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Connections Between Insomnia and Cognitive Aging

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Abstract

Insomnia is a common sleep disorder among older adults, and a risk factor for poor physical and mental health. However, the relationship between insomnia and cognitive health is not well understood. Here, we review observational studies that have investigated whether insomnia is associated with deficits in objective cognitive performance and an increased risk of dementia, magnetic resonance imaging studies that have assessed grey matter volumes and white matter microstructure, and interventional studies that have explored whether the treatment of insomnia can improve cognitive outcomes. There are inconsistent findings regarding impaired performance in objective cognitive tests and reduced grey matter volumes, and limited, emerging, evidence that suggests that insomnia is associated with an increased risk of dementia and reduced white matter integrity. Although the interventional literature is still in its infancy, there is some indication that treatment may have an impact on vigilance. Well-powered studies examining sources of heterogeneity are warranted.

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References

  1. Patel D, Steinberg J, Patel P. Insomnia in the elderly: A review. J Clin Sleep Med 2018, 14: 1017–1024.

    PubMed  PubMed Central  Google Scholar 

  2. American Academy of Sleep Medicine. The International Classification of Sleep Disorders, 3rd ed (ICSD-3). 2014.

  3. American Psychiatric A. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA, 2013.

    Google Scholar 

  4. Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017, 26: 675–700.

    PubMed  Google Scholar 

  5. Taylor DJ, Lichstein KL, Durrence HH. Insomnia as a health risk factor. Behav Sleep Med 2003, 1: 227–247.

    PubMed  Google Scholar 

  6. Yaffe K, Falvey CM, Hoang T. Connections between sleep and cognition in older adults. Lancet Neurol 2014, 13: 1017–1028.

    PubMed  Google Scholar 

  7. Irving K, Hogervorst E, Oliveira D, Kivipelto M. New Developments in Dementia Prevention Research. State of the Art and Future Possibilities, 1st ed., Routledge, 2018.

  8. Fortier-Brochu E, Morin CM. Cognitive impairment in individuals with insomnia: clinical significance and correlates. Sleep 2014, 37: 1787–1798.

    PubMed  PubMed Central  Google Scholar 

  9. Sivertsen B, Hysing M, Wehling E, Pallesen S, Nordhus IH, Espeseth T, et al. Neuropsychological performance in older insomniacs. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2013, 20: 34–48.

    PubMed  Google Scholar 

  10. Joo EY, Noh HJ, Kim JS, Koo DL, Kim D, Hwang KJ, et al. Brain gray matter deficits in patients with chronic primary insomnia. Sleep 2013, 36: 999–1007.

    PubMed  PubMed Central  Google Scholar 

  11. Zhang P, Tan CW, Chen GH, Ge YJ, Xu J, Xia L, et al. Patients with chronic insomnia disorder have increased serum levels of neurofilaments, neuron-specific enolase and S100B: does organic brain damage exist? Sleep Med 2018, 48: 163–171.

    PubMed  Google Scholar 

  12. Altena E, Van Der Werf YD, Strijers RLM, Van Someren EJ. Sleep loss affects vigilance: effects of chronic insomnia and sleep therapy. J Sleep Res 2008, 17: 335–343.

    PubMed  Google Scholar 

  13. Chen GH, Xia L, Wang F, Li XW, Jiao CA. Patients with chronic insomnia have selective impairments in memory that are modulated by cortisol. Psychophysiology 2016, 53: 1567–1576.

    PubMed  Google Scholar 

  14. Nissen C, Kloepfer C, Feige B, Piosczy H, Spiegelhalder K, Voderholzer U, et al. Sleep-related memory consolidation in primary insomnia. J Sleep Res 2011, 20: 129–136.

    PubMed  Google Scholar 

  15. Lovato N, Lack L, Wright H, Cant M, Humphreys J. Working memory performance of older adults with insomnia. J Sleep Res 2013, 22: 251–257.

    PubMed  Google Scholar 

  16. Joo EY, Kim H, Suh S, Hong SB. Hippocampal substructural vulnerability to sleep disturbance and cognitive impairment in patients with chronic primary insomnia: magnetic resonance imaging morphometry. Sleep 2014, 37: 1189–1198.

    PubMed  PubMed Central  Google Scholar 

  17. Li Y, Liu H, Weed JG, Ren R, Sun Y, Tan L, et al. Deficits in attention performance are associated with insufficiency of slow-wave sleep in insomnia. Sleep Med 2016, 24: 124–130.

    PubMed  Google Scholar 

  18. Liu H, Wang D, Li Y, Li Z, Zhang Y, Lei F, et al. Examination of daytime sleepiness and cognitive performance testing in patients with primary insomnia. PLoS One 2014, 9: e100965.

    PubMed  PubMed Central  Google Scholar 

  19. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., APA Press, Washington DC, 1994.

    Google Scholar 

  20. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th-TR ed., APA Press, Washington DC, 2000.

