Depressive Symptoms are the Main Predictor for Subjective Sleep Quality in Patients with Mild Cognitive Impairment--A Controlled Study

Stefan Seidel, Peter Dal-Bianco, Eleonore Pablik, Nina Müller, Claudia Schadenhofer, Claus Lamm, Gerhard Klösch, Doris Moser, Stefanie Klug, Gisela Pusswald, Eduard Auff, Johann Lehrner, Stefan Seidel, Peter Dal-Bianco, Eleonore Pablik, Nina Müller, Claudia Schadenhofer, Claus Lamm, Gerhard Klösch, Doris Moser, Stefanie Klug, Gisela Pusswald, Eduard Auff, Johann Lehrner

Abstract

Objective: Controlled data on predictors of subjective sleep quality in patients with memory complaints are sparse. To improve the amount of comprehensive data on this topic, we assessed factors associated with subjective sleep quality in patients from our memory clinic and healthy individuals.

Methods: Between February 2012 and August 2014 patients with mild cognitive impairment (MCI) and subjective cognitive decline (SCD) from our memory clinic and healthy controls were recruited. Apart from a detailed neuropsychological assessment, the subjective sleep quality, daytime sleepiness and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Beck Depression Inventory (BDI-II).

Results: One hundred fifty eight consecutive patients (132 (84%) MCI patients and 26 (16%) SCD patients) and 75 healthy controls were included in the study. Pairwise comparison of PSQI scores showed that non-amnestic MCI (naMCI) patients (5.4 ± 3.5) had significantly higher PSQI scores than controls (4.3 ± 2.8, p = .003) Pairwise comparison of PSQI subscores showed that naMCI patients (1.1 ± 0.4) had significantly more "sleep disturbances" than controls (0.9 ± 0.5, p = .003). Amnestic MCI (aMCI) (0.8 ± 1.2, p = .006) and naMCI patients (0.7 ± 1.2, p = .002) used "sleep medication" significantly more often than controls (0.1 ± 0.6) Both, aMCI (11.5 ± 8.6, p < .001) and naMCI (11.5 ± 8.6, p < .001) patients showed significantly higher BDI-II scores than healthy controls (6.1 ± 5.3). Linear regression analysis showed that the subjective sleep quality was predicted by depressive symptoms in aMCI (p < .0001) and naMCI (p < .0001) patients as well as controls (p < .0001). This means, that more depressive symptoms worsened subjective sleep quality. In aMCI patients we also found a significant interaction between depressive symptoms and global cognitive function (p = .002).

Discussion: Depressive symptoms were the main predictor of subjective sleep quality in MCI patients and controls, but not in SCD patients. Better global cognitive function ameliorated the negative effect of depressive symptoms on the subjective sleep quality in aMCI patients.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Relative frequency (in percent) of…
Fig 1. Relative frequency (in percent) of good (black) and bad (white) sleepers in each group of patients with the same number of years of education.
The number of patients is shown above the bars and the number of years of education is shown below the bars.
Fig 2. Relative frequency of good (black)…
Fig 2. Relative frequency of good (black) and bad (white) sleepers in each group of patients with similar BDI scores.
The number of patients is shown above the bars and the range of BDI score for each subgroup is shown below the bars.

