with MCI. METHODS One hundred twenty-four participants with MCI and 84 cognitively non-impaired controls (CNI)≥60 years underwent medical history, physical examination, neuropsychiatric evaluation, neuropsychological testing, 3-day actigraphy, assessment of subjective insomnia symptoms, and a single morning plasma cortisol level. The short sleep phenotypes were defined by sleep efficiency below the median of the entire sample (i.e.,≤81%) with at least one insomnia symptom (ISS) or without (SSD). ANOVA models were used to compare the various sleep phenotypes to those who did not present either short sleep or insomnia symptoms [non-insomnia (NI)]. RESULTS MCI participants had higher cortisol levels compared to the CNI group (p = 0.009). MCI participants with insomnia (n = 44) or SSD (n = 38) had higher cortisol levels compared to the NI group (n = 42; p = 0.014 and p = 0.045, respectively). Furthermore, MCI participants with ISS phenotype but not those with insomnia with normal sleep duration had higher cortisol levels compared to NI (p = 0.011 and p = 0.4, respectively). Both linear trend analyses showed that cortisol reached the highest levels in the ISS phenotype. CONCLUSION The ISS and SSD phenotypes are associated with increased cortisol levels in elderly with MCI. Improving sleep quality and duration and decreasing cortisol levels may delay further cognitive decline.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Despina Antypa
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Yun Li
- Department of Sleep Medicine, Mental Health Center of Shantou University, Shantou, Guangdong, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Ioannis Zaganas
- Department of Neurology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Symeon Panagiotakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Efthalia Karagkouni
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Greece
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16
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Zhang B, Jiang S. Heterogeneity in longitudinal trajectories of cognitive performance among middle-aged and older individuals with hypertension: Growth mixture modeling across an 8-year cohort study. Hypertens Res 2021; 45:1037-1046. [PMID: 34952952 DOI: 10.1038/s41440-021-00829-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/06/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022]
Abstract
Hypertension is one of the most prevalent chronic conditions and has been proven to be related to cognitive function. However, there is no evidence regarding the heterogeneity in cognitive trajectories among persons with hypertension. The aims of the current study were to characterize the heterogeneity in longitudinal trajectories of cognitive performance among Chinese middle-aged and older individuals with hypertension and to explore the potential determinants of trajectory memberships. Data from the 2011 to 2018 Chinese Health and Retirement Longitudinal Study (CHARLS) were utilized. Two cognitive measures of executive function and episodic memory were assessed, and conditional growth mixture modeling (GMM) was performed to identify the trajectories of cognitive performance and explore the related factors of cognitive change. The findings revealed three trajectory classes of executive function (stable, sharp decline, smooth decline) and two trajectory classes of episodic memory (stable, decline). Individuals with hypertension who had a higher educational level, moderate nighttime sleep duration, and lower depressive symptoms as well as those who reported consuming alcohol at least once a month were more likely to belong to the optimal stable executive function group. Subjects with a higher educational level, adequate daytime napping duration, and higher BMI were more likely to exhibit stable episodic memory over time. Other factors, including age, sex, community type, marital status, and hypertension treatment, exhibited class-specific effects on growth parameters of cognitive trajectory. Targeting intervention designation is proposed to ameliorate the burdens of cognitive impairment among individuals with hypertension.
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Affiliation(s)
- Baiyang Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Shaohua Jiang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Abstract
Purpose of review Napping is a common behavior across age groups. While studies have shown a benefit of overnight sleep on memory consolidation, given differences in nap frequency, composition, and intent, it is important to consider whether naps serve a memory function across development and aging. Recent findings We review studies of the role of naps in declarative, emotional, and motor procedural memory consolidation across age groups. Recent findings in both developmental and aging populations find that naps benefit learning of many tasks but may require additional learning or sleep bouts compared to young adult populations. These studies have also identified variations in nap physiology based on the purpose of the nap, timing of the nap, or age. Summary These studies lend to our understanding of the function of sleep, and the potential for naps as an intervention for those with reduced nighttime sleep or learning impairments.
