Sleep disruption linked to agitation in those with mild cognitive impairment, dementia

Key takeaways:

• Researchers analyzed data from eight patient/caregiver pairings on sleep patterns and agitation.
• The findings should be confirmed in a larger, more representative sample.

PHILADELPHIA — In a small cohort of individuals with mild cognitive impairment or dementia, sleep disruption was associated with weekly agitation level, according to a presenter.

“We’re trying to find the answer to the following question — are there behaviors associated with agitation that can potentially serve as a target for treatment so that we can alleviate agitation in people with dementia,” Wan-Tai Au-Yeung, PhD, assistant professor of neurology in the School of Medicine at Oregon Health & Science University (OHSU), stated at the Alzheimer’s Association International Conference.

Au-Yeung and colleagues initiated the Monitoring Dementia-Related Agitation Using Technology Evaluations (MODERATE) study, an ongoing longitudinal, observational undertaking expected to last up to 24 months.

With a goal of enrolling 20 patient/caregiver dyads, the researchers offered data on eight pairings. The patients received a diagnosis of mild cognitive impairment or dementia by OHSU clinicians; had symptoms of agitation, motor disturbance, disinhibition or irritability; and lived with a caregiver within their own homes.

The caregivers were required to answer a phone-delivered survey asking whether any of the above-stated behaviors, consistent with those found in the Cohen-Mansfield Agitation Inventory – Short Form (CMAI-SF), had occurred in the previous week. The frequency was rated on a sale of 0 (none) to 5 (daily), whereas total agitation was the sum of the frequency of all agitated behavior, with a maximum score of 70.

The patients were then invited to take part in a home-based sleep study featuring the Emfit bed pressure mat. Each night, caregivers recorded sleep metrics and heart and respiratory rates through the apparatus based on body position and pressure.

Eleven different individual-effects models with random intercepts were constructed from a dependent variable of weekly total agitation level and independent variables of bed pressure plus the week when the weekly mean was calculated. Au-Yeung and colleagues also applied a false discovery correction to P values of the independent variables to identify those which associated with the total agitation level.

According to interim results, the highest correlation for agitation among the 11 different models was “wake after sleep onset” measured in minutes, with the more waking minutes following interrupted sleep associated with weekly agitation level.

“Was poor sleep quality at night causing agitation throughout the week? That’s still unclear,” Au-Yeung noted. “A future direction (would be) to do a similar study with a more diverse sample to confirm these findings.”