Sleep disturbances and cognitive decline:recommendations on clinical assessment and the management

Abstract

In 2004, in Genoa (Italy), the Italian Dementia Research Association (SINDem) was born. The first congress of this new scientific society took place in Rome in 2006. SINDem soon recognized the importance to investigate sleep problems in cognitive decline and created a national "sleep study group "composed by neurologists and sleep specialists. In 2012, The SINDem study group, in close relationship with the Italian Association of sleep medicine (AIMS), published the study "Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients ", confirming the high prevalence of sleep disturbances in a wide Italian population of persons with cognitive decline. The study was supported by a grant from the Italian Minister of Health and was conducted with the fundamental contribution of the Italian National Research Center (CNR). In 2014, the same group published the paper "Recommendations of the Sleep Study Group of the Italian Dementia Research Association (SINDem) on clinical assessment and management of sleep disorders in individuals with mild cognitive impairment and dementia: a clinical review". The recommendations are wide and directed to professionals (neurologists but not exclusively) to try to establish uniform levels of care, promote collaborative studies into areas of uncertainty, and define the qualitative characteristics of Dementia Reference Centers about sleep disturbances.

Sleep Disorders in Mild Cognitive Impairment

“…Participants with EDS were more likely to see a drop in MMSE scores (p = 0.006) [9]. EDS was found to significantly increase the probability of global cognitive decline by 30% while having no significant effect on verbal fluency or visual memory-related activities [13].…”

“…According to a study, even after accounting for all of these potentially confounding variables, there is still a substantial correlation between EDS and cognitive deterioration [13]. Participants with EDS were more likely to see a drop in MMSE scores (p = 0.006) [9].…”

“…Sleep disorders are common and almost always occur in conjunction with cognitive decline in patients. The Sleep Study Group of the Italian Dementia Research Association recommends they must always be thoroughly examined using an in-depth history, physical examination, and questionnaires and scales, directly written by the patient with the support of the direct caregiver, when possible [13]. Follow-up studies employing objective sleep/wake measurements, amyloid PET scan, and volumetric MRI assessment may be able to track changes in sleep patterns, brain amyloid burden, and neuronal damage in the elderly with cognitive impairment [9].…”

“…For insomnia, it is recommended that pharmacological therapy be short-term and reviewed regularly every 4 weeks. Long-term usage of hypnotic medications should be considered only for specific indications [13].…”