High prevalence of sleep disorders and behavioral and psychological symptoms of dementia in late-onset Alzheimer disease

Zhou, Guoyu; Liu, Shuangwu; Yu, Xiaolin; Zhao, Xinjin; Ma, Lin; Shan, Peiyan

doi:10.1097/md.0000000000018405

Cited by 38 publications

(37 citation statements)

References 45 publications

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“…(93/126) of cases were diagnosed with sleep disorders in our cohort of AD patients, which was supported by previous reports showing a significantly higher incidence of sleep disturbance in Alzheimer's disease patients compared to control population 12,37 .…”

Section: Discussionsupporting

confidence: 89%

“…These results were supported by a cross-section study showing an inverse correlation between sleep length and anxiety symptoms in Alzheimer's disease patients 39 and by a recent study from a Chinese cohort showing a close correlation between PSQI scores and depression in Alzheimer's disease patients 37 . So far there is a paucity of literature about the correlation of sleep quality (PSQI scores) with MoCA, GDS and CDR scores, although a weak linear correlation (coefficient of multiple correlation at 0.307-0.34) between sleep quality and GDS score was reported in Alzheimer's disease patients with moderate to severe dementia (CDR 2-3) 40 , indicating a possible connection of sleep disturbance with global deterioration scale at a late stage of AD patients.…”

Section: Discussionsupporting

confidence: 60%

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WITHDRAWN: Sleep Treatment Improves Neuropsychological Symptoms and Reduces Blood Aβ42/pTau Protein in Alzheimer's Disease Patients: a Longitudinal Study

Li¹,

Huang²,

Li³

et al. 2021

Preprint

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Background: Amyloid β peptide-42 (Aβ42) and phosphorylated Tau on Threonine 181 (Tau-pT181) are the core biomarkers in Alzheimer’s disease. Accumulated evidence showed an aberrant elevation of these biomarkers due to sleep disturbance. However, it is not clear if improving sleep quality reduces Aβ42 and Tau-pT181 in Alzheimer’s disease patients.Methods: A longitudinal study was conducted on 126 patients with mild-moderate dementia due to Alzheimer’s disease. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Behavioral and neuropsychological assessment was conducted using multiple self-reporting questionnaire score systems. Aβ42 and Tau-pT181 levels in blood specimens were measured using an ELISA assay kit. All patients received Donepezil treatment for Alzheimer’s disease. Sleep disorders were individually managed with either medication or physical therapy according to their symptom categories.Results: Of the 126 cases, 93 (73.8%) patients were diagnosed with sleep disorders. The PSQI scores significantly correlated with depression and anxiety scores, as well as Aβ42 and Tau-pT181 levels. Also, a significant correlation was found among depression, anxiety, Aβ42 and Tau-pT181 in all patients. Sleep intervention drastically reduced PSQI score, as well as Aβ42 and Tau-pT181 levels, in parallel with improved cognition, deterioration and anxiety scores. Dementia and depression scores were improved only in patients who completely recovered (PSQI < 7) after sleep treatment. There was a 35.9% reduction of Aβ42 levels and a 32.8% reduction of Tau-pT181 levels in this subgroup of patients (56 cases). Conversely, the reduction extent was only 6.9% for Aβ42 and 12.2% for Tau-pT181 in patients who did not completely recover (PSQI ≥ 7 post treatment, 37 cases). Multiple logistic regression analysis revealed that Aβ42 level is the strongest risk factor for sleep disorder incidence and incomplete recovery after sleep treatment.Conclusion: Sleep quality score is associated with patient depression and anxiety status, as well as blood Aβ42 and Tau-pT181 levels. A complete recovery is critical for a full improvement of all behavioral and neuropsychological assessments, which is also associated with a deep reduction of Aβ42 and Tau-pT181 levels. Aβ42 level is a prognostic factor for a diagnosis of sleep disorder and treatment responsiveness.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 60%

WITHDRAWN: Sleep Treatment Improves Neuropsychological Symptoms and Reduces Blood Aβ42/pTau Protein in Alzheimer's Disease Patients: a Longitudinal Study

Li¹,

Huang²,

Li³

et al. 2021

Preprint

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“…Beneficial effect of gamma sensory stimulation on sleep quality in mild to moderate AD patients is particularly relevant, since scientific and clinical observations demonstrating a close relationship between sleep quality and activities of daily living (Zhou et al, 2019). It can be presumed that improving sleep quality in AD patients would provide multiple benefits: better sleep will enhance patients' daytime performance and reduce daytime sleepiness.…”

Section: Discussionmentioning

confidence: 99%

Sensory-Evoked 40-Hz Gamma Oscillation Improves Sleep and Daily Living Activities in Alzheimer’s Disease Patients

Cimenser¹,

Hempel²,

Travers³

et al. 2021

Front. Syst. Neurosci.