References

    1. Ju YE, McLeland JS, Toedebusch CD, Xiong C, Fagan AM, Duntley SP et al. (2013) Sleep quality and preclinical Alzheimer disease. JAMA Neurol 70: 587–593. 1663363 [pii];10.1001/jamaneurol.2013.2334
    1. Beaulieu-Bonneau S, Hudon C (2009) Sleep disturbances in older adults with mild cognitive impairment. Int Psychogeriatr 21: 654–666. S1041610209009120 [pii];10.1017/S1041610209009120
    1. McKinnon A, Terpening Z, Hickie IB, Batchelor J, Grunstein R, Lewis SJ et al. (2014) Prevalence and predictors of poor sleep quality in mild cognitive impairment. J Geriatr Psychiatry Neurol 27: 204–211. 0891988714527516 [pii];10.1177/0891988714527516
    1. Reisberg B, Ferris SH, de Leon MJ, Kluger A, Franssen E, Borenstein J et al. (1989) The stage specific temporal course of Alzheimer's disease: functional and behavioral concomitants based upon cross-sectional and longitudinal observation. Prog Clin Biol Res 317: 23–41.
    1. Van Someren EJ, Hagebeuk EE, Lijzenga C, Scheltens P, de Rooij SE, Jonker C et al. (1996) Circadian rest-activity rhythm disturbances in Alzheimer's disease. Biol Psychiatry 40: 259–270. 0006-3223(95)00370-3 [pii];10.1016/0006-3223(95)00370-3
    1. Naismith SL, Rogers NL, Lewis SJ, Terpening Z, Ip T, Diamond K et al. (2011) Sleep disturbance relates to neuropsychological functioning in late-life depression. J Affect Disord 132: 139–145. S0165-0327(11)00081-4 [pii];10.1016/j.jad.2011.02.027
    1. Jessen F (2014) Subjective and objective cognitive decline at the pre-dementia stage of Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci 264 Suppl 1: 3–7. 10.1007/s00406-014-0539-z
    1. Minett TS, Da Silva RV, Ortiz KZ, Bertolucci PH (2008) Subjective memory complaints in an elderly sample: a cross-sectional study. Int J Geriatr Psychiatry 23: 49–54. 10.1002/gps.1836
    1. Clarnette RM, Almeida OP, Forstl H, Paton A, Martins RN (2001) Clinical characteristics of individuals with subjective memory loss in Western Australia: results from a cross-sectional survey. Int J Geriatr Psychiatry 16: 168–174. 10.1002/1099-1166(200102)16:2<168::AID-GPS291>;2-D [pii].
    1. Smagula SF, Ancoli-Israel S, Blackwell T, Boudreau R, Stefanick ML, Paudel ML et al. (2014) Circadian Rest-Activity Rhythms Predict Future Increases in Depressive Symptoms Among Community-Dwelling Older Men. Am J Geriatr Psychiatry. S1064-7481(14)00193-6 [pii];10.1016/j.jagp.2014.06.007
    1. Lehrner J, Moser D, Klug S, Gleiss A, Auff E, Dal-Bianco P et al. (2013) Subjective memory complaints, depressive symptoms and cognition in patients attending a memory outpatient clinic. Int Psychogeriatr 1–11. S1041610213002263 [pii];10.1017/S1041610213002263
    1. Dilling H, Mombour W, Schmidt MH (2000) Internationale Klassifikation Psychischer Störungen ICD-10 Kapitel V (F). Klinisch-diagnostische Leitlinien, 4th edn Bern: Huber.
    1. Saß H, Wittchen HU, Zaudig M, Houben I (2003) Diagnostisches und statistisches Manualpsychischer Störungen—Textrevision—DSM-IV-TR Göttingen: Hogrefe Verlag für Psychologie.
    1. Petersen RC, Morris JC (2005) Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol 62: 1160–1163. 62/7/1160 [pii];10.1001/archneur.62.7.1160
    1. Stasinopoulus DM, Rigby RA (2007) Generalized additive models for location scale and shape (GAMLSS). Journal of Statistical Software, 23, 1–46.
    1. Pusswald G, Moser D, Gleiss A, Janzek-Hawlat S, Auff E, Dal-Bianco P et al. (2013) Prevalence of mild cognitive impairment subtypes in patients attending a memory outpatient clinic—comparison of two modes of mild cognitive impairment classification. Results of the Vienna Conversion to Dementia Study. Alzheimers Dement 9: 366–376. S1552-5260(12)00031-3 [pii];10.1016/j.jalz.2011. 12.009 . 10.1016/j.jalz.2011.12.009
    1. Kogler B (2013) Subjective Memory Complaint in Mild Cognitive Impairment, Alzheimer's Disease and Parkinson's Disease Vienna: University of Vienna.
    1. Ivnik RJ (1992) Mayo`s older Americans normative studies: WAIS-R, WMS-R and AVLT norms for ages 56 through 97. Clinical Neuropsychology, 6, 1–104.
    1. Folstein MF, Folstein SE, McHugh PR (1975) "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198. 0022-3956(75)90026-6 [pii].
    1. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28: 193–213. 0165-1781(89)90047-4 [pii].
    1. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14: 540–545.
    1. Hautzinger M (2006) Beck Depressions-Inventar (BDI-II), revised edn Frankfurt: Harcourt.
    1. Ausen B, Edman G, Almkvist O, Bogdanovic N (2009) Personality features in subjective cognitive impairment and mild cognitive impairment—early indicators of dementia? Dement Geriatr Cogn Disord 28: 528–535. 000255104 [pii];10.1159/000255104
