Interventions on Lifestyle and Social Support Factors: Sleep Quality and Disorders

Transcription

1 Interventions on Lifestyle and Social Support Factors: Sleep Quality and Disorders Preventing Dementia and Cognitive Impairment: A Workshop Susan M. McCurry, PhD Northwest Research Group on Aging Department of Psychosocial and Community Health University of Washington School of Nursing

2 Background > Normal older adults show decline in both quality and quantity of sleep Sleep fragmentation, excessive daytime sleepiness, circadian dysregulation > Cognitive behavioral therapy for insomnia (CBT-I) is well established and evidencebased. Positive effects of CBT-I are robust over time Efficacious in older adults with a variety of comorbid conditions

3 Sleep and Cognitive Performance > Sleep loss is known to impair performance on attention and executive-control tasks > Evidence sleep plays a role in memory consolidation > More condensed (shorter) and continuous (less fragmented) associated with better cognitive performance in normal older adults

4 Sleep Loss, Cognition, and Morbidities > Chronic sleep loss correlated w/ diabetes, cardiovascular disease, mood disorders, substance misuse, compromised immunity > Neurodegeneration secondary to intermittent hypoxia in sleep disordered breathing > Chronic systemic inflammation increase risk for circadian dysregulation + cognitive decline via epigenetic modulations

5 Sleep and Cognitive Decline > Elevated levels of cerebrospinal fluid amyloid beta (Aß) in preclinical Alzheimer disease associated with lower sleep quality > Abnormalities in sleep architecture reported in mild cognitive impairment (MCI) > Role of sleep in AD? : While the brain sleeps, it clears out harmful waste proteins, including amyloid beta

6 Sleep-Related Pathways to AD Studies suggest a bidirectional relationship between sleep and Alzheimer s disease Circadian dysregulation Poor sleep Inflammation Aß deposition AD pathogenesis Landry GL, Liu-Ambrose T. (2014). Frontiers in Aging Neuroscience. Doi: /fnagi

7 What Draft Report Showed > Conclude: Insufficient evidence for sleep interventions preventing, slowing, or delaying age-related cognitive decline, MCI, or AD onset > Only two sleep intervention studies met review criteria Sleep extension for obese, middle aged shortsleepers (Lucassen 2014) Older adults with poor sleep quality given sleep hygiene education and muscle relaxation (Sun 2013)

8 Possible Reasons for NS Findings-1 > New line of research, studies are only now starting to be conducted CBT-I efficacy trials have typically not included cognitive outcomes Unknown what are the best sleep measures and cognitive performance tasks to use Results may co-vary by time of day cognitive testing done vs. sleep event Many confounding variables (e.g., medical morbidity) to consider impacting both sleep and cognition

9 Possible Reasons for NS Findings-2 > Relationship between sleep and cognitive function is complicated: Longer follow-up periods with sustained sleep improvements may be needed Relationship between sleep and cognition likely vary by dementia etiology Overlap with other behavioral interventions (for example, physical activity also may improve sleep) Sleep/cognition impacts may be different for older and younger adults

10 Sleep, Light, and Dementia > Sleep determined by synchronization of two mechanisms: homeostatic (sleep drive) and circadian (biological clock) > Light is primary cue to biological clock to entrain circadian regulation and sleep-wake rhythms > Evidence for positive effects of bright light on circadian regulation and sleep disruptions in NH residents

11 Summary > Although this draft review found no support for sleep interventions being effective for improving cognition, the small number of studies available and methodological limitations in intervention quality, sample sizes, assessment tools, and consideration of confounding variables suggest the jury is still out.

12 Useful References Daulatzai MA Neurotox Res 28: Forbes D, et al Cochrane Database Syst Rev 2:CD Guarnieri B, Sorbi S Eur Neurol 74: Landray GJ, Liu-Ambrose T Front Aging Neurosci 6:325. Pistollato F, et al Adv Nutr 7: Mander BA, et al Trends Neurosci 39: Mendelsohn AR, Larrick JW Rejuvenation Res 16: Scullin MK, Bliwise DL Perspect Psychol Sci 10: Swaab DF, et al Alzheimer Dis Assoc Disord 17:S114- S122. Wilckens KA, et al Behav Sleep Med 14: