Sleep disturbance and daytime sleepiness predict vascular dementia

School of Medicine, Cardiff University, University Hospital of Wales, Cardiff CF14 4XN UK.
Journal of epidemiology and community health (Impact Factor: 3.5). 09/2011; 65(9):820-4. DOI: 10.1136/jech.2009.100503
Source: PubMed


Disturbed sleep is common throughout the community and is associated with an increase in daytime sleepiness, both of which, in turn are associated with an increased risk of ischaemic vascular disease. The hypothesis that sleep disturbances are predictive of dementia, and in particular vascular dementia was tested in a large community-based cohort of older men.
A questionnaire on sleep disturbances was administered to 1986 men aged 55-69 years in the Caerphilly Cohort Study and 10 years later the men were examined clinically for evidence of dementia or cognitive impairment with no dementia (CIND).
Approximately 20% of the men reported disturbed sleep and 30% reported 'severe' daytime sleepiness. Ten years later 1,225 men (75% of the surviving men in the cohort) were tested and 268 (22%) were found to be cognitively impaired with 93 (7.6%) showing clear evidence of dementia and the remaining 175 (14.3%) showing evidence of CIND. After adjustment for possible confounding, including cognitive function and the taking of sleeping tablets at baseline, sleep disturbances appeared to be predictive of dementia and CIND of vascular origin, while there was no suggestion of prediction of non-vascular cognitive impairment by sleep. Prediction of vascular dementia appeared to be particularly strong for daytime sleepiness, with an adjusted OR of 4.44 (95% CI 2.05 to 9.61). Further adjustments for psychological distress at baseline reduced the size of the relationships, but the ORs remain large, consistent with a direct positive effect of sleep disturbance on vascular dementia.
Sleep disturbances, and in particular severe daytime sleepiness, appear to be strongly predictive of vascular dementia, but have no predictive power for non vascular dementia.

Download full-text


Available from: Antony Bayer,
  • Source
    • "of insomnia often greater in older individuals (Schwartz et al., 1999; Katz and McHorney, 2002). In addition, increasing research demonstrates insomnia to be associated with cognitive decline, as well as risk of Alzheimer's disease, in older adults (Cricco et al., 2001; Elwood et al., 2011; Hahn et al., 2013). Cognitive behavioral therapy (CBT) is a wellestablished treatment for insomnia that has been shown to be efficacious in numerous randomized controlled trials (RCTs) (Morin et al., 1994; Smith et al., 2002; Morin et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Limited research has examined the effects of cognitive behavioral therapy for insomnia (CBT-I) among older adults (age >65 years) receiving treatment in real-world clinical settings and even less has examined effects on outcomes beyond reducing insomnia, such as improved quality of life. The current article examines and compares outcomes of older versus younger (age 18-64 years) veterans receiving CBT-I nationally in nonsleep specialty settings.Method Patient outcomes were assessed using the Insomnia Severity Index, Beck Depression Inventory-II, and the World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed using the Working Alliance Inventory—Short Revised.ResultsA total of 536 younger veterans and 121 older veterans received CBT-I; 77% of older and 64% of younger patients completed all sessions or finished early due to symptom relief. Mean insomnia scores declined from 19.5 to 9.7 in the older group and from 20.9 to 11.1 in the younger group. Within-group effect sizes were d = 2.3 and 2.2 for older and younger groups, respectively. CBT-I also yielded significant improvements in depression and quality of life for both age groups. High and increasing levels of therapeutic alliance were observed for both age groups.Conclusions Older (and younger) patients receiving CBT-I from nonsleep specialists experienced large reductions in insomnia and improvements in depression and quality of life. Effects were similar for both age groups, and the rate of dropout was lower among older adults. The results provide strong support for the effectiveness and acceptability of CBT-I for older adults receiving care in routine treatment settings. Copyright © 2014 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 03/2015; 30(3). DOI:10.1002/gps.4143 · 2.87 Impact Factor
  • Source
    • "Data from the BRFSS indicate that veterans are more likely to report sleep disturbances (not enough sleep and short sleep) compared with nonveterans [3], and in an observational study, older veterans also reported more sleepiness than controls [113]. Sleep quality is a critical emerging risk factor for cognitive aging [114]. Measures of sleep quality such as excessive daytime sleepiness, sleep duration, and sleep latency have been associated with dementia and cognitive impairment [115] [116] [117]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Lifestyle and health-related factors are critical components of the risk for cognitive aging among veterans. Because dementia has a prolonged prodromal phase, understanding effects across the life course could help focus the timing and duration of prevention targets. This perspective may be especially relevant for veterans and health behaviors. Military service may promote development and maintenance of healthy lifestyle behaviors, but the period directly after active duty has ended could be an important transition stage and opportunity to address some important risk factors. Targeting multiple pathways in one intervention may maximize efficiency and benefits for veterans. A recent review of modifiable risk factors for Alzheimer's disease estimated that a 25% reduction of a combination of seven modifiable risk factors including diabetes, hypertension, obesity, depression, physical inactivity, smoking, and education/cognitive inactivity could prevent up to 3 million cases worldwide and 492,000 cases in the United States. Lifestyle interventions to address cardiovascular health in veterans may serve as useful models with both physical and cognitive activity components, dietary intervention, and vascular risk factor management. Although the evidence is accumulating for lifestyle and health-related risk factors as well as military risk factors, more studies are needed to characterize these factors in veterans and to examine the potential interactions between them.
    Alzheimer's and Dementia 06/2014; 10(3):S111–S121. DOI:10.1016/j.jalz.2014.04.010 · 12.41 Impact Factor
  • Source
    • "Previous studies have assessed longitudinal associations between cognitive decline and insomnia-type symptoms in the elderly such as problems initiating and maintaining sleep [10] [11] [12] [13], along with excessive daytime sleepiness [13] [14] [15], snoring [10] [13] [14], sleep duration [10], and obstructive sleep apnoea (OSA) [16]. Excessive daytime sleepiness appears to be the only measure that is reliably associated with cognitive decline or dementia [13] [14], although Elwood et al. [15] reported this to be the case only for Vascular dementia. There are a number of reasons that could explain the mostly null findings including short follow-up periods and insomnia-type symptoms grouped rather than assessed independently. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep is critical for optimal cognitive function, but as we age both cognitive impairment and sleep problems increase. Longitudinal, population-based studies can be used to investigate temporal relationships between sleep and cognition. A total of 2012 cognitively unimpaired individuals 65 years and over were drawn from the MRC Cognitive Function and Ageing Study (CFAS). They answered self-reported measures including: insomnia symptoms and age of onset, night time wakings, snoring, sleep onset latency, napping, daytime sleepiness and duration of night time sleep. Cognition was measured via the Mini-Mental State Examination. It was found that daytime napping at baseline was associated with a lower risk of cognitive decline at two and 10 years, and that obtaining ≤6.5h of night-time sleep and excessive daytime sleepiness at baseline were associated with an increased risk at 10 years. Daytime napping, night-time sleep duration, and excessive daytime sleepiness may be modifiable behaviours open to intervention strategies, or, clinical indicators of future decline in older individuals.
    Sleep Medicine 05/2012; 13(7):886-92. DOI:10.1016/j.sleep.2012.02.003 · 3.15 Impact Factor
Show more