CAN LEARNING AND MEMORY PERFORMANCE PREDICT OBSTRUCTIVE SLEEP APNEA

Abstract

Introduction Memory loss is among the most common early symptoms experienced and recognized in elderly patients who begin to develop mild symptoms of dementia. When performing screening evaluations in geriatric clinics, practitioners work hard to unveil any underlying reversible causes of cognitive impairment. Working in interdisciplinary teams, some clinics will regularly use neuropsychological testing to help delineate different forms and levels of severity of dementia. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a comprehensive validated screening tool used to evaluate patients with signs of dementia and specifically measures domains that include learning, memory, visuospatial abilities, language, attention, and processing speed. Through several years of clinical observations, a specific pattern (Delayed Recall memory is greater than Immediate Recall memory) was identified on the RBANS that pointed to a potential reversible cause of cognitive decline in reliably predicting an underlying diagnosis of obstructive sleep apnea (OSA)1. It is well documented how sleep dysfunction affects cognitive functioning. With subsequent treatment of OSA, patients returned to the geriatric clinics with improved cognitive function, particularly on the RBANS memory scores. Methods retrospective chart review of data will be performed on seniors 65?years old and above who have been referred to geriatrics clinic for neuropsychiatric testing given concerns of cognitive decline. Patients with the specific pattern on the initial evaluation of the RBANS will be identified, and that set of patients will be divided into groups of patients who were diagnosed with OSA versus not. Further subdivision of groups will distinguish those patients who received appropriate treatment for OSA versus those who did not. Additional variables of data to be collected include gender, age, education level, previous diagnoses (e.g., obstructive sleep apnea, mild cognitive impairment, Alzheimer's disease), RBANS data at initial evaluation, RBANS data at follow-up geriatric appointment, diagnoses associated with geriatric clinic and sleep clinic appointments, usage of anti-cholinesterase agents, and any MRI or PET results available. Results The primary outcome will be to show that a specific pattern on the RBANS (Delayed Recall memory is greater than Immediate Recall memory) predicts an OSA diagnosis contributing to cognitive decline. The secondary outcome will be demonstrating how a patient's cognitive function can improve with consistent treatment of their OSA (i.e., using a continuous positive airway pressure machine)–this will be reflected at a patient's one year follow-up of their initial RBANS results. The RBANS data for these particular patients receiving adequate treatment of their OSA will illustrate improvement in immediate memory scores; however, they will maintain the same pattern of Delayed Recall memory being greater than Immediate Recall memory. Conclusions This study aims to show how a specific pattern recognized on neuropsychiatric testing can predict a physiologic condition and serve as a significant finding for neuropsychology, dementia, and sleep apnea screening procedures. This can lead to increased referrals to sleep clinics for unrecognized and undiagnosed OSA. As patients are intercepted at earlier stages of their memory decline, diagnosis and treatment of OSA can be extremely helpful in their recovery and slowing their cognitive decline. Reference: 1. Dexter, D. D., and A. G. Ebert. A Unique Pattern on Memory Testing in Dementia Screening Predicts Obstructive Sleep Apnea. WMJ: official publication of the State Medical Society of Wisconsin 118.1 (2019): 27-29. This research was funded by: Not applicable