Lifestyle Factors and Subjective Cognitive Impairment in Patients Seeking Help at a Memory Disorder Clinic: The Role of Negative Life Events.

BACKGROUND/AIMS: A large proportion of patients at memory disorders clinics are classified as having subjective cognitive impairment (SCI). Previous research has investigated whether particular lifestyle factors known to affect cognition can be useful in differentiating patients who do not show objective evidence of memory decline. There may also exist subgroups of patients with respect to lifestyle factors that could help clinicians to understand the patient group that presents to memory clinics. These may differ in diagnostic outcome. Very little is known about potential subgroups; however, but such information may help guide interventions and potentially eliminate unnecessary diagnostic procedures. The current study investigated patterns of lifestyle-related variables, including stress, sleep, sensory sensitivity, depression, and negative life events in patients presenting to a memory disorders clinic. The aim was to determine whether subgroups existed and whether it was possible to distinguish those with objectively impaired cognition. METHODS: One hundred and seventy-eight patients (mean age 58 years) from a University Hospital Memory Disorders Clinic. RESULTS: Cluster analysis identified three groups of lifestyle-related variables. Strong determinants of clusters were negative life events and age. Patients with a high number of negative life events also tended to have highest self-reported memory complaint, higher levels of stress, depression, and sensory sensitivity. However, they did not perform the worst on memory testing. In contrast, individuals who performed the worst on memory tests were older, tended to have the least memory complaints, and less negative lifestyle factors; this group also included the highest proportion of patients with mild cognitive impairment and had the lowest median amyloid A-beta 42 (Aß42). The group with the best cognitive performance were younger, included the highest proportion of patients with SCI and the highest median Aß42. On lifestyle variables, their ratings fell in between the other groups. CONCLUSIONS: Lifestyle subgroups of patients were determined by stress, emotional problems, and age. The groups were significantly associated with Aß42 and diagnostic outcome. This pattern may confound the differentiation between objective and subjective memory problems. Asking about lifestyle variables, in conjunction with neuropsychological testing, could potentially identify individuals who are not likely to have objective memory impairment and guide interventions.

Criteria for self-reported quantitative sleep characteristics of individuals who sought medical help for disturbed sleep - a survey of a representative sample of the Swedish population.

BACKGROUND: The public often seeks rule-of-thumb criteria for good or poor sleep, with a particular emphasis on sleep duration, sleep latency, and the number of awakenings each night. However, very few criteria are available. AIM: The present study sought to identify such criteria. METHODS: Whether or not a person has sought medical help for sleep problems was selected as an indicator of poor sleep. The group that was studied constituted a representative sample of the general Swedish population (N=1,128), with a response rate of 72.8%. RESULTS: Logistic regression analysis, with an adjustment for age and gender, showed an increased OR for a weekday sleep duration of ≤6 hour, (OR >2, and for <5 hour: OR >6). For weekend sleep, the value was ≤6 hour (OR >2). For awakenings per night, the critical value was ≥2 (OR >2, and for ≥5 awakenings: OR >9), and for a sleep latency the critical value was ≥30 minutes (OR >2, and for ≥45 minutes: OR >6). Adding difficulties falling asleep and early morning awakening (considered qualitative because of the reflected "difficulty"), led to the elimination of all the quantitative variables, except for the number of awakenings. The addition of "negative effects on daytime functioning" and "sleep being a big problem" resulted in the elimination of all the other predictors except age. CONCLUSION: It was concluded that weekday sleep ≤6 hour, ≥2 awakenings/night, and a sleep latency of ≥30 minutes, can function as criteria for poor sleep, but that qualitative sleep variables take over the role of quantitative ones, probably because they represent the integration of quantitative indicators of sleep.

Aging and the Change in Fatigue and Sleep - A Longitudinal Study Across 8 Years in Three Age Groups.

