We investigated the prevalence and correlates of discrepancies between self-reported sleep quality (Pittsburgh Sleep Quality Index) and objective sleep efficiency (actigraphy) in older adults with mild cognitive impairment (MCI) and subsyndromal depression.
Methods:
This was a secondary analysis of a clincial trial with 59 adults aged 60 years and older with MCI and subsyndromal depression. We included baseline data on participants’ subjective sleep quality, objective sleep efficiency, depressive symptoms, insomnia diagnosis, and cognitive functioning.
Results:
Pittsburgh Sleep Quality Index subjective sleep quality and actigraphy-measured sleep efficiency were not significantly correlated (r = −.06; P = .64), with 61% of participants having subjective-objective sleep discrepancies. Correlates of subjective-objective sleep discrepancy included the presence of an insomnia diagnosis and impaired memory, particularly delayed memory.
Conclusion:
These findings are important because subjective underestimation of symptoms in older adults with memory impairments may result in sleep disturbances going unrecognized in clinical practice; on the other hand, an insomnia disorder may be a possible remediable contribution to subjective overestimation of sleep disturbances.
Pace-SchottEFSpencerRM. Age-related changes in the cognitive function of sleep. Prog Brain Res. 2011;191:75–89.
2.
LichsteinKLMorinC. Treatment of Late-Life Insomnia. Thousand Oaks, CA: Sage; 2000.
3.
AllenSRSeilerWOStahelinHBSpiegelR. Seventy-two hour polygraphic and behavioral recordings of wakefulness and sleep in a hospital geriatric unit: comparison between demented and nondemented patients. Sleep. 1987;10(2):143–159.
4.
PrinzPNPeskindERVitalianoPP. Changes in the sleep and waking EEGs of nondemented and demented elderly subjects. J Am Geriatr Soc. 1982;30(2):86–93.
5.
KohlerCAMagalhaesTFOliveiraJM. Neuropsychiatric disturbances in mild cognitive impairment (MCI): a systematic review of population-based studies. Curr Alzheimer Res. 2016;13(10):1066–1082.
6.
DiemSJBlackwellTLStoneKL. Measures of sleep-wake patterns and risk of mild cognitive impairment or dementia in older women. Am J Geriatr Psychiatry. 2016;24(3):248–258.
7.
PotvinOHudonCForgetH. Prevalence of psychiatric disorders in community-dwelling older men and women with cognitive impairment no dementia: results from the ESA study. Aging Ment Health. 2012;16(2):218–227.
8.
YaffeKFalveyCMHoangT. Connections between sleep and cognition in older adults. Lancet Neurol. 2014;13(10):1017–1028.
9.
BuysseDJGermainAMoulDE. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171(10):887–895.
10.
HarsoraPKessmannJ. Nonpharmacologic management of chronic insomnia. Am Fam Physician. 2009;79(2):125–130.
11.
LieJDTuKNShenDDWongBM. Pharmacological treatment of insomnia. P T. 2015;40(11):759–771.
12.
Schutte-RodinSBrochLBuysseDDorseyCSateiaM. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.
13.
BuysseDJReynoldsCF IIIMonkTHBermanSRKupferDJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
14.
GrandnerMAKripkeDFYoonIYYoungstedtSD. Criterion validity of the Pittsburgh Sleep Quality Index: investigation in a non-clinical sample. Sleep Biol Rhythms. 2006;4(2):129–139.
15.
RegesteinQRFriebelyJShifrenJL. Self-reported sleep in postmenopausal women. Menopause. 2004;11(2):198–207.
16.
Van Den BergJFVan RooijFJVosH. Disagreement between subjective and actigraphic measures of sleep duration in a population-based study of elderly persons. J Sleep Res. 2008;17(3):295–302.
17.
KayDBBuysseDJGermainAHallMMonkTH. Subjective-objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment. J Sleep Res. 2015;24(1):32–39.
18.
GanguliMDuYDodgeHHRatcliffGGChangCC. Depressive symptoms and cognitive decline in late life: a prospective epidemiological study. Arch Gen Psychiatry. 2006;63(2):153–160.
19.
FranzenPLBuysseDJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10(4):473–481.
20.
OhayonMM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111.
21.
HohmanTJBeason-HeldLLResnickSM. Cognitive complaints, depressive symptoms, and cognitive impairment: are they related?J Am Geriatr Soc. 2011;59(10):1908–1912.
22.
CraneMKBognerHRBrownGKGalloJJ. The link between depressive symptoms, negative cognitive bias and memory complaints in older adults. Aging Ment Health. 2007;11(6):708–715.
