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Chronobiological Factors Related to Sleep and Neuropsychiatric Symptoms in Persons Living With Dementia

ABSTRACT: Abstract Circadian rhythm disturbances (CRD) are commonly seen in people living with dementia. A clear understanding of the role of CRD in dementia etiology will be beneficial by exploring the exogenous factors (externally influence the duration of sleep hours, such as light/dark cycles) and endogenous factors (internal biological rhythm, such as diurnal cortisol pattern). This symposium will apply a chronobiological approach to study exogenous and endogenous factors that influence circadian rhythm and their effects on sleep and neuropsychiatric symptoms in persons living with dementia (PLWD). Four paper presentations will use secondary data analysis of data from the Healthy Patterns Clinical Trial (NCT03682185), a randomized controlled trial of a home-based activity intervention designed to improve circadian rhythm disorders in PLWD. We will first describe the circadian rhythm pattern reflected by endogenous factors (salivary cortisol), then examine salivary cortisol (endogenous) and white light intensity (exogenous) and on subjective sleep and neuropsychiatric symptoms (including depression) in PLWD, respectively. In session 1, we will present cortisol diurnal rhythm pattern in PLWD using a cross-sectional design. In session 2, we will discuss the relationship between salivary cortisol indicators and depressive symptoms. In session 3, we focus on the association between diurnal cortisol slope and neuropsychiatric symptoms using the baseline data. In session 4, we describe the association between evening white light exposure and subjective sleep. The discussant will describe how these findings build on our understanding the nature of circadian rhythm disturbance in dementia and inform future research and treatment approaches.

SUBMITTER: Hodgson N

PROVIDER: S-EPMC8679941 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundNeuropsychiatric symptoms (NPS) have been reported to be useful in predicting incident dementia among cognitively normal older persons. However, the literature has not been conclusive on the differential utilities of the various NPS in predicting the subtypes of dementia. This study compared the risks of Alzheimer's and non-Alzheimer's dementia associated with the various NPS, among cognitively normal older persons.MethodsThis cohort study included 12,452 participants from the Alzheimer's Disease Centers across USA, who were ≥ 60 years and had normal cognition at baseline. Participants completed the Neuropsychiatric Inventory-Questionnaire at baseline and were followed up almost annually for incident dementia (median follow-up = 4.7 years). Symptom clusters of NPS-as identified from exploratory and confirmatory factor-analyses-were included in the Cox regression to investigate their associations with incident dementia.ResultsThe various NPS showed independent yet differential associations with incident dementia. Although psychotic symptoms were rarely endorsed by the participants, they predicted much higher risk of dementia (HR 3.6, 95% CI 2.0-6.4) than affective symptoms (HR 1.5, 95% CI 1.2-1.8) or agitation symptoms (HR 1.6, 95% CI 1.3-2.1). Psychotic symptoms predicted all dementia subtypes, while affective and agitation symptoms differentially predicted some subtypes. Across dementia subtypes, psychotic symptoms had relatively higher risk estimates than affective or agitation symptoms, with the risk estimates being particularly high in non-Alzheimer's dementia.ConclusionsAmong cognitively normal individuals, the presence of NPS may warrant greater clinical vigilance as precursors to dementia and its subtypes. The findings highlight the need for further research to enrich our understanding on the neurobiological links between various NPS and dementia subtypes. They may also change the clinical approach in managing late-life psychotic symptoms, requiring a greater emphasis on dementia surveillance in the diagnostic criteria of late-life psychotic disorders.

Project description:IMPORTANCE:Neuropsychiatric behaviors of persons with dementia, including agitation, aggression, and rejection of care, are almost universal; occur throughout the disease process; and have negative consequences for both persons with dementia and their caregivers. Nonpharmacological approaches are now recognized as first-line treatment to address these behaviors. One promising approach is activity tailored to the person's interests, abilities, and physical and social environment. An evidence-based program, New Ways for Better Days: Tailoring Activities for Persons With Dementia and Their Caregivers (TAP), draws on occupational therapy principles (person-environment-occupation fit, activity analysis) to meaningfully engage persons with dementia. OBJECTIVE:This case report describes the TAP protocol and clinical reasoning processes underlying use of tailored activities as a therapeutic modality to address dementia-related neuropsychiatric behaviors. DESIGN:This is a case study of an African-American woman in her 60s caring for her father, age 92, who has severe dementia and multiple behaviors. OUTCOMES AND MEASURES:Primary outcomes in this case report include the person with dementia's engagement in an activity and the reported neuropsychiatric behaviors. In addition, the caregiver's confidence in using activities is reported. These and other measures from the TAP protocol are described in full. RESULTS:After working with an occupational therapist for eight sessions, the person with dementia's engagement in activity increased by 50% and his frequency of vocal disturbance decreased, and the caregiver felt more confident in using activities with her father. CONCLUSION AND RELEVANCE:This case report illustrates how occupational therapists working with families of persons with dementia can use the TAP protocol to help them manage neuropsychiatric behaviors by tailoring activities. WHAT THIS ARTICLE ADDS:Occupational therapists are uniquely qualified to systematically assess the cognitive functioning of persons with dementia, caregivers, and home environments and to integrate this information to derive and implement activities tailored to the person's capacities and context, thereby reducing neuropsychiatric behaviors and increasing engagement in meaningful activity.

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Chronobiological Factors Related to Sleep and Neuropsychiatric Symptoms in Persons Living With Dementia

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