  21. World Health Orgnization. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva, Switzerland, 1992.

    Google Scholar 

  22. American Academy of Sleep Medicine. The International Classification of Sleep Disorders, 2nd ed. (ICSD-2), Diagnostic and Coding Manual, Westchester, 2005.

  23. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet 2017, 390: 2673–2734.

    PubMed  Google Scholar 

  24. Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 2011, 10: 819–828.

    PubMed  PubMed Central  Google Scholar 

  25. de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. Insomnia and risk of dementia in older adults: Systematic review and meta-analysis. J Psychiatr Res 2016, 77: 109–115.

    PubMed  Google Scholar 

  26. Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, et al. Sleep disturbances increase the risk of dementia: a systematic review and meta-analysis. Sleep Med Rev 2018, 40: 4–16.

    PubMed  Google Scholar 

  27. Bubu OM, Brannick M, Mortimer J, Umasabor-Bubu O, Sebastião YV, Wen Y, et al. Sleep, cognitive impairment, and Alzheimer’s disease: A systematic review and meta-analysis. Sleep 2017, 40. doi: 10.1093/sleep/zsw032.

  28. Yaffe K, Nettiksimmons J, Yesavage J, Byers A. Sleep quality and risk of dementia among older male veterans. Am J Geriatr Psychiatry 2015, 23: 651–654.

    PubMed  Google Scholar 

  29. Chen PL, Lee WJ, Sun WZ, Oyang YJ, Fuh JL. Risk of dementia in patients with insomnia and long-term use of hypnotics: a population-based retrospective cohort study. PLoS One 2012, 7: e49113.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Altena E, Vrenken H, Van Der Werf YD, van den Heuvel OA, Van Someren EJW. Reduced orbitofrontal and parietal gray matter in chronic insomnia: a voxel-based morphometric study. Biol Psychiatry 2010, 67: 182–185.

    PubMed  Google Scholar 

  31. Bumb JM, Schilling C, Enning F, Haddad L, Paul F, Lederbogen F, et al. Pineal gland volume in primary insomnia and healthy controls: a magnetic resonance imaging study. J Sleep Res 2014, 23: 276–282.

    Google Scholar 

  32. Dai XJ, Jiang J, Zhang Z, Nie X, Liu BX, Pei L, et al. Plasticity and susceptibility of brain morphometry alterations to insufficient sleep. Front Psychiatry 2018, 9: 266.

    PubMed  PubMed Central  Google Scholar 

  33. Spiegelhalder K, Regen W, Baglioni C, Klöppel S, Abdulkadir A, Hennig J, et al. Insomnia does not appear to be associated with substantial structural brain changes. Sleep 2013, 36: 731–737.

    PubMed  PubMed Central  Google Scholar 

  34. Spiegelhalder K, Regen W, Prem M, Baglioni C, Nissen C, Feige B, et al. Reduced anterior internal capsule white matter integrity in primary insomnia. Hum Brain Mapp 2014, 35: 3431–3438.

    PubMed  Google Scholar 

  35. Li S, Tian J, Bauer A, Huang R, Wen H, Li M, et al. Reduced integrity of right lateralized white matter in patients with primary insomnia: A diffusion-tensor imaging study. Radiology 2016, 280: 520–528.

    PubMed  Google Scholar 

  36. Kang JM, Joo SW, Son YD, Kim H, Ko KP, Lee JS, et al. Low white-matter integrity between the left thalamus and inferior frontal gyrus in patients with insomnia disorder. J Psychiatry Neurosci 2018, 43: 366–374.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Sexton CE, Zsoldos E, Filippini N, Griffanti L, Winkler A, Mahmood A, et al. Associations between self-reported sleep quality and white matter in community-dwelling older adults: A prospective cohort study. Hum Brain Mapp 2017, 38: 5465–5473.

    PubMed  PubMed Central  Google Scholar 

  38. Wilckens KA, Hall MH, Nebes RD, Monk TH, Buysse DJ. Changes in cognitive performance are associated with changes in sleep in older adults with insomnia. Behav Sleep Med 2016, 14: 295–310.

    PubMed  Google Scholar 

  39. Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 2006, 295: 2851–2858.

    PubMed  Google Scholar 

  40. Kyle SD, Miller CB, Rogers Z, Siriwardena AN, MacMahon KM, Espie CA. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: Implications for the clinical management of insomnia disorder. Sleep 2014, 37: 229–237.

    PubMed  PubMed Central  Google Scholar 

  41. Roth T, Coulouvrat C, Hajak G, Lakoma MD, Sampson NA, Shahly V, et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition Criteria: Results from the America Insomnia Survey. Biol Psychiatry 2011, 69: 592–600.

    PubMed  Google Scholar 

  42. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002, 6: 97–111.

    PubMed  Google Scholar 

  43. Herbert V, Kyle SD, Pratt D. Does cognitive behavioural therapy for insomnia improve cognitive performance? A systematic review and narrative synthesis. Sleep Med Rev 2018, 39: 37–51.

