Restricted accessResearch articleFirst published online 2022-1
Association Between Informant-Reported Sleep Disturbance and Incident Dementia: An Analysis of the National Alzheimer’s Coordinating Center Uniform Data Set
Informants’ reports can be useful in screening patients for future risk of dementia. We aimed to determine whether informant-reported sleep disturbance is associated with incident dementia, whether this association varies by baseline cognitive level and whether the severity of informant-reported sleep disturbance is associated with incident dementia among those with sleep disturbance. A longitudinal retrospective cohort study was conducted using the uniform data set collected by the National Alzheimer’s Coordinating Center. Older adults without dementia at baseline living with informants were included in analysis. Cox proportional hazards models showed that participants with an informant-reported sleep disturbance were more likely to develop dementia, although this association may be specific for older adults with normal cognition. In addition, older adults with more severe sleep disturbance had a higher risk of incident dementia than those with mild sleep disturbance. Informant-reported information on sleep quality may be useful for prompting cognitive screening.
AlbertM. S.DeKoskyS. T.DicksonD.DuboisB.FeldmanH. H.FoxN. C.GamstA.HoltzmanD. M.JagustW. J.PetersenR. C. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7(3), 270–279. https://doi.org/10.1016/j.jalz.2011.03.008
2.
Ancoli-IsraelS.PalmerB. W.CookeJ. R.Corey-BloomJ.FiorentinoL.NatarajanL.LiuL.AyalonL.HeF.LoredoJ. S. (2008). Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: A randomized controlled study. Journal of the American Geriatrics Society, 56(11), 2076–2081. https://doi.org/10.1111/j.1532-5415.2008.01934.x
3.
BabulalG. M.GhoshalN.HeadD.VernonE. K.HoltzmanD. M.BenzingerT. L.FaganA. M.MorrisJ. C.RoeC. M. (2016). Mood changes in cognitively normal older adults are linked to Alzheimer disease biomarker levels. The American Journal of Geriatric Psychiatry, 24(11), 1095–1104. https://doi.org/10.1016/j.jagp.2016.04.004
4.
BeeklyD. L.RamosE. M.LeeW. W.DeitrichW. D.JackaM. E.WuJ.HubbardJ. L.KoepsellT. D.MorrisJ. C.KukullW. A. (2007). The National Alzheimer’s Coordinating Center (NACC) database: The uniform data set. Alzheimer Disease and Associated Disorders, 21(3), 249–258.
5.
BesserL.KukullW.KnopmanD. S.ChuiH.GalaskoD.WeintraubS.JichaG.CarlssonC.BurnsJ.QuinnJ. (2018). Version 3 of the national Alzheimer’s coordinating center’s uniform data set. Alzheimer Disease and Associated Disorders, 32(4), 351–358.
6.
BurkeS. L.HuT.SpadolaC. E.BurgessA.LiT.CadetT. (2019). Treatment of sleep disturbance may reduce the risk of future probable Alzheimer’s disease. Journal of Aging and Health, 31(2), 322–342. https://doi.org/10.1177/0898264318795567
7.
BurkeS. L.MaramaldiP.CadetT.KukullW. (2016). Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: Dementia. International Psychogeriatrics, 28(9), 1409–1424. https://doi.org/10.1017/S1041610216000405
8.
CummingsJ. (1994). The Neuropsychiatric Inventory Questionnaire: Background and administration. Mary S. Easton Center for Alzheimer’s Disease Research.
9.
DaviesH. D.O’HaraR.MumenthalerM. S.CassidyE. L.BuffumM.KimJ. M.DanielsenC. E.NodaA.KraemerH. C.SheikhJ. I. (2005). Underreporting of behavioral problems in older hospitalized patients. The Gerontologist, 45(4), 535–538. https://doi.org/10.1093/geront/45.4.535
10.
DuboisB.PadovaniA.ScheltensP.RossiA.Dell’AgnelloG. (2016). Timely diagnosis for Alzheimer’s disease: A literature review on benefits and challenges. Journal of Alzheimer’s Disease, 49(3), 617–631. https://doi.org/10.3233/JAD-150692
11.