23.
GotlibIHJoormannJ. Cognition and depression: current status and future directions. Annu Rev Clin Psychol. 2010;6:285–312.
24.
GildengersAGButtersMAAlbertSM. Design and implementation of an intervention development study: Retaining Cognition while Avoiding Late-Life Depression (ReCALL). Am J Geriatr Psychiatry. 2016;24(6):444–454.
25.
KroenkeKSpitzerRLWilliamsJB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.
26.
FirstMSpitzerRGibbonMWilliamsJ. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Washington, DC: American Psychiatric Press; 1997.
27.
TengELChuiHC. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry1987;48(8):314–318.
28.
ReitanRWolfsonD. The Halstead-Reitan Neuropsychological Test Battery. Tucson, AZ: Neuropsychology Press; 1993.
29.
WechslerD. Wechsler Adult Intelligence Scale-III. San Antonio, TX, The Psychological Corporation; 1996.
30.
O’CaoimhRGaoYMcGladeC. Comparison of the Quick Mild Cognitive Impairment (Qmci) screen and the SMMSE in screening for mild cognitive impairment. Age Ageing. 2012;41(5):624–629.
RandolphCTierneyMCMohrEChaseTN. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol. 1998;20(3):310–319.
33.
DelisDKaplanEKramerJ. Delis-Kaplan Executive Function System. San Antonio, TX: The Psychological Corporation; 2001.
34.
JormAF. The informant questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr. 2004;16(3):275–293.
35.
HolmMRogersJ. The performance assessment of self-care skills (PASS). In: Hemphill-PearsonBJ, ed. Assessments in Occupational Therapy Mental Health. 2nd ed. Thorofare, NJ: Slack, Thorofare; 2008.
36.
HughesCPBergLDanzigerWLCobenLAMartinRL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982;140:566–572.
37.
Movement Disorder Society Task Force on Rating Scales for Parkinson’s D. The Unified Parkinson’s Disease Rating Scale (UPDRS): status and recommendations. Mov Disord. 2003;18(7):738–750.
38.
PetersenRC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183–194.
39.
LandryGJBestJRLiu-AmbroseT. Measuring sleep quality in older adults: a comparison using subjective and objective methods. Front Aging Neurosci. 2015;7:166.
40.
NasreddineZSPhillipsNABedirianV. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.
41.
FolsteinMFFolsteinSEMcHughPR. “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198.
42.
GoldJMQueernCLannoneVNBuchananRW. Repeatable Battery for the Assessment of Neuropsychological Status as a screening test in schizophrenia I: sensitivity, reliability, and validity. Am J Psychiatry. 1999;156(12):1944–1950.
43.
LalondeRHannequinD. The neurobiological basis of time estimation and temporal order. Rev Neurosci. 1999;10(2):151–173.
44.
PapagnoCAllegraACardaciM. Time estimation in Alzheimer’s disease and the role of the central executive. Brain Cogn. 2004;54(1):18–23.
45.
FrankelBLCourseyRDBuchbinderRSnyderF. Recorded and reported sleep in chronic primary insomnia. Arch Gen Psychiatry. 1976;33(5):615–623.
46.
O’DonnellDSilvaEJMünchMRondaJMWangWDuffyJF. Comparison of subjective and objective assessments of sleep in healthy older subjects without sleep complaints. J Sleep Res. 2009;18(2):254–263.
PatelSRWengJRueschmanM. Reproducibility of a standardized actigraphy scoring algorithm for sleep in a US Hispanic/Latino population. Sleep. 2015;38(9):1497–1503.
49.
PerlisMLSmithMTAndrewsPJOrffHGilesDE. Beta/gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. Sleep. 2001;24(1):110–117.
50.
St-JeanGTurcotteIPerusseADBastienCH. REM and NREM power spectral analysis on two consecutive nights in psychophysiological and paradoxical insomnia sufferers. Int J Psychophysiol. 2013;89(2):181–194.
51.
BailletMCosinCSchweitzerP. Mood influences the concordance of subjective and objective measures of sleep duration in older adults. Front Aging Neurosci. 2016;8:181.
52.
FaulFErdfelderELangAGBuchnerA. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–191.
American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–631.
55.
CarrM. Sedative and psychotropic medications. Nurs BC. 2005;37(5):29–30.
56.
KimWHKimJHKimBS. The role of depression in the insomnia of people with subjective memory impairment, mild cognitive impairment, and dementia in a community sample of elderly individuals in South Korea. Int Psychogeriatr. 2017;29(4):653–661.
