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Identifier 000457692
Title Η σχέση των διαταραχών του ύπνου, της διάθεσης και του άγχους και των δεικτών στρες και φλεγονής , με την ήπια γνωσιακή διαταραχή (MCI) και την ήπιας- μέτριας βαρύτητας άνοια
Alternative Title The relationship of sleep, mood and anxiety disorders , and markers of stress and inflammation to mild cognitive impairment (MCI) and mild-moderate dementia
Author Κουτεντάκη Ειρήνη Εμμ.
Thesis advisor Μπάστα, Μαρία
Reviewer Βγόντζας, Αλέξανδρος
Ζαγανάς, Ιωάννης
Σίμος, Παναγιώτης
Σχίζα, Σοφία
Σκαρμέας, Νικόλαος
Αλεξόπουλος, Παναγιώτης
Abstract Population aging is a feature of modern Western societies and is associated with cognitive decline, resulting in increased morbidity and institutionalization and an increased social impact expressed by years of disability and high health care costs in European countries including Greece. As dementia is a progressive neurodegenerative disease where recovery is usually unattainable, the identification and early intervention on modifiable risk factors is of particular importance. The purpose of this study was to examine the relationship of sleep, mood and anxiety disorders, and markers of stress and inflammation, with cognitive functioning (determined either coarsely based on the MMSE or through a thorough neuropsychological/neuropsychiatric assessment supporting a diagnosis of mild cognitive impairment disorder (MCI) or dementia in a large culturally homogenous cohort of elderly population (n=3140), residing mainly in rural areas of the Heraklion Regional Unit of Crete. Individual objectives of this study were to investigate: 1. The possible relationship of sleep and its disorders with cognitive functioning, namely: (a) the prevalence and risk factors associated with insomnia-like symptoms in the general population, (b) the association of insomnia-like symptoms with cognitive impairment (based on MMSE), and (c) the relationship between specific indices of cognitive functioning and sleep duration and quality (both subjective and objectively determined) in older adults with MCI and dementia. 2. The possible relationship between objective daytime sleep and cognitive performance and levels of inflammatory markers. 3. The possible synergistic effect of cortisol levels and inflammation on the cognitive performance of elderly people without dementia. 4. The incidence of depression among community-dwelling elderly and its comorbidity with cognitive decline. This study uses data from an extensive database of sociodemographic, neuropsychiatric, neuropsychological, and actigraphic data as well as blood inflammatory marker measurements drawn from the Cretan Aging Cohort, a large culturally homogenous cohort of an elderly population, residing primarily in rural areas of the prefecture of Heraklion, Crete, Greece. It was developed as part of a multidisciplinary study ("Thales: Multidisciplinary Network for the Study of Alzheimer's Disease") by a team of experts, including primary care physicians (PHC), neurologists, psychiatrists, neuropsychologists, geriatricians, geneticists and other health professionals. The larger study was conducted in 2 phases. In phase 1, 3140 elderly people aged 60-100 years were examined, and they completed a structured interview where sociodemographic information, anthropometric measurements, current physical and mental health were collected. Participants with possible cognitive impairment (MMSE<24, n=636) were referred for a thorough neuropsychiatric and neuropsychological evaluation in Phase 2 of the study, while plasma levels of inflammatory markers (IL-6, TNFα) and cortisol were also measured. Also, an objective measurement of sleep was performed with three 24-hour actigraphy. All information obtained through history, neuropsychiatric and neuropsychological examination, was reviewed and consensus diagnoses were reached. To investigate the research questions of the study, sub-samples of the above population were used and corresponding statistical analyses were performed. From the individual analyses carried out we came to the following conclusions: 1. Insomnia-type symptoms are highly prevalent in community-dwelling elderly in Crete, and are associated with female gender, age, stress, widowhood, and co-existing physical conditions. In addition, insomnia symptoms (and mainly fragmented sleep) are associated with an increased risk for cognitive impairment. 2. Long- objective sleep duration in multidomain MCI/Alzheimer’s Disease (AD) patients is associated with impaired performance on neuropsychological tests. 3. Objective sleep duration is increased in mild/moderate AD relative to MCI/CNI, while objective napping in patients with mild/moderate dementia is associated with worse cognitive performance. The current results indicate that long objective daytime sleepiness is associated with worse cognitive performance and higher levels of inflammation, as measured by IL-6 levels, in patients with dementia. Increased nap duration is associated with increased levels of inflammation in AD subjects. 4. Α synergistic effect of stress and inflammation on cognitive functioning of non-demented elderly is demonstrated. Higher chronic stress, as reflected by higher plasma cortisol levels, combined with higher systemic inflammation, as expressed by IL-6 levels, are inversely related to executive functions in non- demented older adults, and this effect is more pronounced among elderly patients with MCI compared to elderly without cognitive impairment (CNI). 5. Cognitive functioning in the elderly of the prefecture of Heraklion is negatively related to the existence of a history of depression and anxiety as well as to receiving anxiolytic drugs. In addition, elderly individuals with a diagnosis of MCI have significantly higher rates of clinical depression than both individuals with dementia and cognitively healthy controls. In conclusion, we suggest that treating insomnia may improve cognitive performance in older individuals. We also suggest that among patients with MCI, those who sleep longer have more severe cognitive decline, and early intervention to address modifiable factors may ameliorate or delay their cognitive decline. Also, it seems that daytime sleep in dementia patients may be an indicator of disease severity related to higher inflammation levels. Future studies focusing on preventing or reversing inflammation at early stages among patients at risk for dementia may be useful in improving cognitive functioning or delaying the progress of cognitive decline in older adults with or without cognitive impairment. Finally, based on the synergistic effect of cortisol and inflammation levels in elderly, treating conditions associated with hypercortisolemia (such as depression, anxiety, and insomnia) in combination with targeting inflammation may be a promising strategy to improve/delay the course of cognitive decline.
Language Greek, English
Subject Mild cognitive impairment
Ύπνος
Φλεγμονή
Issue date 2023-12-08
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
Permanent Link https://elocus.lib.uoc.gr//dlib/5/1/8/metadata-dlib-1694508004-753812-31579.tkl Bookmark and Share
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