Nighttime Behavior Research Articles

Napping and Obesity in Adults - What do we Know?

To review the evidence on the relationship between daytime napping and obesity. There is concern that napping may be harmful to metabolic health. Prospective studies have shown long time daytime napping (> 1h) is associated with increased diabetes risk which may be partly associated with obesity. Evidence from numerous cross-sectional studies and meta-analyses of cross-sectional studies have shown that long time napping (> 1h) but not short time napping is associated with increased risk of obesity, and this is seen worldwide. Inference regarding the nature of association from cross-sectional studies is limited; it is suggested the association is bidirectional. Prospective studies on the association between daytime napping and obesity are few and results unclear. Large longitudinal studies integrating daytime napping duration and night-time sleep behaviour and detailed information on lifestyle influences is needed to help elucidate further the associations of long time napping with obesity.

Around the clock: unveiling giraffe rest-activity rhythms and social dynamics

Understanding the daily activity patterns and social dynamics of giraffes (Giraffa camelopardalis) is crucial for their management and conservation. In this study, a comprehensive 24-hour observational analysis of three female reticulated giraffes kept for three weeks at the Opel-Zoo in Kronberg, Germany, was conducted. Using infrared-sensitive cameras, the study captured behavioral data across baseline and two intervention phases involving changes in group composition. Social network analysis was performed using the Mantel test to assess changes in social interactions between day and night and across different study periods, while the MRQAP was applied to evaluate the influence of individual subtypes on the social structure. During the day, the giraffes exhibited a high level of activity, primarily engaging in walking, standing, and feeding behaviors. Diurnal resting was minimal, with sporadic lying phases. Night-time behavior was markedly different, with the giraffes spending most of the night lying down, interspersed with periods of feeding. The presence of a male giraffe during one intervention phase significantly altered diurnal activity patterns, increasing standing behaviors and decreasing feeding time. Social interactions, including nearest neighbor preferences, varied across day and night periods and changed with alterations in group composition. The study highlights the complexity of giraffe social dynamics and their adaptation to different social contexts. These findings provide valuable insights into the natural behavioral rhythms and social behaviors of giraffes, which are essential for effective zoo management and conservation strategies.

Associations between genotype, phenotype and behaviours measured by the Rett syndrome behaviour questionnaire in Rett syndrome

IntroductionRett syndrome (RTT) is a rare neurodevelopmental disorder with developmental impairments, comorbidities, and abnormal behaviours such as hand stereotypies and emotional features. The Rett Syndrome Behaviour Questionnaire (RSBQ) was developed to describe the behavioural and emotional features of RTT. Little is known how RSBQ scores are associated with genetic and clinical characteristics in RTT. This study investigated relationships between genotype, age, walking, hand function, sleep, and RSBQ total and subscale scores in RTT.MethodsThis is a cross-sectional analysis of data collected in the Australian Rett Syndrome Database and the International Rett Syndrome Phenotype Database. Parent caregivers completed the RSBQ and Sleep Disturbance Scale for Children [subscales for disorders of initiating and maintaining sleep (DIMS), disorders of excessive somnolence (DOES)], and provided information on age, variant type, functional abilities (mobility, hand function), seizure frequency and gastrointestinal problems. Associations between the RSBQ scores and the independent variables were modelled using linear regression.ResultsData were available for 365 individuals with RTT [median (range) age 17.8 (2.9–51.9) years, 2 males]. Compared to adults, 2- to 12-year-old children had higher mean Total, Night-time Behaviour and Fear/Anxiety scores. Compared to individuals with a C-terminal deletion, individuals with the p.Arg255* variant had higher mean Total and Night-time Behaviours scores, whereas the p.Arg294* variant had higher mean Mood scores. Individuals with intermediate mobility and hand function abilities had a higher mean Total score. Total RSBQ and subscale scores were similar across categories for seizures, constipation, and reflux, but were higher with abnormal DIMS and abnormal DOES scores.ConclusionExcept for associations with sleep, the RSBQ measures the behavioural phenotype rather than clinical severity in RTT, as traditionally conceptualised in terms of functional abilities and comorbidities. When designing clinical trials, the RSBQ needs to be complemented by other outcome measures to assess specific core functions and associated comorbidities in RTT.

