Background/Aims: Sleep disturbances are common in the elderly and in persons with cognitive decline. The aim of this study was to describe frequency and characteristics of insomnia, excessive daytime sleepiness, sleep-disordered breathing, REM behavior disorder and restless legs syndrome in a large cohort of persons with mild cognitive impairment or dementia. Methods: 431 consecutive patients were enrolled in 10 Italian neurological centers: 204 had Alzheimer’s disease, 138 mild cognitive impairment, 43 vascular dementia, 25 frontotemporal dementia and 21 Lewy body dementia or Parkinson’s disease dementia. Sleep disorders were investigated with a battery of standardized questions and questionnaires. Results: Over 60% of persons had one or more sleep disturbances almost invariably associated one to another without any evident and specific pattern of co-occurrence. Persons with Alzheimer’s disease and those with mild cognitive impairment had the same frequency of any sleep disorder. Sleep-disordered breathing was more frequent in vascular dementia. REM behavior disorder was more represented in Lewy body or Parkinson’s disease dementia. Conclusion: A careful clinical evaluation of sleep disorders should be performed routinely in the clinical setting of persons with cognitive decline. Instrumental supports should be used only in selected patients.

Keywords:
Frontotemporal dementia, Lewy body dementia, Parkinson’s disease dementia, Vascular dementia, Sleep disorders, Excessive daytime sleepiness, Mild cognitive impairment, Alzheimer’s disease
1.
Ancoli-Israel S, Ayalon L: Diagnosis and treatment of sleep disorders in older adults. Am J Geriatr Psychiatry 2006;14:95–103.
2.
Stepnowsky C, Ancoli-Israel S: Sleep and its disorders in seniors. Sleep Med Clin 2008;3:281–293.
3.
Chokroverty S: Sleep and neurodegenerative diseases. Semin Neurol 2009;29:446–467.
4.
Dauvilliers Y: Insomnia in patients with neurodegenerative conditions. Sleep Med 2007;8:27–34.
5.
Vitiello MV, Borson S: Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs 2001;15:777–796.
6.
Deschenes CL, McCurry SM: Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep 2009;11:20–26.
7.
International Classification of Sleep Disorders, ed 2: Diagnostic and Coding Manual. Westchester, American Academy of Sleep Medicine, 2005.
8.
Boeve BF, Silber MH, Ferman TJ, Lucas JA, Parisi JE: Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Movement Disord 2001;16:622–630.
9.
Harper DG, Stopa EG, McKee AC, Satlin A, Harlan PC, Goldstein R, et al: Differential circadian rhythm disturbances in men with Alzheimer’s disease and frontotemporal degeneration. Arch Gen Psychiatry 2001;58:353–360.
10.
Grace JB, Walker MP, McKeith IG: A comparison of sleep profiles in patients with dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry 2000;15:1028–1033.
11.
Bracco L, Piccini C, Moretti M, Mascalchi M, Sforza A, Nacmias B, Cellini E, Bagnoli S, Sorbi S: Alzheimer’s disease: role of size and location of white matter changes in determining cognitive deficits. Dement Geriatr Cogn Disord 2005;20:358–366.
12.
Peters F, Perani D, Herholz K, Holthoff V, Beuthien-Baumann B, Sorbi S, Pupi A, Degueldre C, Lemaire C, Collette F, Salmon E: Orbitofrontal dysfunction related to both apathy and disinhibition in frontotemporal dementia. Dement Geriatr Cogn Disord 2006;21:373–379.
13.
Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, et al: Pathophysiology of REM sleep behavior disorder and relevance to neurodegenerative disease. Brain 2007;130:2770–2788.
14.
Iranzo A, Molinuevo JL, Santamaría J, Serradell M, Martí MJ, Valldeoriola F, et al: Rapid-eye-movement sleep behavior disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 2006;5:572–577.
15.
Hermann DM, Bassetti CL: Sleep-related breathing and sleep-wake disturbances in ischemic stroke. Neurology 2009;73:1313–1322.
16.
Fuh J-L, Wang S-J, Cummings JL: Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. J Neurol Neurosurg Psychiatr 2005;76:1337–1341.
17.
Gauthier S, Reisberg B, Zaudig M, et al: Mild cognitive impairment. Lancet 2006;367:1262–1270.
18.
Gagnon J-F, Vendette M, Postuma RB, et al: Mild cognitive impairment in rapid eye movement sleep behavior disorder and Parkinson’s disease. Ann Neurol 2009;66:39–47.
19.
American Psychiatric Association: DSM IV-TR Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision, 2000.
20.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
21.
Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al: Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250–260.
22.
McKeith IG: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the Consortium on DLB International Workshop. J Alzheimers Dis 2006;9(3 suppl): 417–423.
23.
Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund L-O, et al: Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240–246.
24.
