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Preclinical cognitive decline and subsequent sleep disturbance in older women

From the Department of Psychiatry (K.Y., D.E.B.), University of California, San Francisco, and the San Francisco VA Medical Center; Departments of Neurology and Epidemiology (K.Y.), University of California, San Francisco; San Francisco Coordinating Center and California Pacific Medical Center Research Institute (T.B., K.L.S.); and Department of Psychiatry (S.A.-I.), University of California, San Diego, and Veterans Affairs San Diego Healthcare System.

Address correspondence and reprint requests to Dr. Kristine Yaffe, 4150 Clement Street (181G), San Francisco, CA 94903 Kristine.Yaffe{at}ucsf.edu

Objective: To determine whether longitudinal cognitive decline is associated with increased risk of sleep disturbance in older, nondemented, community-dwelling women.

Methods: We studied 2,474 women (mean age 68.9 years) who were part of a prospective study started in 1986; women with baseline or follow-up evidence of possible dementia were excluded. Cognitive data were gathered over 15 years for modified Mini-Mental State Examination (mMMSE) and 13 years for Trails B; cognitive decline was defined as declining >1.5 SDs on the mMMSE (3 points) or Trails B (>92 seconds). Sleep disturbance was measured objectively using actigraphy (Sleepwatch-O, Ambulatory Monitoring) at the 15-year follow-up visit; measures included total sleep hours, sleep efficiency, sleep latency, napping, and time awake after sleep onset (WASO).

Results: During follow-up, 11% of women declined on mMMSE and 15% on Trails B. Cognitive decliners were more likely than non-decliners to experience sleep disturbance at follow-up on most measures. For women who declined on mMMSE, adjusted ORs (aOR) (95% CI) were 1.71 (1.24, 2.37) for sleep efficiency <70%, 1.57 (1.12, 2.21) for sleep latency 1 hour, and 1.43 (1.07, 1.92) for WASO 90 minutes. Results were similar for women who declined on Trails B; in addition, these women were more likely to nap >2 hours per day (aOR: 1.73; 95% CI: 1.28, 2.33). Cognitive decline on either test was not associated with total sleep time.

Conclusions: Cognitive decline is associated with sleep disturbance in nondemented community-dwelling elderly women.

Supported by NIH grants AG05407, AR35582, AG05394, AR35584, AR35583, AG08415. Dr. Yaffe is supported in part by NIA R01 AG021918.

Disclosure: The authors report no conflicts of interest.

Received July 3, 2006. Accepted in final form February 5, 2007.

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