Effects of Urban Lighting at Night on Daytime Songbird Aggression

Many animals require sleep for daily functions. In spring, songbirds expend a great deal of energy early in the day by singing to attract mates and aggressively protecting territory. Some evidence suggests that artificial lighting at night (ALAN) in the environment of wild birds increases their nighttime activity that, in turn, contributes to sleep loss. This study investigated how ALAN affects northern cardinal (Cardinalis cardinalis) response to experimental aggressive intrusion by conspecifics. The hypothesis tested is that high ALAN near cardinal roosting spots would cause those individuals to have less energy for daytime aggressive behaviors. After selecting known dark and bright urban roosting locations, ALAN was measured at specific sites with active cardinal territories during nighttime hours. Observers returned in the morning to present cardinal territorial songs using standardized call playback protocols. Aggressive behaviors of responding cardinals were recorded and used to quantify aggression intensity. Standard aggression measures included response latency, distance from bird to speaker, number of songs, hops, and flip flops. An aggression index was obtained using factor analysis which confirmed that aggressive responses featured short latency and approach distances, few chips, and many songs, flip flops, and hops. Analysis of variance revealed that cardinals roosting in high ALAN engaged in significantly more aggressive morning responses; directly contradicting predictions and previously published findings. One possible explanation for this result is that high ALAN might improve sleep in cardinals. To test this, autonomous recording units (ARUs) were placed in study locations to record nighttime calling behaviors in high and low ALAN. Insufficient data were obtained to clarify whether nighttime activity was reduced significantly by ALAN exposure. However, results showed that nighttime activity by cardinals is strongly influenced by moonlight, and that determination of the influence of ALAN on nighttime and daytime avian behavior must include measures of lunar illumination.

Individual consistency of hissing displays across night and day in a free-living female songbird

Birds have evolved a variety of antipredator strategies, which have been extensively studied during day-time. Yet, how diurnal birds directly respond to nocturnal predation threats remains largely elusive, despite that predation risk can be high during both night- and day-time. One form of antipredator behaviour found in several tit species when confronted with a predator at the nest is the hissing display. As for many forms of antipredator behaviour, studies on hissing displays have so far focussed on the day-time. Here, we exposed cavity-nesting free-living female great tits (Parus major) to simulated predator intrusions inside their nest box during both night- and day-time. We showed that 28 % of females uttered at least one hissing call during night-time, while the occurrence of hissing calls was higher during day-time (84 %). Hissing females at night, compared to non-hissing females, produced more hissing calls during day-time, providing evidence for individual cross-context consistency. Night-time hissing behaviour did not predict lay date, clutch size, breeding or nest success, indicating the absence of consequences in terms of current reproduction. Together, we reveal the hitherto undescribed occurrence of hissing displays at night in a cavity-nesting bird, while simultaneously strengthening the evidence for the existence of hissing behavioural types.

Sleep and nighttime behavior disorders in older adults: associations with hypercholesterolemia and hypertriglyceridemia at baseline, and a predictive analysis of incident cases at 12 months follow-up.

Sleep disorders, particularly insomnia and obstructive sleep apnea, are associated with dyslipidemia in the general population. The study's aim was to explore the association between pathological Cholesterol and Triglyceride levels, and sleep and nighttime behavior disorders (SNBD) in older adults, whether they might predict SNBD onset, and to emphasize the role of body mass index (BMI) in this association. Alzheimer's Disease Neuroimaging Initiative (ADNI) population with complete Cholesterol, Triglyceride, SNBD, and neurocognitive data were included. Logistic regression was performed to study the association between hypercholesterolemia, hypertriglyceridemia, and SNBD at baseline and at12 months. Relevant confounders, particularly BMI, were adjusted for. Among the 2,216 included cases, 1,045 (47%) were females, and the median age was 73 years (IQR: 68, 78). At baseline, 357 (16%) had SNBD and 327 (18%) at 12 months; 187 of them were incident cases. There were more cases of baseline SNBD in the hypertriglyceridemia group than in those without (19% vs. 14%, P-value = 0.003). Similarly, more follow-up SNBD cases had hypertriglyceridemia at baseline (21% vs. 16%, P-value = 0.025). SNBD cases at baseline had significantly higher serum Triglyceride levels than those without (132 vs. 118mg/dL, P-value < 0.001). Only hypertriglyceridemia was significantly associated with baseline SNBD (crude OR = 1.43, 95%CI: 1.13,1.80, P-value = 0.003), even after adjustment for confounding factors (adj. OR = 1.36, 95%CI: 1.06,1.74, P-value = 0.016) and (BMI-adj. OR = 1.29, 95%CI: 1.00,1.66, P-value = 0.048). None of the dyslipidemia forms did predict incident cases at 12 months. Hypertriglyceridemia, but not hypercholesterolemia, was associated with higher odds of SNBD. The association was independent of BMI. None of the dyslipidemia forms did predict incident SNBD over 12 months. Sleep disorders should motivate a systematic screening of dyslipidemia in older adults and vice versa.