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Pathological proteins contributing to Alzheimer’s disease (AD) are known to disrupt normal neuronal functions in the brain, leading to unbalanced neuronal excitatory-inhibitory tone, distorted neuronal synchrony, and network oscillations. However, it has been proposed that abnormalities in neuronal activity directly contribute to the pathogenesis of the disease, and in fact it has been demonstrated that induction of synchronized 40 Hz gamma oscillation of neuronal networks by sensory stimulation reverses AD-related pathological markers in transgenic mice carrying AD-related human pathological genes. Based on these findings, the current study evaluated whether non-invasive sensory stimulation inducing cortical 40 Hz gamma oscillation is clinically beneficial for AD patients. Patients with mild to moderate AD (n = 22) were randomized to active treatment group (n = 14; gamma sensory stimulation therapy) or to sham group (n = 8). Participants in the active treatment group received precisely timed, 40 Hz visual and auditory stimulations during eye-closed condition to induce cortical 40 Hz steady-state oscillations in 1-h daily sessions over a 6-month period. Participants in the sham group were exposed to similar sensory stimulation designed to not evoke cortical 40 Hz steady-state oscillations that are observed in the active treatment patients. During the trial, nighttime activities of the patients were monitored with continuous actigraphy recordings, and their functional abilities were measured by Alzheimer’s Disease Cooperative Study – Activities of Daily Living (ADCS-ADL) scale. Results of this study demonstrated that 1-h daily therapy was well tolerated throughout the 6-month treatment period by all subjects. Patients receiving gamma sensory stimulation showed significantly reduced nighttime active periods, in contrast, to deterioration in sleep quality in sham group patients. Patients in the sham group also showed the expected, significant decline in ADCS-ADL scores, whereas patients in the gamma sensory stimulation group fully maintained their functional abilities over the 6-month period. These findings confirm the safe application of 40 Hz sensory stimulation in AD patients and demonstrate a high adherence to daily treatment. Furthermore, this is the first time that beneficial clinical effects of the therapy are reported, justifying expanded and longer trials to explore additional clinical benefits and disease-modifying properties of gamma sensory stimulation therapy.Clinical Trial Registration:clinicaltrials.gov, identifier: NCT03556280.

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“…The SDI is a questionnaire that evaluates the severity and frequency of sleep-related problems derived from the NPI (insomnia, night roaming, daytime sleep, etc.). Zhou et al [34] have reported that higher PSQI total scores and scores of sleep latency from PSQI components in AD patients are associated with higher NPI total scores. Meanwhile, Cupidi et al [35] have analyzed scores of the seven components of the PSQI for caregivers of AD patients and found that their PSQI total scores and scores for two components (sleep latency and sleep disturbances) are significantly increased compared to those scores of controls.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Subjective and Objective Sleep Quality with Caregiver Burden in Patients with Alzheimer’s Disease

Lee

Kim²,

Lee³

et al. 2021

Sleep Med Res

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Background and ObjectiveaaSleep disturbance in patients with Alzheimer's disease (AD) could increase institutionalization due to caregiver burden. The objective of this study was to examine the relationship of subjective and objective sleep quality with caregiver burden in AD patients with insomnia symptoms. MethodsaaAD patients of mild to moderate degree were recruited. They were assessed with the Pittsburgh Sleep Quality Index (PSQI), Korean version of the Epworth Sleepiness Scale, and Mini-Mental Status Examination in the Korean version of Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet. Caregiver burden was evaluated with Korean version of the Neuropsychiatric Inventory Questionnaire (KNPI-Q) and Korean version of the Zarit Burden Interview (ZBI-K). Actigraphy recording (Actiwatch 2; Philips Respironics) was conducted for five days at home. Thirty-four patients (age 78.44 ± 6.14, M:F = 9:25) were analyzed. These patients were divided into two groups by the median of KNPI-Q for caregiver distress [KNPI-Q(d)] and ZBI-K scores. Sleep parameters were compared between the two groups. ResultsaaAmong seven components of PSQI, sleep latency was correlated with KNPI-Q(d) score. The patients with higher KNPI-Q(d) scores had lower sleep efficiency (SE) (p = 0.002), greater wake after sleep onset (p = 0.037), and higher fragmentation index (p = 0.040) than those with lower KNPI-Q(d) scores. Those with higher ZBI-K scores had lower SE (p = 0.026) than those with lower ZBI-K scores. Stepwise multiple regression revealed that SE predicted 16% of KNPI-Q(d) scores (p = 0.012). ConclusionsaaDifficulty in sleep initiation according to subjective reports was associated with caregiver burden in our AD patients. In objective sleep quality, a significant difference in difficulty of sleep maintenance was found between higher and lower caregiver burden groups. This suggests that sleep maintenance is essential for reducing caregiver burden.

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High prevalence of sleep disorders and behavioral and psychological symptoms of dementia in late-onset Alzheimer disease

Cited by 38 publications

References 45 publications

WITHDRAWN: Sleep Treatment Improves Neuropsychological Symptoms and Reduces Blood Aβ42/pTau Protein in Alzheimer's Disease Patients: a Longitudinal Study

WITHDRAWN: Sleep Treatment Improves Neuropsychological Symptoms and Reduces Blood Aβ42/pTau Protein in Alzheimer's Disease Patients: a Longitudinal Study

Sensory-Evoked 40-Hz Gamma Oscillation Improves Sleep and Daily Living Activities in Alzheimer’s Disease Patients

Relationship of Subjective and Objective Sleep Quality with Caregiver Burden in Patients with Alzheimer’s Disease

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