Sleep disturbances are key symptoms of very early stage Alzheimer disease with behavioral and psychological symptoms: a Japan multi-center cross-sectional study (J-BIRD)
Yasunobu Kabeshita
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
The Sleep Medical Center of Osaka University Hospital, Suita, Japan
Search for more papers by this authorCorresponding Author
Hiroyoshi Adachi
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
The Sleep Medical Center of Osaka University Hospital, Suita, Japan
Correspondence to: H. Adachi, MD, PhD, E-mail: [email protected]Search for more papers by this authorMasateru Matsushita
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorHideki Kanemoto
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorShunsuke Sato
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorYukiko Suzuki
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorKenji Yoshiyama
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorTatsuo Shimomura
Department of Rehabilitation Medicine, Akita Prefectural Centre of Rehabilitation and Psychiatric Medicine, Daisen, Japan
Search for more papers by this authorTaku Yoshida
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorHideaki Shimizu
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorTeruhisa Matsumoto
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorTakaaki Mori
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorTetsuo Kashibayashi
Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
Search for more papers by this authorHibiki Tanaka
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorYutaka Hatada
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorMamoru Hashimoto
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorYoshiyuki Nishio
Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorKenjiro Komori
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Zaidan-Niihama Hospital, Niihama, Japan
Search for more papers by this authorToshihisa Tanaka
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorKazumasa Yokoyama
Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
Search for more papers by this authorSatoshi Tanimukai
Department of Community and Geriatric Nursing, Ehime University Graduate School of Medicine, Toon, Japan
Search for more papers by this authorManabu Ikeda
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorMasatoshi Takeda
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Aino University, Ibaraki, Japan
Search for more papers by this authorEtsuro Mori
Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorTakashi Kudo
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorHiroaki Kazui
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorYasunobu Kabeshita
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
The Sleep Medical Center of Osaka University Hospital, Suita, Japan
Search for more papers by this authorCorresponding Author
Hiroyoshi Adachi
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
The Sleep Medical Center of Osaka University Hospital, Suita, Japan
Correspondence to: H. Adachi, MD, PhD, E-mail: [email protected]Search for more papers by this authorMasateru Matsushita
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorHideki Kanemoto
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorShunsuke Sato
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorYukiko Suzuki
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorKenji Yoshiyama
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorTatsuo Shimomura
Department of Rehabilitation Medicine, Akita Prefectural Centre of Rehabilitation and Psychiatric Medicine, Daisen, Japan
Search for more papers by this authorTaku Yoshida
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorHideaki Shimizu
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorTeruhisa Matsumoto
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorTakaaki Mori
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Search for more papers by this authorTetsuo Kashibayashi
Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
Search for more papers by this authorHibiki Tanaka
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorYutaka Hatada
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorMamoru Hashimoto
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorYoshiyuki Nishio
Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorKenjiro Komori
Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan
Zaidan-Niihama Hospital, Niihama, Japan
Search for more papers by this authorToshihisa Tanaka
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorKazumasa Yokoyama
Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
Search for more papers by this authorSatoshi Tanimukai
Department of Community and Geriatric Nursing, Ehime University Graduate School of Medicine, Toon, Japan
Search for more papers by this authorManabu Ikeda
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorMasatoshi Takeda
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Aino University, Ibaraki, Japan
Search for more papers by this authorEtsuro Mori
Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorTakashi Kudo
Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorHiroaki Kazui
Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Search for more papers by this authorAbstract
Background
Sleep disturbances in Alzheimer disease (AD) may affect behavioral and psychological symptoms of dementia (BPSD). Our aim was to elucidate the associations between sleep disturbances and other BPSD at different stages of AD.
Methods
This investigation was part of a multicenter-retrospective study in Japan (J-BIRD). Eligible for final analyses were 684 AD patients. Global severity of dementia was estimated using the Clinical Dementia Rating (CDR) scale. BPSD were assessed using the Neuropsychiatric Inventory (NPI). We analyzed the relationships between sleep disturbances and BPSD at different stages of AD according to the CDR score.
Results
Among the 684 AD patients, 146 (21.3%) had sleep disturbances. Patients with very early AD (CDR 0.5) and sleep disturbances had significantly more BPSD than those without sleep disturbances, as indicated by the higher prevalence of the following four NPI items: anxiety, euphoria, disinhibition, and aberrant motor behavior. In AD at CDR 2, (moderate AD) only one NPI item (irritability) was affected, while none was affected at CDR 1 (mild AD) and 3 (severe AD). Multiple regression analyses were performed in those with AD having various CDR scores. At CDR 0.5, the presence of sleep disturbances was associated with a high total NPI score (β = 0.32, p < 0.001). However, other factors, including cognitive decline, age, gender, and years of education, were not significantly associated with the NPI score. At CDR 1 and 2, no factor was significantly related to BPSD.
Conclusion
Sleep disturbances were strongly associated with other BPSD in the very early stage of AD. Copyright © 2016 John Wiley & Sons, Ltd.
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