A - 109 Neuropsychiatric Inventory Questionnaire Subfactors and Cognition in Parkinson’s Disease

Abstract Objective Patients with Parkinson’s disease (PD) commonly experience neuropsychiatric symptoms, often garnered through informant interview, that may be associated with poorer cognitive functioning. Recently, the Neuropsychiatric Inventory Questionnaire (NPI-Q) was found to have three factors with differential association to cognition in patients with PD. We sought to further examine this relationship in those with the condition. Method A sample of 42 patients with PD were seen for neuropsychological evaluation (85.7% male, 97.6% White, mean age 70.88 [SD = 7.16], mean years education 15.74 [SD = 2.99]). A knowledgeable informant completed the NPI-Q. Spearman correlations examined relationships between cognition (Digit Span, BVMT-R, CVLT-3, BNT-2, D-KEFS Color-Word Interference, COWAT, Animal Fluency, Trail Making Test), NPI-Q Total Severity, and severity for three factors (Mood [depression, anxiety, apathy, motor, nighttime behaviors, eating]; Hyperactivity [mania, aggression/agitation, disinhibition, irritability]; Psychotic Symptoms [delusions, hallucinations]). Results NPI-Q total severity was generally low (mean = 3.90, SD = 5.12). Total severity and severity of Mood and Hyperactivity were unrelated to cognition. More severe Psychotic Symptoms were related to worse Digit Span (r = −0.41, p = 0.008), BVMT-R Learning (r = −0.33, p = 0.03) and Delayed Recall (r = −0.34, p = 0.03), and D-KEFS Inhibition Time (r = 0.44, p = 0.006). Conclusions In a modest sample of patients with PD, severity of psychotic symptoms was related to worse auditory attention/working memory, visual learning and memory, and inhibition. No other NPI-Q score was associated with cognitive functioning. Findings support the utility of the NPI-Q in PD and the importance of considering specific neuropsychiatric factors and their implications for cognitive functioning.

Factors Associated with Increased Burden of Caregivers of People with Dementia with Lewy Bodies.

The burden of caregivers of people with dementia with Lewy bodies (DLB) is high; however, factors related to their caregiving burden are not fully clarified. We herein investigated factors associated with increasing caregiver burden for caregivers of people with DLB. To explore factors associated with caregiver burden, a linear regression analysis was conducted using the J-ZBI_8 total score as the dependent variable and a total of 36 factors as independent variables. This analysis included 252 pairs of people with DLB and their caregivers. Caregivers' mean J-ZBI_8 was 8.4, indicating that caregiver burden was generally high. First, we identified 20 factors associated with caregiver burden in univariable analysis. Finally, multivariable analysis found three significant factors: irritability (β = 0.208, p < 0.001), use of "short stay" or "small-scale, multifunctional home care" (β = 0.208, p < 0.001), and nighttime behavior (β = 0.138, p = 0.020) were significantly associated with J-ZBI_8 total scores. Irritability and nighttime behavior were found to be contributing factors to caregiver burden. High caregiver burden among caregivers of people with DLB may result in the use of social services providing overnight stays, but to what extent such services reduce caregiver burden is unknown.