    1. Ganguli M, Du Y, Dodge HH, Ratcliff GG, Chang CC (2006) Depressive symptoms and cognitive decline in late life: a prospective epidemiological study. Arch Gen Psychiatry 63: 153–160. 63/2/153 [pii];10.1001/archpsyc.63.2.153
    1. Potvin O, Lorrain D, Forget H, Dube M, Grenier S, Preville M et al. (2012) Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults. Sleep 35: 491–499. 10.5665/sleep.1732
    1. Reisberg B, Shulman MB, Torossian C, Leng L, Zhu W (2010) Outcome over seven years of healthy adults with and without subjective cognitive impairment. Alzheimers Dement 6: 11–24. S1552-5260(09)02327-9 [pii];10.1016/j.jalz.2009.10.002
    1. Carmeli C, Donati A, Antille V, Viceic D, Ghika J, von GA et al. (2013) Demyelination in mild cognitive impairment suggests progression path to Alzheimer's disease. PLoS One 8: e72759 10.1371/journal.pone.0072759 ;PONE-D-13-15971 [pii].
    1. Adam AM, Potvin O, Callahan BL, Bastien C, Lorrain D, Desjardins S et al. (2014) Subjective sleep quality in non-demented older adults with and without cognitive impairment. Int J Geriatr Psychiatry 29: 970–977. 10.1002/gps.4087
    1. Bixler E (2009) Sleep and society: an epidemiological perspective. Sleep Med 10 Suppl 1: S3–S6. S1389-9457(09)00246-9 [pii];10.1016/j.sleep.2009.07.005
    1. Hayes TL, Riley T, Mattek N, Pavel M, Kaye JA (2013) Sleep Habits in Mild Cognitive Impairment. Alzheimer Dis Assoc Disord. 10.1097/WAD.0000000000000010
    1. Dlugaj M, Weinreich G, Weimar C, Stang A, Dragano N, Wessendorf TE et al. (2014) Sleep-disordered breathing, sleep quality, and mild cognitive impairment in the general population. J Alzheimers Dis 41: 479–497. L741433273323713 [pii];10.3233/JAD-132132
    1. van der Helm E, Gujar N, Nishida M, Walker MP (2011) Sleep-dependent facilitation of episodic memory details. PLoS One 6: e27421 10.1371/journal.pone.0027421 ;PONE-D-11-14450 [pii].
    1. Shao Y, Lei Y, Wang L, Zhai T, Jin X, Ni W et al. (2014) Altered resting-state amygdala functional connectivity after 36 hours of total sleep deprivation. PLoS One 9: e112222 10.1371/journal.pone.0112222 ;PONE-D-14-03335 [pii].
    1. Sexton CE, Mackay CE, Ebmeier KP (2013) A systematic review and meta-analysis of magnetic resonance imaging studies in late-life depression. Am J Geriatr Psychiatry 21: 184–195. S1064-7481(12)00023-1 [pii];10.1016/j.jagp.2012.10.019
    1. Zheng C, Zhang T (2015) Synaptic plasticity-related neural oscillations on hippocampus-prefrontal cortex pathway in depression. Neuroscience. S0306-4522(15)00139-6 [pii];10.1016/j.neuroscience.2015.01.071
    1. Han Y, Lui S, Kuang W, Lang Q, Zou L, Jia J (2012) Anatomical and functional deficits in patients with amnestic mild cognitive impairment. PLoS One 7: e28664 10.1371/journal.pone.0028664 ;PONE-D-11-15797 [pii].
    1. Fotuhi M, Do D, Jack C (2012) Modifiable factors that alter the size of the hippocampus with ageing. Nat Rev Neurol 8: 189–202. nrneurol.2012.27 [pii];10.1038/nrneurol.2012.27
    1. Keage HA, Banks S, Yang KL, Morgan K, Brayne C, Matthews FE (2012) What sleep characteristics predict cognitive decline in the elderly? Sleep Med 13: 886–892. S1389-9457(12)00101-3 [pii];10.1016/j.sleep.2012.02.003
    1. Ferman TJ, Smith GE, Kantarci K, Boeve BF, Pankratz VS, Dickson DW et al. (2013) Nonamnestic mild cognitive impairment progresses to dementia with Lewy bodies. Neurology 81: 2032–2038. 01.wnl.0000436942.55281.47 [pii];10.1212/01.wnl.0000436942.55281.47
    1. Roure N, Gomez S, Mediano O, Duran J, Pena ML, Capote F et al. (2008) Daytime sleepiness and polysomnography in obstructive sleep apnea patients. Sleep Med 9: 727–731. S1389-9457(08)00051-8 [pii];10.1016/j.sleep.2008.02.006
    1. Terpening Z, Lewis SJ, Yee B, Grunstein R, Hickie IB, Naismith SL (2015) Association between Sleep-Disordered Breathing and Neuropsychological Performance in Older Adults with Mild Cognitive Impairment. J Alzheimers Dis. 78222Q2384041176 [pii];10.3233/JAD-141860
    1. Ward AM, McLaren DG, Schultz AP, Chhatwal J, Boot BP, Hedden T et al. (2013) Daytime sleepiness is associated with decreased default mode network connectivity in both young and cognitively intact elderly subjects. Sleep 36: 1609–1615. 10.5665/sleep.3108
    1. Hita-Yanez E, Atienza M, Cantero JL (2013) Polysomnographic and subjective sleep markers of mild cognitive impairment. Sleep 36: 1327–1334. 10.5665/sleep.2956
    1. Tranah GJ, Blackwell T, Stone KL, Ancoli-Israel S, Paudel ML, Ensrud KE et al. (2011) Circadian activity rhythms and risk of incident dementia and mild cognitive impairment in older women. Ann Neurol 70: 722–732. 10.1002/ana.22468
    1. Wang YP, Gorenstein C (2013) Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II. Clinics (Sao Paulo) 68: 1274–1287. S1807-59322013000901274 [pii];10.6061/clinics/2013(09)15

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever