Sleep and subjective cognitive decline in cognitively healthy elderly: Results from two cohorts

Abstract

Subjective cognitive decline (SCD) may reflect a dementia prodrome or modifiable risk factor such as sleep disturbance. What is the association between sleep and SCD? Cross-sectional design, from two studies of older adults: the WHICAP in the USA, and the HELIAD in Greece. 1576 WHICAP and 1456 HELIAD participants, without mild cognitive impairment, dementia, or severe depression/anxiety were included. Participants were mostly women, with 12 (WHICAP) and 8 (HELIAD) mean years of education. Sleep problems were estimated using the Sleep Scale from the Medical Outcomes Study. SCD was assessed using a structured complaint questionnaire that queries for subjective memory and other cognitive symptoms. Multinomial or logistic regression models were used to examine whether sleep problems were associated with complaints about general cognition, memory, naming, orientation, and calculations. Age, sex, education, sleep medication, use of medications affecting cognition, comorbidities, depression and anxiety were used as covariates. Objective cognition was also used estimated by summarizing neuropsychological performance into composite z-scores. Sleep problems were associated with two or more complaints; WHICAP:β=1.93(95%CI: 1.59–2.34),p≤0.0001, HELIAD:β=1.48(95%CI:1.20–1.83),(p≤0.0001). Sleep problems were associated with complaints in all the cognitive sub-categories except orientation for the WHICAP. The associations were noted regardless of objective cognition. At any given level of objective cognition, sleep disturbance is accompanied by subjective cognitive impairment. The replicability in two ethnically, genetically, and culturally different cohorts adds validity to our results. Results have implications for the correlates, and potential etiology of SCD, which should be considered in the assessment and treatment of older adults with cognitive complaints.

Subjective Cognitive Decline and Nighttime Sleep Alterations, a Longitudinal Analysis

“…Tsapanou et al (2018) found more sleep problems associated with an increased amount of SCD level and sleep problems, in this case, were associated in their study with subjective memory issues, particularly naming and calculations in two large cohorts of cognitively healthy older adults. They found in an unadjusted multinomial regression model, that more subjective sleep problems were associated with more total SCD (Tsapanou et al, 2018).…”

“…Sleep alterations are prevalent among older adults who are at risk of developing dementia (Palmer et al, 2018; Lucey et al, 2019). So far, there have been few studies that have analyzed the objective quality of sleep in these individuals, most of them have considered subjective parameters (Cavuoto et al, 2015; Landry et al, 2015; Smagula et al, 2016; Lysen et al, 2018; Tsapanou et al, 2018).…”

“…Researches show that sleep disorders, such as fragmented sleep or reduced total sleep time (TST) or increased night-time wake are very common in patients with MCI and AD (Jelicic et al, 2002; Ju et al, 2013, 2014; da Silva, 2015; Dubois et al, 2016). Few studies show that sleep is altered in the SCD individuals (Lauriola et al, 2016; Nakakubo et al, 2018; Tsapanou et al, 2018).…”

Sleep Apnea Syndrome in an Elderly Population Admitted to a Geriatric Unit: Prevalence and Effect on Cognitive Function

“…It is often underdiagnosed (Peppard et al, 2013), though its prevalence is increasing and was recently shown to be up to 40% in the general population (Heinzer et al, 2015), and likely higher in the elderly population (Al Lawati et al, 2009;Heinzer et al, 2015). SAS interrupts sleep and causes intermittent hypoxia (Rosenzweig et al, 2015) which could contribute to a range of pathophysiological consequences, including cognitive impairment (Wallace and Bucks, 2013;Arli et al, 2015), particularly in older patients (Yaffe et al, 2011;Osorio et al, 2015;Tsapanou et al, 2018). In fact, SAS is more prevalent in patients suffering from neurodegenerative diseases (Moran et al, 2005;Emamian et al, 2016) and is suspected to increase risks of developing Alzheimer's disease (Aoki et al, 2014;Osorio et al, 2015;Liguori and Placidi, 2018).…”

Comment on “Sleep disturbances and later cognitive status: a multi-centre study”

“…Lastly, the analysis of sleep organization in individuals in the preclinical phase of dementia/AD, the so-called subjective cognitive decline (SCD) (24), should be performed in order to evaluate if SCD is a possible consequence of altered sleep architecture. For example, Tsapanou et al observed in recent research that increased sleep problems were associated with increased SCD after adjustment for demographics, clinical factors and global cognition (25).…”