Phenotyping sleep disturbances in ADHD and identifying harmonised outcome measures

AbstractAttention deficit hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder. Currently, the diagnosis and treatment of ADHD in children and adolescents is primarily centred on daytime functioning and the associated impairment of academic performance, although disrupted and restless sleep have been frequently reported in individuals with ADHD. Further, it has been recognised that sleep disorders not only intensify existing ADHD symptoms but in some cases can also mimic ADHD symptoms in the paediatric population with primary sleep disorders. Under the title ‘The blind spot: sleep as a child’s right issue?’, professionals from diverse disciplines, including medicine and social sciences as well as individuals with an interest in ADHD and sleep medicine, including laypeople, have initiated a unifying discourse. The objective of this discourse is to improve our understanding of the diagnosis and treatment of ADHD and disruptive behaviours and to develop personalised and precision medicine. Research has shown that the existing, primarily descriptive and categorical diagnostic systems do not capture the heterogeneous nature of youth with attentional and behavioural difficulties and the phenotypic expressions thereof, including nighttime behaviours and sleep. New strategies for clinical phenotyping and the exploration of patient-reported behaviours are necessary to expand our understanding and develop personalised treatment approaches. In this position paper, we outline gaps in the clinical care of ADHD and related sleep disturbances, review strategies for closing these gaps to meet the needs of individuals with ADHD, and suggest a roadmap for escaping the one-size-fits-all approach that has characterised ADHD treatment algorithms to date.

Dementia Subtypes Defined Through Neuropsychiatric Symptom–Associated Brain Connectivity Patterns

Understanding the heterogeneity of neuropsychiatric symptoms (NPSs) and associated brain abnormalities is essential for effective management and treatment of dementia. To identify dementia subtypes with distinct functional connectivity associated with neuropsychiatric subsyndromes. Using data from the Open Access Series of Imaging Studies-3 (OASIS-3; recruitment began in 2005) and Alzheimer Disease Neuroimaging Initiative (ADNI; recruitment began in 2004) databases, this cross-sectional study analyzed resting-state functional magnetic resonance imaging (fMRI) scans, clinical assessments, and neuropsychological measures of participants aged 42 to 95 years. The fMRI data were processed from July 2022 to February 2024, with secondary analysis conducted from August 2022 to March 2024. Participants without medical conditions or medical contraindications for MRI were recruited. A multivariate sparse canonical correlation analysis was conducted to identify functional connectivity-informed NPS subsyndromes, including behavioral and anxiety subsyndromes. Subsequently, a clustering analysis was performed on obtained latent connectivity profiles to reveal neurophysiological subtypes, and differences in abnormal connectivity and phenotypic profiles between subtypes were examined. Among 1098 participants in OASIS-3, 177 individuals who had fMRI and at least 1 NPS at baseline were included (78 female [44.1%]; median [IQR] age, 72 [67-78] years) as a discovery dataset. There were 2 neuropsychiatric subsyndromes identified: behavioral (r = 0.22; P = .002; P for permutation = .007) and anxiety (r = 0.19; P = .01; P for permutation = .006) subsyndromes from connectivity NPS-associated latent features. The behavioral subsyndrome was characterized by connections predominantly involving the default mode (within-network contribution by summed correlation coefficients = 54) and somatomotor (within-network contribution = 58) networks and NPSs involving nighttime behavior disturbance (R = -0.29; P < .001), agitation (R = -0.28; P = .001), and apathy (R = -0.23; P = .007). The anxiety subsyndrome mainly consisted of connections involving the visual network (within-network contribution = 53) and anxiety-related NPSs (R = 0.36; P < .001). By clustering individuals along these 2 subsyndrome-associated connectivity latent features, 3 subtypes were found (subtype 1: 45 participants; subtype 2: 43 participants; subtype 3: 66 participants). Patients with dementia of subtype 3 exhibited similar brain connectivity and cognitive behavior patterns to those of healthy individuals. However, patients with dementia of subtypes 1 and 2 had different dysfunctional connectivity profiles involving the frontoparietal control network (FPC) and somatomotor network (the difference by summed z values was 230 within the SMN and 173 between the SMN and FPC for subtype 1 and 473 between the SMN and visual network for subtype 2) compared with those of healthy individuals. These dysfunctional connectivity patterns were associated with differences in baseline dementia severity (eg, the median [IQR] of the total score of NPSs was 2 [2-7] for subtype 3 vs 6 [3-8] for subtype 1; P = .04 and 5.5 [3-11] for subtype 2; P = .03) and longitudinal progression of cognitive impairment and behavioral dysfunction (eg, the overall interaction association between time and subtypes to orientation was F = 4.88; P = .008; using the time × subtype 3 interaction item as the reference level: β = 0.05; t = 2.6 for time × subtype 2; P = .01). These findings were further validated using a replication dataset of 193 participants (127 female [65.8%]; median [IQR] age, 74 [69-77] years) consisting of 154 newly released participants from OASIS-3 and 39 participants from ADNI. These findings may provide a novel framework to disentangle the neuropsychiatric and brain functional heterogeneity of dementia, offering a promising avenue to improve clinical management and facilitate the timely development of targeted interventions for patients with dementia.