Fatigue is prevalent in the population and usually linked to sleep problems, and both are related to age. However, previous studies have been cross-sectional. The purpose of the present study was to investigate the trajectories of sleep and fatigue across 8 years of aging in a large group (N > 8.000) of individuals. A second purpose was to investigate whether fatigue trajectories would differ between age groups, and whether different trajectories of fatigue would be reflected in a corresponding difference in trajectories for sleep variables. Results from mixed model analyses showed that fatigue decreased across 8 years in all age groups, while sleep problems increased, non-restorative sleep decreased, weekend sleep duration decreased, and weekday sleep duration showed different patterns depending on age. Furthermore, the larger the decrease in fatigue, the larger was the increase in sleep duration across years, the lower was the increase of sleep problems, and the larger was the decrease of non-restorative sleep. The results suggest that aging has positive effects on fatigue and sleep and that these changes are linked.

Lifestyle Factors Are Important Contributors to Subjective Memory Complaints among Patients without Objective Memory Impairment or Positive Neurochemical Biomarkers for Alzheimer's Disease.

BACKGROUND/AIMS: Many patients presenting to a memory disorders clinic for subjective memory complaints do not show objective evidence of decline on neuropsychological data, have nonpathological biomarkers for Alzheimer's disease, and do not develop a neurodegenerative disorder. Lifestyle variables, including subjective sleep problems and stress, are factors known to affect cognition. Little is known about how these factors contribute to patients' subjective sense of memory decline. Understanding how lifestyle factors are associated with the subjective sense of failing memory that causes patients to seek a formal evaluation is important both for diagnostic workup purposes and for finding appropriate interventions and treatment for these persons, who are not likely in the early stages of a neurodegenerative disease. The current study investigated specific lifestyle variables, such as sleep and stress, to characterize those patients that are unlikely to deteriorate cognitively. METHODS: Two hundred nine patients (mean age 58 years) from a university hospital memory disorders clinic were included. RESULTS: Sleep problems and having much to do distinguished those with subjective, but not objective, memory complaints and non-pathological biomarkers for Alzheimer's disease. CONCLUSIONS: Lifestyle factors including sleep and stress are useful in characterizing subjective memory complaints from objective problems. Inclusion of these variables could potentially improve health care utilization efficiency and guide interventions.

Neurologic and neurodevelopmental phenotypes in young children with early-treated combined methylmalonic acidemia and homocystinuria, cobalamin C type.

Abnormal neurodevelopment has been widely reported in combined methylmalonic aciduria (MMA) and homocystinuria, cblC type (cblC disease), but neurodevelopmental phenotypes in cblC have not previously been systematically studied. We sought to further characterize developmental neurology in children with molecularly-confirmed cblC. Thirteen children at our center with cblC, born since implementation of expanded newborn screening in New York State, undertook standard-of-care evaluations with a pediatric neurologist and pediatric ophthalmologist. At most recent follow-up (mean age 50 months, range 9-84 months), of twelve children with early-onset cblC, three (25%) had a history of clinical seizures and two (17%) meet criteria for microcephaly. A majority of children had hypotonia and nystagmus. Twelve out of thirteen (92%) underwent neurodevelopmental evaluation (mean age 41 months; range 9-76 months), each child tested with standardized parental interviews and, where possible, age- and disability-appropriate neuropsychological batteries. All patients showed evidence of developmental delay with the exception of one patient with a genotype predictive of attenuated disease and near-normal biochemical parameters. Neurodevelopmental deficits were noted most prominently in motor skills, with relative preservation of socialization and communication skills. Nine children with early-onset cblC underwent magnetic resonance imaging and spectroscopy (MRI/MRS) at mean age of 47 months (range 6-81 months); common abnormalities included callosal thinning, craniocaudally short pons, and increased T2 FLAIR signal in periventricular and periatrial white matter. Our study further characterizes variable neurodevelopmental phenotypes in treated cblC, and provides insights into the etiopathogenesis of disordered neurodevelopment frequently encountered in cblC. Plasma homocysteine and MMA, routinely measured at clinical follow-up, may be poor predictors for neurodevelopmental outcomes. Additional data from large, prospective, multi-center natural history studies are required to more accurately define the role of these metabolites and others, as well as that of other genetic and environmental factors in the etiopathogenesis of the neurologic components of this disorder.