Longitudinal sleep, pain interference, and depressive symptoms in cognitively impaired older adults

Abstract

AbstractBackgroundPoor sleep, pain, and depression are interrelated factors in older adulthood that may impair cognition. Few studies have examined associations among sleep, pain interference (i.e., how pain interferes with daily living), and depression with cognitive status. Therefore, we investigated these associations in verbally communicative older adults with and without cognitive impairment (CI). We hypothesized that individuals with CI will be more impacted by all variables in relation to the control group.MethodSleep (Neuro‐QoL Sleep), pain interference (Brief Pain Inventory‐Short Form), depression (15‐item Geriatric Depression Scale), and cognitive function (Telephone Interview for Cognitive Status) were investigated in older adults (ages ≥ 65) with CI (N = 16) compared to age‐ and sex‐matched controls (N = 28). Sleep, pain, and depression data were collected weekly over six weeks to allow for a detailed assessment of potential changes in symptoms. Data analyses were conducted in R using linear mixed effects models and conditional growth curve analysis.ResultAcross our sample, we found that more sleep disturbances were associated with more severe depression (p<0.001), greater pain interference was associated with more severe depression (p<0.001), and more sleep disturbances were associated with greater pain interference (p<0.001). There was a significant interaction between cognitive status and sleep disturbances on depression (p = 0.0005), such that the CI group had a stronger positive relationship between sleep disturbances with depression severity. Similarly, there was a significant interaction between cognitive status and pain interference on depression (p<0.001), such that the CI group had a stronger positive relationship between pain interference and depression severity.ConclusionThe findings demonstrate that the relationship among sleep, pain, and depression remain a concern in older adults with CI. As sleep worsened, depression tended to increase across both groups, yet in those with CI, this finding was stronger. Similarly, as pain interference worsened, depression tended to worsen in both groups, but this association was stronger in those with CI. Additional attention to the assessment, prevention, and treatment of sleep disturbance, pain, and depression in people living with and without CI is warranted, especially as individuals with CI may have difficulties communicating these problems.