Neuropsychological Functioning in Older Adults with Mild Cognitive Impairment and Insomnia Randomized to CBT-I or Control Group

Cassidy-Eagle, Erin; Siebern, Allison T.; Unti, Lisa; Glassman, Jill R.; O’Hara, Ruth

doi:10.1080/07317115.2017.1384777

Cited by 64 publications

(57 citation statements)

References 40 publications

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“…44,45 While psychosocial sleep hygiene measures that are effective in cognitively healthy persons generally do not work for PLWD, persons with mild cognitive impairment may benefit from modified cognitive-behavioral therapy for insomnia (CBT-I). 46 The evidence for currently known nonpharmacological interventions such as light therapy, physical exercise, and multicomponent interventions is inconclusive, 47 although a recent manualized treatment for sleep disturbance (DREAM-START) 48 has shown potential for improving sleep and quality of life of the person with dementia, and for reducing family carers' stress. Apathy/withdrawal, which was associated with caregiver depression in this sample, can be effectively targeted with nonpharmacological interventions such as simulated presence, multisensory stimulation, reminiscence, music therapy, and tailored activities.…”

Section: Discussionmentioning

confidence: 99%

Neuropsychiatric symptom profiles ofcommunity‐dwellingpersons living with dementia: Factor structures revisited

Regier

Hodgson

Gitlin

2020

Int J Geriat Psychiatry

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Objectives: Most persons living with dementia (PLWD) will develop neuropsychiatric symptoms (NPS) at some point. NPS are often clustered into subsyndromes with other related symptoms, but the evidence supporting commonly used clusters is insufficient. We reexamine behavioral clusters in community-dwelling PLWD and identify associated risk factors and potential contributors. Methods: This study used baseline data from a longitudinal behavioral intervention study of 250 community-dwelling older adults with dementia and their caregivers. Using exploratory factor analysis (principal component analysis [PCA]), the factor structure of NPS frequency scores of the Neuropsychiatric Inventory (NPI-C) was evaluated. Multiple linear regressions assessed the association of the derived behavioral clusters with caregiver burden, caregiver depression, and quality of life of the PLWD.

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Section: Discussionmentioning

confidence: 99%

Neuropsychiatric symptom profiles ofcommunity‐dwellingpersons living with dementia: Factor structures revisited

Regier

Hodgson

Gitlin

2020

Int J Geriat Psychiatry

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“…Moreover, such findings extend to Alzheimer's specific cohorts, where both sleep hygiene alone [189] and in combination with light therapy [190,191] have been shown to benefit sleep quality. Similarly, CBT-I has been shown to benefit sleep quality and executive function in mild cognitive impairment [192]. Akin to bright light therapy, there is a relative paucity of high-quality studies in Parkinson's specific cohorts, with most studies employing subjective outcomes suggesting benefit [193][194][195], whereas objective measures have tended to be negative [105,196].…”

Section: Behavioral Measuresmentioning

confidence: 99%

The Treatment of Sleep Dysfunction in Neurodegenerative Disorders

2021

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Sleep dysfunction is highly prevalent across the spectrum of neurodegenerative conditions and is a key determinant of quality of life for both patients and their families. Mounting recent evidence also suggests that such dysfunction exacerbates cognitive and affective clinical features of neurodegeneration, as well as disease progression through acceleration of pathogenic processes. Effective assessment and treatment of sleep dysfunction in neurodegeneration is therefore of paramount importance; yet robust therapeutic guidelines are lacking, owing in part to a historical paucity of effective treatments and trials. Here, we review the common sleep abnormalities evident in neurodegenerative disease states and evaluate the latest evidence for traditional and emerging interventions, both pharmacological and nonpharmacological. Interventions considered include conservative measures, targeted treatments of specific clinical sleep pathologies, established sedating and alerting agents, melatonin, and orexin antagonists, as well as bright light therapy, behavioral measures, and slow-wave sleep augmentation techniques. We conclude by providing a suggested framework for treatment based on contemporary evidence and highlight areas that may emerge as major therapeutic advances in the near future.

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“…42 43 Further, CBT for insomnia has shown benefits to executive functioning in a small randomised study of people with MCI and insomnia. 44 Whether CBT needs to be adapted for late-life depression and could show benefits to cognitive decline requires further exploration. 45 Of note, although not significant after adjustment for multiple comparisons, the presence of non-accidental self-injury and psychotic symptoms appeared to be associated with a lower dementia risk.…”

Section: Open Accessmentioning

confidence: 99%

Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care

et al. 2020

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ObjectivesDepression can be a prodromal feature or a risk factor for dementia. We aimed to investigate which clinical factors in patients with late-life depression are associated with a higher risk of developing dementia and a more rapid conversion.DesignRetrospective cohort study.SettingSouth London and Maudsley NHS Foundation Trust (SLaM) secondary mental healthcare services.ParticipantsThe SLaM Clinical Record Interactive Search was used to retrieve anonymised data on 3659 patients aged 65 years or older who had received a diagnosis of depression in mental health services and had been followed up for at least 3 months.Outcome measuresPredictors of development of incident dementia were investigated, including demographic factors, health status rated on the Health of the National Outcome scale for older people (HoNOS65+), depression recurrence and treatments including psychotropic drugs and cognitive behavioural therapy (CBT).ResultsIn total, 806 (22.0%) patients developed dementia over a mean follow-up time of 2.7 years. Significant predictors of receiving a dementia diagnosis in fully adjusted models and after accounting for multiple comparisons were older age (adjusted HR=1.04, 95% CI 1.03 to 1.06 per year difference from sample mean) and the HoNOS65+ subscale measuring cognitive problems (HR=4.72, 95% CI 3.67 to 6.06 for scores in the problematic range). Recurrent depressive disorder or past depression (HR=0.65, 95% CI 0.55 to 0.77) and the receipt of CBT (HR=0.73 95% CI 0.61 to 0.87) were associated with a lower dementia risk. Over time, hazards related to age increased and hazards related to cognitive problems decreased.ConclusionsIn older adults with depression, a higher risk of being subsequently diagnosed with dementia was predicted by higher age, new onset depression, severity of cognitive symptoms and not receiving CBT. Further exploration is needed to determine whether the latter risk factors are responsive to interventions.

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Neuropsychological Functioning in Older Adults with Mild Cognitive Impairment and Insomnia Randomized to CBT-I or Control Group

Abstract: Results suggest that a non-pharmacological intervention to improve sleep in older adults with MCI also improve cognitive functioning. Further exploration of the mechanisms underlying these improvements is warranted.

Cited by 64 publications

References 40 publications

Neuropsychiatric symptom profiles ofcommunity‐dwellingpersons living with dementia: Factor structures revisited

Neuropsychiatric symptom profiles ofcommunity‐dwellingpersons living with dementia: Factor structures revisited

The Treatment of Sleep Dysfunction in Neurodegenerative Disorders

Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care

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