Fernandez-MendozaJ.CalhounS. L.BixlerE. O.KaratarakiM.LiaoD.Vela-BuenoA.Ramos-PlatonM. J.SauderK. A.BastaM.VgontzasA. N. (2011). Sleep misperception and chronic insomnia in the general population: The role of objective sleep duration and psychological profiles. Psychosomatic Medicine, 73(1), 88–97. https://doi.org/10.1097/PSY.0b013e3181fe365a
12.
FittsW.WeintraubD.MassimoL.ChahineL.Chen-PlotkinA.DudaJ. E.HurtigH. I.RickJ.TrojanowskiJ. Q.DahodwalaN. (2015). Caregiver report of apathy predicts dementia in Parkinson’s disease. Parkinsonism & Related Disorders, 21(8), 992–995. https://doi.org/10.1016/j.parkreldis.2015.06.009
13.
FreemanD.SheavesB.GoodwinG. M.YuL.-M.NicklessA.HarrisonP. J.EmsleyR.LuikA. I.FosterR. G.WadekarV. (2017). The effects of improving sleep on mental health (OASIS): A randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4(10), 749–758. https://doi.org/10.1016/S2215-0366(17)30328-0
14.
GedaY. E.RobertsR. O.KnopmanD. S.PetersenR. C.ChristiansonT. J.PankratzV. S.SmithG. E.BoeveB. F.IvnikR. J.TangalosE. G. (2008). Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: Population-based study. Archives of General Psychiatry, 65(10), 1193–1198. https://doi.org/10.1001/archpsyc.65.10.1193
15.
HarveyA. G.TangN. K. (2012). (Mis)perception of sleep in insomnia: A puzzle and a resolution. Psychological Bulletin, 138(1), 77–101. https://doi.org/10.1037/a0025730
16.
HoekertM.Riemersma-van der LekR. F.SwaabD. F.KauferD.Van SomerenE. J. (2006). Comparison between informant-observed and actigraphic assessments of sleep-wake rhythm disturbances in demented residents of homes for the elderly. The American Journal of Geriatric Psychiatry, 14(2), 104–111. https://doi.org/10.1097/01.JGP.0000192481.27931.c5
17.
IrwinM. R.VitielloM. V. (2019). Implications of sleep disturbance and inflammation for Alzheimer’s disease dementia. The Lancet Neurology, 18(3), 296–306. https://doi.org/10.1016/S1474-4422(18)30450-2
18.
JuY.-E. S.LuceyB. P.HoltzmanD. M. (2014). Sleep and Alzheimer disease pathology—A bidirectional relationship. Nature Reviews Neurology, 10(2), 115–119. https://doi.org/10.1038/nrneurol.2013.269
19.
JuY.-E. S.McLelandJ. S.ToedebuschC. D.XiongC.FaganA. M.DuntleyS. P.MorrisJ. C.HoltzmanD. M. (2013). Sleep quality and preclinical Alzheimer disease. JAMA Neurology, 70(5), 587–593. https://doi.org/10.1001/jamaneurol.2013.2334
20.
KangJ.-E.LimM. M.BatemanR. J.LeeJ. J.SmythL. P.CirritoJ. R.FujikiN.NishinoS.HoltzmanD. M. (2009). Amyloid-β dynamics are regulated by orexin and the sleep-wake cycle. Science, 326(5955), 1005–1007. https://doi.org/10.1126/science.1180962
21.
LauderdaleD. S.KnutsonK. L.YanL. L.LiuK.RathouzP. J. (2008). Self-reported and measured sleep duration: How similar are they?Epidemiology, 19, 838–845. https://doi.org/10.1097/EDE.0b013e318187a7b0
22.
LedgerC.KaramehW. K.MunozD. G.FischerC. E.SchweizerT. A. (2020). Gender role in sleep disturbances among older adults with traumatic brain injury. International Review of Psychiatry, 32(1), 39–45.
23.
LivingstonG.HuntleyJ.SommerladA.AmesD.BallardC.BanerjeeS.BrayneC.BurnsA.Cohen-MansfieldJ.CooperC. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
24.