Comparative efficacy and safety of olanzapine and risperidone in the treatment of psychiatric and behavioral symptoms of Alzheimer's disease: Systematic review and meta-analysis.

Olanzapine and risperidone have emerged as the most widely used drugs as short-term prescription in the treatment of behavioral disturbances in dementia. The present systematic review and meta-analysis was hence performed to investigate the effectiveness and safety profile of olanzapine and risperidone in the treatment of behavioral and psychological symptoms of dementia (BPSD), aiming to provide updated suggestion for clinical physicians and caregivers. Prospective controlled clinical studies were included, of which available data was extracted. Outcomes of BEHAVE-AD scores with the variation of grades, specific behaviors variables, as well as safety signals were pooled for the analysis by odds rates and weighted mean differences, respectively. Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang. Prospective, controlled clinical studies, conducted to compare the effectiveness and safety profile of olanzapine and risperidone in the treatment of BPSD. Interested data including baseline characteristics and necessary outcomes from the included studies were extracted independently by 2 investigators. BEHAVE-AD scale was adopted to assess the efficacy in the present study. All behaviors were evaluated at the time of the initiation of the treatment, as well as the completion of drugs courses. Adverse events were assessed with the criteria of Treatment Emergent Symptom Scale, or Coding Symbols for a Thesaurus of Adverse Reaction Terms dictionary. Weighted mean difference was used for the pooled analysis. A total of 2427 participants were included in the present meta-analysis. Comparative OR on response rate, and remarkable response rate between olanzapine and risperidone was 0.65 (95% CI: 0.51-0.84; P = .0008), and 0.62 (95% CI: 0.50-0.78; P < .0001), respectively. There were statistical differences observed by olanzapine on the improvement of variables including delusions (WMD, -1.83, 95% CI, -3.20, -0.47), and nighttime behavior disturbances (WMD, -1.99, 95% CI, -3.60, -0.38) when compared to risperidone. Our results suggested that olanzapine might be statistically superior to risperidone on the reduction of BPSD of Alzheimer's disease, especially in the relief of delusions and nighttime behavior disturbances. In addition, olanzapine was shown statistically lower risks of agitation, sleep disturbance, and extrapyramidal signs.

Neuropsychiatric symptom burden in early-onset and late-onset Alzheimer's disease as a function of age.

We examined the burden of neuropsychiatric symptoms (NPSs) in early-onset (EO) and late-onset (LO) Alzheimer's disease (AD) and adjusted for age effects via the inclusion of cognitively unimpaired (CU) individuals. Cross-sectional data from 2940 EOAD, 8665 LOAD, and 8775 age-stratified CU individuals (early-CU, n=2433; late-CU, n=6342) from the National Alzheimer's Coordinating Center database were included. Fisher's exact tests compared EOAD and LOAD on the presence and severity of NPSs. Multiple logistic regression models included an age*diagnosis interaction to examine age effects. Presence (ps<0.0001) and severity (ps<0.05) of NPS were greater in EOAD than in LOAD. However, after adjusting for base rates in NPS in CU individuals (age effects), only elation and eating behaviors were more frequent in EOAD (ps<0.05) and nighttime behaviors more frequent and severe in LOAD (ps<0.05). Few NPSs were specific to the EOAD versus LOAD. Previous findings of greater NPS burden in EOAD may partially reflect age effects. Adjusting for age effect, elation and eating problems are more frequent in EOAD. Adjusting for age effect, sleep disturbances are more frequent and severe in LOAD. Age effects underlie higher neuropsychiatric symptom presentation in EOAD than in LOAD.

High serum Cholesterol and Triglyceride levels in older adults: associations with sleep and nighttime behavior disorders at baseline and a prediction analysis of incidental cases at 12 months follow-up.