Fillenbaum GG, Peterson B, Morris JC: Estimating the validity of the clinical Dementia Rating Scale: the CERAD experience. Consortium to Establish a Registry for Alzheimer’s Disease. Aging (Milan) 1996;8:379–385.
25.
Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
26.
Gallagher D, Nies G, Thompson LW: Reliability of the Beck Depression Inventory with older adults. J Consult Clin Psychol 1982;50:152–153.
27.
Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist 1969;9:179–186.
28.
De Vreese LP, Caffarra P, Savarè R, Cerutti R, Franceschi M, Grossi E; Multicentre Study Group: Functional disability in early Alzheimer’s disease – a validation study of the Italian version of the disability assessment for dementia scale. Dement Geriatr Cogn Disord 2008;25:186–194.
29.
Terzano MG, Parrino L, Cirignotta F, et al: Studio Morfeo: insomnia in primary care, a survey conducted on the Italian population. Sleep Med 2004;5:67–75.
30.
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP: Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131:485–491.
31.
Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J, Restless Legs Syndrome Diagnosis and Epidemiology Workshop at the National Institutes of Health, International Restless Legs Syndrome Study Group: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003;4:101–119.
32.
Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K: Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and morbidity in Augsburg elderly. Neurology 2000;54:1064–1068.
33.
Boeve BF, Molano JR, Ferman TJ, Smith GE, Lin SC, Bieniek K, Haidar W, Tippmann-Peikert M, Knopman DS, Graff-Radford NR, Lucas JA, Petersen RC, Silber MH: Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in an aging and dementia cohort. Sleep Med 2011;12:445–453.
34.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213.
35.
Buysse DJ, Reynolds CF 3rd, Monk TH, Hoch CC, Yeager AL, Kupfer DJ: Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep 1991;14:331–338. Erratum in: Sleep 1992;15:83.
36.
Foley DJ, Monjan AA, Izmirlian G, Hays JC, Blazer DG: Incidence and remission of insomnia among elderly adults in a biracial cohort. Sleep 1999;22(suppl 2):S373–S378.
37.
Aalten P, Verhey FR, Boziki M, et al: Neuropsychiatric syndromes in dementia. Results from the European Alzheimer Disease Consortium. Part I. Dement Geriatr Cogn Disord 2007;24:457–463.
38.
Aalten P, Verhey FR, Boziki M, et al: Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer Disease Consortium. Part II. Dement Geriatr Cogn Disord 2008;25:1–8.
39.
Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, Phillips BA, Thorpy MJ, Vitiello MV, Zee PC: Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc 2009;57:761–789.
40.
Rebok GW, Rovner BW, Folstein MF: Sleep disturbance and Alzheimer’s disease: relationship to behavioral problems. Aging (Milan) 1991;3:193–196.
41.
McCurry SM, Logsdon RG, Teri L, et al: Characteristics of sleep disturbance in community-dwelling Alzheimer’s disease patients. J Geriatr Psychiatry Neurol 1999;12:53–59.
42.
Moran M, Lynch CA, Walsh C, Coen R, Coakley D, Lawlor BA: Sleep disturbance in mild to moderate Alzheimer’s disease. Sleep Med 2005;6:347–352.
43.
Prinz PN, Vitaliano PP, Vitiello MV, et al: Sleep, EEG and mental function changes in senile dementia of the Alzheimer’s type. Neurobiol Aging 1982;3:361–70.
44.
Hancock P, Larner AJ: Diagnostic utility of the Pittsburgh Sleep Quality Index in memory clinics. Int J Geriatr Psychiatry 2009;24:1237–1241.
45.
Anderson KN, Hatfield C, Kipps C, Hastings M, Hodges JR: Disrupted sleep and circadian patterns in frontotemporal dementia. Eur J Neurol 2009;16:317–323.
46.
Boeve BF, Dickson DW, Olson EJ, et al: Insights into REM sleep behavior disorder pathophysiology in brainstem-predominant Lewy body disease. Sleep Medicine 2007;8:60–64.
47.
Britton TC, Chaudhuri KR: REM sleep behavior disorder and the risk of developing Parkinson disease or dementia. Neurology 2009;72:1294–1295.
48.
Calzetti S, Negrotti A, Bonavina G, Angelini M, Marchesi E: Absence of co-morbidity of Parkinson’s disease and restless legs syndrome: a case-control study in patients attending a movement disorders clinic. Neurol Sci 2009;30:119–122.
49.
Lee JE, Shin H-W, Kim KS, Sohn YH: Factors contributing to the development of restless legs syndrome in patients with Parkinson disease. Movement Disord 2009;24:579–582.
50.
Yesavage JA, Friedman L, Ancoli-Israel S, Bliwise D, Singer C, Vitiello MV, Monjan AA, Lebowitz B: Development of diagnostic criteria for defining sleep disturbance in Alzheimer’s disease. J Geriatr Psychiatry Neurol 2003;16:131–139.
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2012
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