Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
20 September 2023Sleep and dementia – risk reduction and management
Chris Fox- TIMES chief investigator.
Up to 44% of patients with Alzheimer’s disease (AD) have sleep disturbances, and that number rises to 90% for those with dementia with Lewy bodies or Parkinson disease dementia. Sleep disturbance among People Living With Dementia (PLWD) and Mild Cognitive Impairment (MCI) in the community, can negatively impact daily living, exacerbate carer fatigue, and expedite care home admission. The cause of sleep disturbance in PLWD/MCI is multifactorial, with age, psychological disorders, medicine side-effects, co-morbidities, social factors, and the environment, all interacting and impacting individuals differently over time. Consequently, sleep disturbance for PLWD/MCI is complex and difficult to manage.
Evidence has grown over the past several years that sleep disturbances are a risk factor for dementia. Dementia has a long development period, so early symptoms of disease may cause changes in sleep some years prior to clinical diagnosis, leading to spurious associations between sleep and dementia risk, especially in the short term. Short sleep has been suggested to increase the risk of dementia potentially through reduced glymphatic clearance of metabolite waste, inflammation, or other mediating mechanisms. However, a 2019 meta-analysis of prospective studies found that long, but not short, sleep duration was associated with a higher dementia risk, whereas another 2019 meta-analysis of prospective studies, which included cognitive decline as well as dementia as an endpoint, suggested that both short and long sleep were risk factors. Two recently published studies reported a higher dementia risk associated with actigraphy-measured daytime napping or self-reported dozing off during the daytime unintentionally, but a Mendelian randomization analysis reported that daytime napping was associated with a lower Alzheimer’s disease risk.
We need to change in the way we identify, assess and manage sleep disturbance in PLWD/MCI is therefore needed, and there is growing support for a more person-centred approach to help patients and carers. However, to do this, we need a better understanding of the factors that influence the delivery and efficacy of person-centred care for PLWD/MCI who experience sleep disturbance.