This study explored the association between dyslipidemia and sleep and nighttime behavior disorders (SNBD) in the elderly. ADNI population with complete Cholesterol, Triglyceride, SNBD, and neurocognitive data were included. Logistic regression was performed to study the association between dyslipidemia and SNBD at baseline and 12 months. Relevant confounders were adjusted for. Among the 2,216 included cases, 1,045 (47%) were females, and the median age was 73 (IQR: 68, 78). At baseline, 357 (16%) had SNBD, and 327 (18%) at 12 months; 187 were incident cases.There were more cases of baseline SNBD in the hypertriglyceridemia group than in those without (19% vs. 14%, p-value=0.003). Similarly, more follow-up SNBD cases had hypertriglyceridemia at baseline (21% vs. 16%, p-value=0.025). SNBD cases at baseline had significantly higher serum Triglyceride levels than those without (132 vs. 118mg/dL, p-value<0.001).Only hypertriglyceridemia was significantly associated with baseline SNBD (crude OR=1.43, 95%CI: 1.13,1.80, p-value=0.003), even after adjustment for confounding factors (adj.OR=1.36, 95%CI: 1.06,1.74, p-value=0.016) and (BMI-adj.OR=1.29, 95%CI: 1.00,1.66, p-value=0.048). None of the dyslipidemia forms did predict incident cases at 12 months. Hypertriglyceridemia, but not hypercholesterolemia, was associated with higher odds of SNBD. None of the dyslipidemia forms predicted incidental SNBD over 12 months.

Sex Differences in the Severity and Progression of Neuropsychiatric Symptoms Across Different Dementia Types.

Dementia presents not only differing neuropsychiatric symptoms (NPS) across Alzheimer disease (AD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB) but also subjective cognitive decline (SCD). This study examined sex-based variations in NPS severity and progression across these conditions. We performed a longitudinal cohort study including 1,068 participants. Hierarchical generalized linear mixed models were used to model NPS as a function of disease severity and biological sex at birth. Female participants with AD exhibited NPS more frequently than male participants. In FTD, female participants had more frequent delusions, hallucinations, and depression/dysphoria, while male participants had higher instances of agitation/aggression, apathy, disinhibition, and irritability/lability. In DLB, male participants showed higher instances of depression, and female participants more frequently experienced anxiety. In SCD, female participants showed higher nighttime behaviors. The trajectory of NPS significantly differed between sexes. These findings highlight sex-specific NPS impact in different neurodegenerative conditions.

Breaking the spell: Changes in the behavior of two zoo-kept tigers (Panthera tigris) after exposure to a distinct feast-and-fast feeding regime.

The behavior of zoo carnivores has received intense attention due to their propensity for locomotor stereotypies. We observed two adult male tiger (Panthera tigris) siblings kept together for the duration of 104 days by round-the-clock video observation. The period consisted of three baseline periods with the zoo's regular feeding regime of five feeding days per week interrupted by two individual fasting days, with feeding occurring in the evening (B1-B3 of 14 days each). These periods were interrupted by two intervention periods (I1: randomized feeding times, 28 days; I2: gorge-feeding with three 10-day fasting periods, 34 days). As expected, day and night-time behavior was different, with the majority of sleep occurring at night. Pacing, which was mainly considered anticipatory, significantly decreased from 88 ± 132 min/day during B1 to 20 ± 33 min/day during B3. Pacing did not increase during the fasting days of I2. Over the course of whole study, lying time decreased and nonpacing locomotion increased. A major difference was observed between gorge-feeding and the subsequent first fasting days: during gorge-feeding, tigers spent a large part of the day feeding and locomoting (and less sleeping); on the subsequent day, they locomoted about 4.5 h less and slept about 4.3 h more. We suggest that interrupting routines by fasting periods of several days may be effective for reducing regular anticipatory behavior and creates an across-day structure that may correspond to the evolved psychological disposition of large carnivores.

