Sleep and Cognitive Decline: A Strong Bidirectional Relationship. It Is Time for Specific Recommendations on Routine Assessment and the Management of Sleep Disorders in Patients with Mild Cognitive Impairment and Dementia

Abstract

Background: Sleep disturbances and disruption of the neural regulation of the sleep-wake rhythm appear to be involved in the cellular and molecular mechanisms of cognitive decline. Although sleep problems are highly prevalent in mild cognitive impairment (MCI) and many types of dementia, they have not been systematically investigated in the clinical setting and are often only investigated by sleep specialists upon individual request. Summary: This review discusses sleep disorders in the context of cognitive decline and provides an overview of the clinical diagnosis and management of these disorders in patients with dementia and MCI. Key Messages: Sleep disorders are largely underestimated and do not receive sufficient attention in the global management of dementia patients. Sleep disturbances have a significant impact on cognitive and physical functions in individuals with cognitive decline and may be associated with important psychological distress and depression. They are positively associated with the severity of behavioral problems and cognitive impairment. Clinical Implications: The recent recommendations by the Sleep Study Group of the Italian Dementia Research Association can be used as a guideline for the clinical assessment and management of sleep disorders in MCI and dementia patients. Sleep disorders should be carefully investigated using an in-depth sleep history, physical examination, questionnaires and clinical scales and should be validated with the support of a direct caregiver. The recommendations for older adults can be used as a framework to guide the diagnosis and treatment of sleep disorders in individuals with dementia and MCI. The management strategy should be based on the choice of different treatments for each sleep problem present in the same patient, while avoiding adverse interactions between treatments.

Daytime sleepiness and nighttime sleep quality across the full spectrum of cognitive presentations in essential tremor

“…Alterations in nighttime sleep architecture, including shorter sleep duration, are associated with both age and cognitive impairment in patients with PD [40] as well as those without PD [41–43]. Older adults frequently report dissatisfaction with their sleep quality, and up to 50% of older adults report disturbed sleep, though there are often comorbid medical or psychiatric contributors.…”

Features of Circadian Rhythms in Patients with Cerebrovascular Diseases

“…There are reports that chronobiological disorders are detected in patients with arterial hypertension [70][71][72], diabetes mellitus [73][74][75], cardiac ischemia [11,12,14,61,66], dementia [67][68][69][70], etc. Nowadays there is a lot of data on the existence of chronobiological patterns in the development of stroke and myocardial infarction (MI) [11,12,14].…”

Sleep and mild cognitive impairment

“…Sleep disturbances in quality and quantity of sleep, as well as disruption of the sleep-wake rhythm, occur frequently in older adults with cognitive impairment and there is growing support for a bidirectional relationship (Guarnieri & Sorbi 2015). Studies looking at cognitive functioning have linked sleep disturbance prospectively to the emergence of cognitive deficits (Beaulieu-Bonneau & Hudon 2009), and have identified sleep issues as part of a prodromal syndrome of various neurodegenerative diseases (Postuma et al 2009).…”