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Objective@#To investigate the clinical characteristics of sleep disorders(SD)in patients with Alzheimer's disease(AD), and the relationship between SD and cognitive impairment.@*Methods@#According to the inclusion and exclusion criteria of AD, 89 consecutive AD patients admitted to Beijing Tiantan Hospital from January 2016 to January 2017 were included.The Pittsburgh sleep quality index(PSQI)scale was used to evaluate the overall sleep status.The patients were randomized into the AD with SD(AD-SD)group(PSQI>7)and the AD without SD(AD-NSD)group(PSQI<7). The cognitive function of AD patients was evaluated by the Montreal cognitive assessment(MoCA)scale, and the overall cognitive function and cognitive domains were compared between the AD-SD and AD-NSD groups.@*Results@#Of the 89 AD patients, 71 cases(79.78%)had SD.There was no significant difference in gender, age, age of onset, education level and disease duration between the AD-SD and AD-NSD groups(P>0.05). The factors in the PSQI scale had significant differences between AD-SD和AD-NSD groups, including sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, administration of sleeping medication and daytime dysfunction(P<0.05). Compared with the AD-NSD group, the AD-SD group showed that the total score of MoCA scale was significantly reduced(P<0.05), and the scores of delayed recall and language were significantly decreased(P<0.05). There was a negative correlation of the sleep time with the total score of MoCA scale and the score of delayed recall in the AD-SD group(r=-0.245 and -0.249, P=0.041 and 0.039). Night SD was negative correlated with the total score of MoCA scale and the score of delayed recall(r=-0.248 and -0.283, P=0.038 and 0.018).@*Conclusions@#The incidence of AD-SD is up to 79.78%.AD-SD patients have a worse subjective sleep quality, longer time to fall asleep, shorter sleep time, lower sleep efficiency, higher night SD, more use of sleep drugs and more daytime dysfunction.General cognitive dysfunction, delayed recall and language impairment are more obvious in AD-SD patients.In AD-SD group, longer time to fall asleep and night SD are related to the general cognitive function and delayed recall.
ABSTRACT
Objective To investigate the clinical characteristics of sleep disorders (SD)in patients with Alzheimer's disease(AD),and the relationship between SD and cognitive impairment.Methods According to the inclusion and exclusion criteria of AD,89 consecutive AD patients admitted to Beijing Tiantan Hospital from January 2016 to January 2017 were included.The Pittsburgh sleep quality index(PSQI)scale was used to evaluate the overall sleep status.The patients were randomized into the AD with SD(AD-SD) group (PSQI＞ 7) and the AD without SD (AD-NSD) group (PSQI ＜ 7).The cognitive function of AD patients was evaluated by the Montreal cognitive assessment (MoCA) scale,and the overall cognitive function and cognitive domains were compared between the AD-SD and AD-NSD groups.Results Of the 89 AD patients,71 cases (79.78％)had SD.There was no significant difference in gender,age,age of onset,education level and disease duration between the AD-SD and AD-NSD groups(P＞0.05).The factors in the PSQI scale had significant differences between AD-SD 和 AD-NSD groups,including sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disturbance,administration of sleeping medication and daytime dysfunction(P＜0.05).Compared with the AD-NSD group,the AD-SD group showed that the total score of MoCA scale was significantly reduced(P＜0.05),and the scores of delayed recall and language were significantly decreased(P ＜ 0.05).There was a negative correlation of the sleep time with the total score of MoCA scale and the score of delayed recall in the AD-SD group(r =-0.245 and 0.249,P =0.041 and 0.039).Night SD was negative correlated with the total score of MoCA scale and the score of delayed recall(r=0.248 and-0.283,P =0.038 and 0.018).Conclusions The incidence of AD-SD is up to 79.78％.AD-SD patients have a worse subjective sleep quality,longer time to fall asleep,shorter sleep time,lower sleep efficiency,higher night SD,more use of sleep drugs and more daytime dysfunction.General cognitive dysfunction,delayed recall and language impairment are more obvious in AD-SD patients.In AD-SD group,longer time to fall asleep and night SD are related to the general cognitive function and delayed recall.
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Objective To investigate the clinical features of Parkinson disease (PD)with constipation.Methods From October 2013 to August 2015,a total of 204 PD patients were consecutively recruited from the Departments of Geriatrics and Neurology,Beijing Tiantan Hospital,Capital Medical University,and were evaluated by Rome Ⅲ diagnostic criteria for functional constipation and other related scales of motor symptoms(MS)and non-motor symptoms(NMS),the activity of daily living(ADL)and quality of life.Results Overall,131 of 204(64.2％)PD patients with constipation were assigned to the PD-C group and 73 of 204 (35.8％)PD patients without constipation were assigned to the PD-NC group.In the PD-C group,38 of 131(29％)PD patients had constipation before motor symptoms occurred.The mean age and age of onset in the PD-C group were significantly older than those in the PD-NC group (64.13 ± 9.67 vs.58.35 ± 11.37;60.07 ± 10.46 vs.55.10±12.97;F=2.287,4.948;t=3.827,-2.788;P＜0.01 for both).Meanwhile,compared with the PD-NC group,the PD-C group was associated with dramatically longer disease duration (2.25,range:1.00-5.00 vs.2.00,range:1.00-3.13;Z =-2.254;P ＜ 0.05),increased scores of the Unified Parkinson Disease Rating Scale (UPDRS) Ⅲ (26.00 scores,range:18.00 37.50 vs.19.00,range:12.50-31.00;Z =-2.349,P ＜ 0.05),more advanced stages on the Hoehn-Yahr (H-Y) scale (2.00 stage,range:1.50-2.50 vs.1.50,range:1.00-2.50;Z=-2.334,P＜0.05),higher total numbers of NMS(11.00,range:6.00-15.00 vs.6.00,range:3.00-11.00;Z=-3.715,P＜0.05),and higher numbers of NMS occurring before and after MS(before,2.00,range:0.00-4.00 vs.1.00,range:0.00-2.00;after,8.00,range:3.00-14.00 vs.5.00,range:2.00-9.50;Z =-2.612,-2.630,respectively;P＜0.05 for both).Additionally,there were significant differences between the groups in the scores of the Hamilton depression scale (HAMD),the Hamilton anxiety scale (HAMA),the Pittsburgh sleep quality index (PSQI),the scales for outcomes in Parkinson disease-autonomic (SCOPA-AUT),the Fatigue severity scale (FSS),the Apathy scale,the Montreal Cognitive Assessment(MoCA)scale,the UPDRS Ⅱ and ADL Scale,and the PDQL-39 (all P＜0.05).Binary Logistic regression analysis showed that age,SCOPA-AUT,HAMA and HAMD were risk factors for PD-C(OR=1.091,1.107,1.10 and 1.080;P＜0.05 for all).Conclusions PD patients have a high incidence of constipation,and more than a quarter of patients have constipation before MS occurs.Meanwhile,PD patients with constipation are usually associated with old age and late age of onset,long disease duration,severe MS,frequent and severe NMS,bad cognition,emotional state and sleep,severe fatigue,and apathy.Moreover,advanced age,autonomic dysfunction,anxiety and depression increase the risk of PD with constipation.Constipation has a serious negative impact on the activity of daily living and quality of life in PD patients.