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Affiliation(s)
- Bethany J Jones
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts, U.S.A
- Neuroscience & Behavior Program, University of Massachusetts, Amherst, Amherst, Massachusetts, U.S.A
| | - Rebecca M C Spencer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts, U.S.A
- Neuroscience & Behavior Program, University of Massachusetts, Amherst, Amherst, Massachusetts, U.S.A
- Institute for Applied Life Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts, U.S.A
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18
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Basta M, Zaganas I, Simos P, Koutentaki E, Dimovasili C, Mathioudakis L, Bourbouli M, Panagiotakis S, Kapetanaki S, Vgontzas A. Apolipoprotein E ɛ4 (APOE ɛ4) Allele is Associated with Long Sleep Duration Among Elderly with Cognitive Impairment. J Alzheimers Dis 2021; 79:763-771. [DOI: 10.3233/jad-200958] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Apolipoprotein E gene (APOE) ɛ4 allele increases the risk for Alzheimer’s disease (AD). Furthermore, among patients with cognitive impairment, longer sleep duration is associated with worse cognitive performance. To date, literature examining the associations between APOE ɛ4 allele and objective sleep duration is limited. Objective: Our aim was to assess the association between APOE ɛ4 and objective sleep duration, among patients with mild cognitive impairment (MCI) and AD. A sub-sample of 89 patients with AD (n = 49) and MCI (n = 40) were recruited from a large, population-based cohort of 3,140 elders (>60 years) residing on Crete, Greece. Methods: All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, 3-day 24 h actigraphy and APOE ɛ4 allele genotyping. Comparisons of sleep duration variables between APOE ɛ4 allele carriers and non-carriers were assessed using ANCOVA, controlling for confounders. Results: The sample included 18 APOE ɛ4 carriers and 71 non-carriers, aged 78.6±6.6 and 78.2±6.5 years, respectively. Comparisons between the APOE ɛ4 carriers and non-carriers revealed no significant differences in terms of demographic and clinical variables. In terms of objective sleep duration across the two groups, APOE ɛ4 carriers compared to non-carriers had significantly longer nighttime Total Sleep Time (nTST) (7.7±1.4 versus 7.2±1.3 h, respectively, p = 0.011), as well as 24 h TST (8.5±1.6 versus 7.8±1.5 h, respectively, p = 0.012). Conclusion: Among patients with MCI and AD, APOE ɛ4 carriers have longer objective nighttime and 24 h sleep duration compared to non-carriers. These findings further support that objective long sleep duration is a genetically-driven pre-clinical marker associated with worse prognosis in elderly with cognitive impairment.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Ioannis Zaganas
- Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Computational Biomedicine Lab, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Eirini Koutentaki
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | | | | | - Mara Bourbouli
- Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | | | | | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
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Bertsias A, Symvoulakis E, Tziraki C, Panagiotakis S, Mathioudakis L, Zaganas I, Basta M, Boumpas D, Simos P, Vgontzas A, Lionis C. Cognitive Impairment and Dementia in Primary Care: Current Knowledge and Future Directions Based on Findings From a Large Cross-Sectional Study in Crete, Greece. Front Med (Lausanne) 2020; 7:592924. [PMID: 33330553 PMCID: PMC7719838 DOI: 10.3389/fmed.2020.592924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/29/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Dementia severely affects the quality of life of patients and their caregivers; however, it is often not adequately addressed in the context of a primary care consultation, especially in patients with multi-morbidity. Study Population and Methods: A cross-sectional study was conducted between March-2013 and December-2014 among 3,140 consecutive patients aged >60 years visiting 14 primary health care practices in Crete, Greece. The Mini-Mental-State-Examination [MMSE] was used to measure cognitive status using the conventional 24-point cut-off. Participants who scored low on MMSE were matched with a group of elders scoring >24 points, according to age and education; both groups underwent comprehensive neuropsychiatric and neuropsychological assessment. For the diagnosis of dementia and Mild-Cognitive-Impairment (MCI), the Diagnostic and Statistical Manual-of-Mental-Disorders (DSM-IV) criteria and the International-Working-Group (IWG) criteria were used. Chronic conditions were categorized according to ICD-10 categories. Logistic regression was used to provide associations between chronic illnesses and cognitive impairment according to MMSE scores. Generalized Linear Model Lasso Regularization was used for feature selection in MMSE items. A two-layer artificial neural network model was used to classify participants as impaired (dementia/MCI) vs. non-impaired. Results: In the total sample of 3,140 participants (42.1% men; mean age 73.7 SD = 7.8 years), low MMSE scores were identified in 645 (20.5%) participants. Among participants with low MMSE scores 344 (54.1%) underwent comprehensive neuropsychiatric evaluation and 185 (53.8%) were diagnosed with Mild-Cognitive-Impairment (MCI) and 118 (34.3%) with dementia. Mental and behavioral disorders (F00-F99) and diseases of the nervous system (G00-G99) increased the odds of low MMSE scores in both genders. Generalized linear model lasso regularization indicated that 7/30 MMSE questions contributed the most to the classification of patients as impaired (dementia/MCI) vs. non-impaired with a combined accuracy of 82.0%. These MMSE items were questions 5, 13, 19, 20, 22, 23, and 26 of the Greek version of MMSE assessing orientation in time, repetition, calculation, registration, and visuo-constructive ability. Conclusions: Our study identified certain chronic illness-complexes that were associated with low MMSE scores within the context of primary care consultation. Also, our analysis indicated that seven MMSE items provide strong evidence for the presence of dementia or MCI.
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Affiliation(s)
- Antonios Bertsias
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Chariklia Tziraki
- MELABEV - Community Clubs for Eldercare, Research and Development Department, Jerusalem, Israel
| | - Symeon Panagiotakis
- Department of Internal Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Lambros Mathioudakis
- Department of Neurology, School of Medicine, University of Crete, Heraklion, Greece
| | - Ioannis Zaganas
- Department of Neurology, School of Medicine, University of Crete, Heraklion, Greece
| | - Maria Basta
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitrios Boumpas
- Department of Internal Medicine, School of Medicine, University of Athens, Athens, Greece
| | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece
- Computational Biomedicine Lab, Institute of Computer Science, Foundation for Research and Technology-Hellas, Herakleion, Greece
| | - Alexandros Vgontzas
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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