LuceyB. P.HicksT. J.McLelandJ. S.ToedebuschC. D.BoydJ.ElbertD. L.PattersonB. W.BatyJ.MorrisJ. C.OvodV. (2018). Effect of sleep on overnight cerebrospinal fluid amyloid β kinetics. Annals of Neurology, 83(1), 197–204. https://doi.org/10.1002/ana.25117
25.
ManderB. A.RaoV.LuB.SaletinJ. M.LindquistJ. R.Ancoli-IsraelS.JagustW.WalkerM. P. (2013). Prefrontal atrophy, disrupted NREM slow waves and impaired hippocampal-dependent memory in aging. Nature Neuroscience, 16(3), 357–364. https://doi.org/10.1038/nn.3324
26.
McKhannG. M.KnopmanD. S.ChertkowH.HymanB. T.JackC. R.Jr.KawasC. H.KlunkW. E.KoroshetzW. J.ManlyJ. J.MayeuxR. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7(3), 263–269. https://doi.org/10.1016/j.jalz.2011.03.005
27.
MilaniniB.CatellaS.PerkovichB.Esmaeili-FiridouniP.WendelkenL.PaulR.GreeneM.KetelleR.ValcourV. (2017). Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: The UCSF HIV over 60 cohort study. AIDS Care, 29(9), 1178–1185. https://doi.org/10.1080/09540121.2017.1281877
28.
MorrisJ. C. (1997). Clinical dementia rating: A reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9(Suppl. 1), 173–176. https://doi.org/10.1017/s1041610297004870
29.
MorrisJ. C.WeintraubS.ChuiH. C.CummingsJ.DeCarliC.FerrisS.FosterN. L.GalaskoD.Graff-RadfordN.PeskindE. R. (2006). The Uniform Data Set (UDS): Clinical and cognitive variables and descriptive data from Alzheimer Disease Centers. Alzheimer Disease and Associated Disorders, 20(4), 210–216.
30.
MusaG.HenríquezF.Muñoz-NeiraC.DelgadoC.LilloP.SlachevskyA. (2017). Utility of the Neuropsychiatric Inventory Questionnaire (NPI-Q) in the assessment of a sample of patients with Alzheimer’s disease in Chile. Dementia & Neuropsychologia, 11(2), 129–136.
31.
National Academies of Sciences, Engineering, and Medicine. (2017). Preventing cognitive decline and dementia: A way forward. The National Academies Press.
OsorioR. S.AyappaI.MantuaJ.GumbT.VargaA.MooneyA. M.BurschtinO. E.TaxinZ.DuringE.SpectorN. (2014). The interaction between sleep-disordered breathing and apolipoprotein E genotype on cerebrospinal fluid biomarkers for Alzheimer’s disease in cognitively normal elderly individuals. Neurobiology of Aging, 35(6), 1318–1324. https://doi.org/10.1016/j.neurobiolaging.2013.12.030
34.
PachecoJ.GohJ. O.KrautM. A.FerrucciL.ResnickS. M. (2015). Greater cortical thinning in normal older adults predicts later cognitive impairment. Neurobiology of Aging, 36(2), 903–908. https://doi.org/10.1016/j.neurobiolaging.2014.08.031
35.
RabinL. A.WangC.KatzM. J.DerbyC. A.BuschkeH.Lip tonR. B. (2012). Predicting Alzheimer’s disease: Neuropsychological tests, self-reports, and informant reports of cognitive difficulties. Journal of the American Geriatrics Society, 60(6), 1128–1134. https://doi.org/10.1111/j.1532-5415.2012.03956.x
36.
Riemersma-van der LekR. F.SwaabD. F.TwiskJ.HolE. M.HoogendijkW. J.Van SomerenE. J. (2008). Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial. Journal of the American Medical Association, 299(22), 2642–2655. https://doi.org/10.1001/jama.299.22.2642
37.
SeligmanS. C.KamathV.GiovannettiT.ArnoldS. E.MobergP. J. (2013). Olfaction and apathy in Alzheimer’s disease, mild cognitive impairment, and healthy older adults. Aging & Mental Health, 17(5), 564–570. https://doi.org/10.1080/13607863.2013.768208
38.
