Longitudinal Associations Between Mild Behavioral Impairment, Sleep Disturbance, and Progression to Dementia
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Abstract
Background: Clinical guidelines recommend incorporating non-cognitive markers like mild behavioral impairment (MBI) and sleep disturbance (SD) into dementia screening to improve detection. Objective: We investigated the longitudinal associations between MBI, SD, and incident dementia. Methods: 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. Results: 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). Conclusions: 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.
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27.6%)
Typo: "...were CN, 3293 (27.6%) had MCI.." :)
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include
Typo: "...includes participant..."
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Mild Behavioral Impairment
Did you consider breaking apart the MBI analysis by category (decreased motivation, emotional dysregulation, impulse dyscontrol, social inappropriateness, abnormal perception/thought) versus using a global MBI score to better see where the relationship between MBI, SD and dementia is strongest (if any)? This could help extrapolate the potential common cause/pathology.
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may not identify all presentations of SD,
I agree with this limitation. The NPI-Q nighttime behavior question excludes the ability to identify other types of sleep-wake disorders and even though the score is based on the answer from an informant, there is often a gap between the subjective perception of sleep and objective data via PSG. The question also doesn’t capture sleep behavior or CBT-I attempts. Although CBT-I is moderately effective for insomnia at best, cases where this has been attempted and proved unsuccessful could help point to neurobiological drivers of the SD-MBI-dementia relationship.
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