    PubMed  Google Scholar 

  44. Noh HJ, Joo EY, Kim ST, Yoon SM, Koo DL, Kim D, et al. The relationship between hippocampal volume and cognition in patients with chronic primary insomnia. J Clin Neurol 2012, 8: 130–138.

    PubMed  PubMed Central  Google Scholar 

  45. Bellesi M. Sleep and oligodendrocyte functions. Curr Sleep Med Rep 2015, 1: 20–26.

    PubMed  PubMed Central  Google Scholar 

  46. Meerlo P, Mistlberger RE, Jacobs BL, Heller HC, McGinty D. New neurons in the adult brain: the role of sleep and consequences of sleep loss. Sleep Med Rev 2009, 13: 187–194.

    Google Scholar 

  47. Lim J, Dinges DF. A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychol Bull 2010, 136: 375–389.

    PubMed  PubMed Central  Google Scholar 

  48. Elvsashagen T, Norbom LB, Pedersen PO, Quraishi SH, Bjornerud A, Malt UF, et al. Widespread changes in white matter microstructure after a day of waking and sleep deprivation. PLoS One 2015, 10: e0127351.

    PubMed  PubMed Central  Google Scholar 

  49. Lim AS, Ellison BA, Wang JL, Yu L, Schneider JA, Buchman AS, et al. Sleep is related to neuron numbers in the ventrolateral preoptic/intermediate nucleus in older adults with and without Alzheimer’s disease. Brain 2014, 137: 2847–2861.

    PubMed  PubMed Central  Google Scholar 

  50. Holth J, Patel T, Holtzman DM. Sleep in Alzheimer’s disease - Beyond amyloid. Neurobiol Sleep Circadian Rhythms 2017, 2: 4–14.

    PubMed  Google Scholar 

  51. Karageorgiou E, Vossel KA. Brain rhythm attractor breakdown in Alzheimer’s disease: Functional and pathologic implications. Alzheimers Dement 2017, 13: 1054–1067.

    PubMed  PubMed Central  Google Scholar 

  52. Ehrenberg AJ, Suemoto CK, França Resende EdP, Petersen C, Leite REP, Rodriguez RD, et al. Neuropathologic correlates of psychiatric symptoms in Alzheimer’s disease. J Alzheimers Dis 2018, 66: 115–126.

    CAS  PubMed  Google Scholar 

  53. Braak H, Thal DR, Ghebremedhin E, Del Tredici K. Stages of the pathologic process in Alzheimer disease: age categories from 1 to 100 years. J Neuropathol Exp Neurol 2011, 70: 960–969.

    CAS  PubMed  Google Scholar 

  54. Grinberg LT, Rüb U, Ferretti REL, Nitrini R, Farfel JM, Polichiso L, et al. The dorsal raphe nucleus shows phospho-tau neurofibrillary changes before the transentorhinal region in Alzheimer’s disease. A precocious onset? Neuropathol Appl Neurobiol 2009, 35: 406–416.

    CAS  Google Scholar 

  55. Roh JH, Huang Y, Bero AW, Kasten T, Stewart FR, Bateman RJ, et al. Disruption of the sleep-wake cycle and diurnal fluctuation of β-amyloid in mice with Alzheimer’s disease pathology. Sci Transl Med 2012, 4: 150ra122.

    PubMed  PubMed Central  Google Scholar 

  56. Kang JE, Lim MM, Bateman RJ, Lee JJ, Smyth LP, Cirrito JR, et al. Amyloid-beta dynamics are regulated by orexin and the sleep-wake cycle. Science 2009, 326: 1005–1007.

    CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This review was supported in part by the Global Brain Health Institute and Alzheimer’s Association (GBHI ALZ-18-543785, GBHI ALZ UK-19-588605), the National Institute for Health Research Oxford Health Biomedical Research Centre, the Tau Consortium, the American Brain Foundation (AANF-14-ALZ330017), and the National Institute on Aging (1K99AG056598).

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Authors and Affiliations

  1. Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA

    Claire E. Sexton, Elissaios Karageorgiou, Jenny Zitser, Talita Rosa & Yue Leng

  2. Department of Psychiatry, University of Oxford, Oxford, UK

    Claire E. Sexton

  3. Neurological Institute of Athens, Athens, Greece

    Konstantina Sykara & Elissaios Karageorgiou

  4. Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA, USA

    Kristine Yaffe & Yue Leng

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  1. Claire E. Sexton
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  2. Konstantina Sykara
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Correspondence to Yue Leng.

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CES reports consulting fees from Jazz Pharmaceuticals.

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Sexton, C.E., Sykara, K., Karageorgiou, E. et al. Connections Between Insomnia and Cognitive Aging. Neurosci. Bull. 36, 77–84 (2020). https://doi.org/10.1007/s12264-019-00401-9

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