Background and purposeThe COVID epidemic is affecting individuals worldwide, and Alzheimer's disease (AD) and amnesic mild cognitive impairment (MCI) patients are at risk due to their characteristics and age.We analysed the impact of the pandemic on these patients' neuropsychiatric symptoms and their quality of life after five weeks of lockdown in Spain. MethodsWe tested 40 subjects with a diagnosis of MCI (20) or mild AD (20) from the Cognitive Stimulation Program of Cognitive Disorders Unit. All patients had undergone a previous evaluation during the month before the lockdown, and they were re-evaluated after 5 weeks of lockdown. The Neuropsychiatric Inventory (NPI) and EuroQol-5D were used to evaluate the neuropsychiatric symptoms and quality of life of patients and caregivers. ResultsThe total baseline NPI score was 33.75 (22.28) vs 39.05 (27.96) after confinement (p=0.028). The most frequent neuropsychiatric symptoms affected were apathy (4.15 (3.78) vs 5.75 (4.02); p=0.002) and anxiety (3.95 (3.73) vs 5.30 (4.01); p=0.006) in MCI patients and apathy (2.35(2.70) vs 3.75 (3.78); p=0.036), agitation (0.45 (1.14) vs 1.50 (2.66); p=0.029) and aberrant motor behaviour (1.25 (2.86) vs 2.00 (2.93); p=0.044) in AD patients. We did not observe differences in EuroQol-5D scores during the reevaluation. Approximately 30% of patients and 40% of caregivers reported a worsening of their health status during confinement.

Sleep disturbances occur frequently in patients with Parkinson's disease (PD). The aim of this study was to investigate the effects of rotigotine on sleep fluctuations in a sample of PD patients with self-reported complaints of nocturnal awakenings. This prospective, open-label, observational, and multicenter study enrolled consecutive outpatients with PD and administered rotigotine (mean dose 8.9 mg/day) for 3 months. The primary endpoint was the change from baseline in sleep fragmentation, assessed using the sleep maintenance subscale score of the Parkinson's Disease Sleep Scale (PDSS). The newly designed Parkinson's Disease Sleep Fragmentation Questionnaire (PD-SFQ) was used to measure other sleep parameters. A total of 62 patients were enrolled (mean age 70.2 years; 66% male). At 3 months, rotigotine significantly improved sleep fragmentation from baseline on the PDSS-2 sleep maintenance subscale (from 3.4 ± 0.9 to 1.9 ± 1.4; P < 0.0001). Rotigotine also significantly improved nocturnal motor symptoms (P < 0.0001), restless legs-like symptoms (P < 0.005), and nocturia (P = 0.004). Rotigotine significantly improved self-reported complaints of sleep fragmentation in PD patients and could be a useful treatment to improve this specific sleep problem in PD. However, these results are based on a small and clinically heterogeneous sample so they must be taken cautiously.

Background Alterations in circadian rhythms are present in the presymptomatic stage of Alzheimer’s disease (AD), possibly contributing to its pathogenesis. However, it is unknown whether such alterations are associated with worse outcomes once individuals are diagnosed with symptomatic disease. We aimed to evaluate the association between the circadian rest-activity pattern and AD-related features in patients with mild-moderate AD. Methods We assessed the circadian rest-activity pattern of consecutive patients with mild-moderate AD through actigraphy for 14 days. Cerebrospinal fluid was obtained to determine the levels of important pathological markers including amyloid-beta protein (Aβ42), phosphorylated tau (P-tau), total tau (T-tau), and neurofilament light (NF-L). Neuropsychological evaluation was conducted at the beginning of the study and after 12 months of follow-up. Linear regression models were performed considering the global population and Aβ42+ patients only. Results The cohort included 100 patients with mild-moderate AD. The median age [p25;p75] was 76.0 [73.0;80.0] years and 63.0% were female. Older age (effect size [SE] of 0.324 [0.096]; p = 0.001) and male sex (0.780 [0.193]; p = 0.001) were associated with increased fragmentation and decreased synchronization of the rhythm, respectively. After adjusting for age, sex, and season of the year, increased levels of T-tau (effect size [95% CI] of 0.343 [0.139 to 0.547]; p = 0.001) and NF-L (0.444 [0.212 to 0.676]; p = 0.001) were associated with a higher amplitude of the rest-activity rhythm. Increased fragmentation of the rhythm at baseline was associated with greater cognitive decline after one year of follow-up independent of age, sex, T-tau/Aβ42 ratio, educational level, and season of the year (− 0.715 [− 1.272 to − 0.157]; p = 0.013). Similar findings were obtained considering only the Aβ42+ patients. Conclusions Our results suggest a potential role of the circadian rest-activity pattern in predicting the cognitive decline of patients with mild-moderate AD. Further studies are warranted to confirm these findings and to elucidate whether there is causality among the observed associations.