Impact of motor dysfunction on neuropsychiatric symptom profile in patients with autopsy-confirmed Alzheimer’s disease

Motor dysfunction, which includes changes in gait, balance, and/or functional mobility, is a lesser-known feature of Alzheimer’s Disease (AD), especially as it relates to the development of neuropsychiatric symptoms (NPS). This study (1) compared rates of NPS between autopsy-confirmed AD patients with and without early-onset motor dysfunction and (2) compared rates of non-AD dementia autopsy pathology (Lewy Body disease, Frontotemporal Lobar degeneration) between these groups. This retrospective longitudinal cohort study utilized National Alzheimer’s Coordinating Center (NACC) data. Participants (N = 856) were required to have moderate-to-severe autopsy-confirmed AD, Clinical Dementia Rating-Global scores of ≤1 at their index visit, and NPS and clinician-rated motor data. Early motor dysfunction was associated with significantly higher NPI-Q total scores (T = 4.48, p < .001) and higher odds of delusions (OR [95%CI]: 1.73 [1.02–2.96]), hallucinations (2.45 [1.35–4.56]), depression (1.51 [1.11–2.06]), irritability (1.50 [1.09–2.08]), apathy (1.70 [1.24–2.36]), anxiety (1.38 [1.01–1.90]), nighttime behaviors (1.98 [1.40–2.81]), and appetite/eating problems (1.56 [1.09–2.25]). Early motor dysfunction was also associated with higher Lewy Body disease pathology (1.41 [1.03–1.93]), but not Frontotemporal Lobar degeneration (1.10 [0.71–1.69]), on autopsy. Our results suggest that motor symptoms in early AD are associated with a higher number and severity of NPS, which may be partially explained by comorbid non-AD neuropathology.

Neuropsychiatric symptoms and brain morphology in patients with mild cognitive impairment, cerebrovascular disease and Parkinson disease: A cross sectional and longitudinal study.

Neuropsychiatric symptoms (NPS) increase risk of developing dementia and are linked to various neurodegenerative conditions, including mild cognitive impairment (MCI due to Alzheimer's disease [AD]), cerebrovascular disease (CVD), and Parkinson's disease (PD). We explored the structural neural correlates of NPS cross-sectionally and longitudinally across various neurodegenerative diagnoses. The study included individuals with MCI due to AD, (n=74), CVD (n=143), and PD (n=137) at baseline, and at 2-years follow-up (MCI due to AD, n=37, CVD n=103, and PD n=84). We assessed the severity of NPS using the Neuropsychiatric Inventory Questionnaire. For brain structure we included cortical thickness and subcortical volume of predefined regions of interest associated with corticolimbic and frontal-executive circuits. Cross-sectional analysis revealed significant negative correlations between appetite with both circuits in the MCI and CVD groups, while apathy was associated with these circuits in both the MCI and PD groups. Longitudinally, changes in apathy scores in the MCI group were negatively linked to the changes of the frontal-executive circuit. In the CVD group, changes in agitation and nighttime behavior were negatively associated with the corticolimbic and frontal-executive circuits, respectively. In the PD group, changes in disinhibition and apathy were positively associated with the corticolimbic and frontal-executive circuits, respectively. The observed correlations suggest that underlying pathological changes in the brain may contribute to alterations in neural activity associated with MBI. Notably, the difference between cross-sectional and longitudinal results indicates the necessity of conducting longitudinal studies for reproducible findings and drawing robust inferences.

Eating problems in people with dementia with Lewy bodies: Associations with various symptoms and the physician's understanding.

Eating problems frequently occur in people with dementia with Lewy bodies (DLB), but few studies have investigated the clinical background of this phenomenon. This study examined the relationship between eating problems and various symptoms of DLB and the relation between the treatment needs for DLB people with eating problems and the understanding of their eating problems by caregivers and physicians. This was a subanalysis of a cross-sectional, questionnaire-based survey study. Two hundred sixty-one subjects with DLB were divided into subjects with or without eating problems. Logistic or linear regression analysis was used to investigate the factors influencing eating problems. The treatment needs of DLB people for their eating problems and the understanding of these needs by caregivers and physicians were calculated as participant-caregiver and participant-physician kappa coefficient. Of the 261 participants, 27% suffered from eating problems. The presence of eating problems in participants with DLB was related to depression (p = 0.01, OR : 2.19, 95% CI: 1.23-3.91) and apathy (p = 0.01, OR 2.15, 95% CI: 1.20-3.87), while the worsening of eating problems was related to dysphagia (β = 0.24, p = 0.03), apathy (β = 0.23, p = 0.05), and nighttime behavior (β = 0.24, p = 0.04). The participant-physician kappa coefficient for physician understanding of constipation, weight loss, dysphagia, weight gain, and increase in appetite was significantly lower than the corresponding participant-caregiver kappa coefficient (p-value of five symptoms < 0.01). Physicians need to pay more attention to eating problems and their neuropsychiatric background in the long-term support and management of DLB subjects.