SharmaR. A.VargaA. W.BubuO. M.PirragliaE.KamK.ParekhA.WohlleberM.MillerM. D.AndradeA.LewisC. (2018). Obstructive sleep apnea severity affects amyloid burden in cognitively normal elderly: A longitudinal study. American Journal of Respiratory and Critical Care Medicine, 197(7), 933–943.
39.
ShiL.ChenS.-J.MaM.-Y.BaoY.-P.HanY.WangY.-M.ShiJ.VitielloM. V.LuL. (2018). Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Medicine Reviews, 40, 4–16. https://doi.org/10.1016/j.smrv.2017.06.010
40.
ShimA.HoganM.HalldinK.ClarkH.BehrensB.GriffithC.Umasabor-BubuO. Q.BubuO. M. (2017). Sleep disordered breathing, ApoE4 and β-amyloid deposition in cognitively normal elderly. Alzheimer’s & Dementia, 13(7), P1124–P1125. https://doi.org/10.1016/j.jalz.2017.06.1632
41.
ShokouhiS. (2019). Associations of informant-based sleep reports with Alzheimer’s disease pathologies. Clinical Interventions in Aging, 14, 1631–1642. https://doi.org/10.2147/CIA.S215208
42.
Smith-GambleV.BaiyewuO.PerkinsA. J.GurejeO.HallK. S.OgunniyiA.HuiS. L.HendrieH. C. (2002). Informant reports of changes in personality predict dementia in a population-based study of elderly African Americans and Yoruba. The American Journal of Geriatric Psychiatry, 10(6), 724–732. https://doi.org/10.1097/00019442-200211000-00011
43.
SpiraA. P.GonzalezC. E.VenkatramanV. K.WuM. N.PachecoJ.SimonsickE. M.FerrucciL.ResnickS. M. (2016). Sleep duration and subsequent cortical thinning in cognitively normal older adults. Sleep, 39(5), 1121–1128. https://doi.org/10.5665/sleep.5768
44.
WallerK. L.MortensenE. L.AvlundK.OslerM.FagerlundB.LauritzenM.JennumP. (2016). Subjective sleep quality and daytime sleepiness in late midlife and their association with age-related changes in cognition. Sleep Medicine, 17, 165–173. https://doi.org/10.1016/j.sleep.2015.01.004
45.
WeintraubS.BesserL.DodgeH. H.TeylanM.FerrisS.GoldsteinF. C.GiordaniB.KramerJ.LoewensteinD.MarsonD. (2018). Version 3 of the Alzheimer Disease Centers’ neuropsychological test battery in the Uniform Data Set (UDS). Alzheimer Disease and Associated Disorders, 32(1), 10–17.
46.
WennbergA. M.WuM. N.RosenbergP. B.SpiraA. P. (2017). Sleep disturbance, cognitive decline, and dementia: A review. Seminars in Neurology, 37, 395–406.
47.
WesterbergC. E.FlorczakS. M.WeintraubS.MesulamM.-M.MarshallL.ZeeP. C.PallerK. A. (2015). Memory improvement via slow-oscillatory stimulation during sleep in older adults. Neurobiology of Aging, 36(9), 2577–2586. https://doi.org/10.1016/j.neurobiolaging.2015.05.014
48.
XieL.KangH.XuQ.ChenM. J.LiaoY.ThiyagarajanM.O’DonnellJ.ChristensenD. J.NicholsonC.IliffJ. J. (2013). Sleep drives metabolite clearance from the adult brain. Science, 342(6156), 373–377. https://doi.org/10.1126/science.1241224
49.
XuW.TanC.-C.ZouJ.-J.CaoX.-P.TanL. (2020). Sleep problems and risk of all-cause cognitive decline or dementia: An updated systematic review and meta-analysis. Journal of Neurology, Neurosurgery, and Psychiatry, 91(3), 236–244. https://doi.org/10.1136/jnnp-2019-321896
50.
YaffeK.LaffanA. M.HarrisonS. L.RedlineS.SpiraA. P.EnsrudK. E.Ancoli-IsraelS.StoneK. L. (2011). Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. Journal of the American Medical Association, 306(6), 613–619.
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