Longitudinal Associations Between Mild Behavioral Impairment, Sleep Disturbance, and Progression to Dementia.

Clinical guidelines recommend incorporating non-cognitive markers like mild behavioral impairment (MBI) and sleep disturbance (SD) into dementia screening to improve detection. We investigated the longitudinal associations between MBI, SD, and incident dementia. Participant data were from the National Alzheimer's Coordinating Center in the United States. MBI was derived from the Neuropsychiatric Inventory Questionnaire (NPI-Q) using a published algorithm. SD was determined using the NPI-Q nighttime behaviors item. Cox proportional hazard regressions with time-dependant variables for MBI, SD, and cognitive diagnosis were used to model associations between baseline 1) MBI and incident SD (n = 11,277); 2) SD and incident MBI (n = 10,535); 3) MBI with concurrent SD and incident dementia (n = 13,544); and 4) MBI without concurrent SD and incident dementia (n = 11,921). Models were adjusted for first-visit age, sex, education, cognitive diagnosis, race, and for multiple comparisons using the Benjamini-Hochberg method. The rate of developing SD was 3.1-fold higher in older adults with MBI at baseline compared to those without MBI (95% CI: 2.8-3.3). The rate of developing MBI was 1.5-fold higher in older adults with baseline SD than those without SD (95% CI: 1.3-1.8). The rate of developing dementia was 2.2-fold greater in older adults with both MBI and SD, as opposed to SD alone (95% CI:1.9-2.6). There is a bidirectional relationship between MBI and SD. Older adults with SD develop dementia at higher rates when co-occurring with MBI. Future studies should explore the mechanisms underlying these relationships, and dementia screening may be improved by assessing for both MBI and SD.

Sleep Disturbances predict cognitive decline in cognitively healthy adults

AbstractBackgroundSleep disturbances, including insomnia, poor sleep quality, and sleep fragmentation, are implicated in the development and progression of Alzheimer’s disease and related dementias in older adults. However, the effect of sleep disturbances on lifespan in those with cognitive impairment has not been studied independently from other neuropsychiatric symptoms such as disinhibition. The purpose of this study was to determine if sleep disturbances predict increased risk of earlier mortality across cognitive status (e.g., normal, mild cognitive impairment [MCI] and dementia) and risk of mortality independent from other neuropsychiatric symptoms known to predict dementia.MethodThe National Alzheimer’s Coordinating Center database was used to evaluate the mortality risk conferred by nighttime behaviors as determined by the neuropsychiatric inventory questionnaire (NPI‐Q). The effect of nighttime behaviors was used as a surrogate for sleep disturbances at the participant’s baseline assessment. Based on previous work, cognitive status was stratified by normal cognitive, MCI, and dementia using Montreal Cognitive Assessment scores. Covariates of age, sex, education, race, and other NPI‐Q items on mortality risk were analyzed using Cox regression.ResultThe sample was comprised of 31,288 participants, of whom 10,329 (33%) died during follow‐up and lasted a median [interquartile range] of 56.5 [30.2 – 88.8] months for deaths and 39.5 [23.1 – 75.1] months for survivors. One‐fifth of patients (n = 6509) experienced nighttime behaviors (e.g., nighttime awakenings). Worse cognitive status, older age, female sex, lower education, and increased neuropsychiatric burden increased mortality risk (ps≤.02). However, when explored independently, nighttime behaviors were found to predict earlier mortality (hazard ratio [HR]: 1.11 95% CI: [1.06,1.16], p&lt;.001).ConclusionFindings expand on current evidence that the cross‐sectional prevalence of sleep disturbances increases with worsening cognition. Sleep disturbances predicted a higher risk of mortality while controlling for other variables. Potential mechanisms by which sleep disturbances may play a role in cognitive impairment or earlier mortality should be explored, including circadian rhythm disturbances and alteration in homeostatic and motivational processes.