The Moderating Role of Pain Self-efficacy in the Relationships Among Caregiver Burden and Care Recipient Pain and Neuropsychiatric Symptoms in a Sample of Persons With Dementia.

Past research suggests relationships among dementia caregiver burden and care recipient pain and neuropsychiatric symptoms, but no prior work has examined the influence of pain self-efficacy on these associations. A sample of 502 dementia caregivers completed an online protocol assessing caregiver burden and care recipient neuropsychiatric symptoms, presence of pain, and pain self-efficacy in this cross-sectional, observational study. The indirect effect of neuropsychiatric symptoms on the relationship between pain and caregiver burden was significant. Pain self-efficacy significantly moderated the effect of pain on neuropsychiatric symptoms (P=0.04) and the direct association between pain and caregiver burden (P=0.004), but did not moderate the indirect effect. Future research should explore how pain influences neuropsychiatric symptoms, and whether improvement in pain self-efficacy in dementia care recipients attenuates the influence of pain on neuropsychiatric symptoms and caregiver burden in other samples.

Owner quality of life, caregiver burden and anticipatory grief: How they differ, why it matters.

BACKGROUND: Understanding client perspective is important for veterinary communications, particularly during problem visits. Key client experiences of caregiver burden, anticipatory grief and quality of life (QoL) have been previously examined in this context, but never simultaneously considered. METHODS: A sample of 393 owners of an elderly or seriously ill companion animal was recruited online to complete cross-sectional measures of psychosocial function, companion animal presentation and demographics. RESULTS: Exploratory factor analysis demonstrated that owner caregiver burden, anticipatory grief and QoL reflect distinct constructs. Cluster analysis showed these experiences occur in four separate owner profiles: 'distressed', 'resilient', 'non-distressed' and owners experiencing strain due to 'other influences'. These groups appear to be differentially influenced by various factors, such as the companion animal's QoL, nature of the illness and the owner's attachment. They also show distinct differences in consideration of euthanasia and emotional functioning, including experience of stress and depressive symptoms. CONCLUSIONS: Constructs of caregiver burden, anticipatory grief and QoL are not interchangeable and may differentially impact owner decisions and behaviour. The veterinarian's understanding of owner profiles relevant to these issues and distinguishing underlying features may foster effective communication.

Varying roles of glucoregulatory function measures in postprandial cognition following milk consumption.

PURPOSE: Past work suggests milk consumption may facilitate cognition in children and college students with higher fasting glucose compared to other beverages (e.g., fruit juice). However, no studies have evaluated this phenomenon in adults, or considered other measures of glucoregulatory function. This open-label study assessed the role of glucoregulatory function in postprandial cognition after milk intake in adults. We hypothesized participants with lower fasting or post-consumption plasma glucose following a glucose excursion challenge (glucose response) would demonstrate better cognition following beverages of higher (juice) versus lower (milk) or no (water) glycemic content. METHODS: Forty-four nondiabetic, overnight-fasted adults attended three laboratory visits, ingesting 237 mL of 2% fat milk, apple juice, or water at each visit in a randomized, counterbalanced, crossover design. Participants completed cognitive testing (CNS Vital Signs) at baseline and 30, 90, and 150 min post-ingestion; primary outcomes were CNS Vital Signs composite scores. Fasting and post-consumption plasma glucose levels were assessed, with glucose response indexed as the change in plasma glucose from baseline to 30 min after juice (ΔGlucose). RESULTS: Mixed modeling revealed participants with higher fasting glucose demonstrated better complex attention after water versus juice at 30 min, but better performance after juice versus water at 150 min (p = 0.02). Participants with a larger ΔGlucose demonstrated better processing speed (p = 0.01) 30 min after milk versus water; this effect also reversed at 150 min. CONCLUSION: Different methods of measuring glucoregulatory function reveal its differing roles in postprandial cognition. Time since ingestion may also determine which beverages best optimize cognition.

Biological sex and glucoregulation modulate postprandial cognition following dairy milk and fruit juice in healthy school-age children.

Objectives: Recent work suggests potential postprandial benefits for cognition and on-task behavior in children, depending on the macronutrients consumed, as well as individual differences such as sex and glucoregulation. We examined the effects of 1% milk versus apple juice on cognition and on-task behavior among healthy school-age children, predicting that milk would promote better performance and a greater presence of on-task behavior compared to juice. We also examined how sex and glucoregulation influenced cognition and behavior following each beverage.Methods: Eighty-four English-speaking children ages 8-12 (45 female, 39 male) attended two 0800 testing sessions after fasting overnight in a crossover design. Participant sessions were counterbalanced to include 237 mL of 1% milk or apple juice. Behavioral measures and complex attentional and executive function tasks were assessed at baseline, 30, 90, and 120 min post-ingestion. Outcomes were analyzed using repeated measures mixed models.Results: Participants with fasting glucose levels above 89.91 mg/dL responded more quickly in an inhibitory control paradigm following milk. Females performed faster on a vigilance task, but less accurately in a working memory paradigm after milk versus juice. No effects were found for on-task behavior.Discussion: Results demonstrated modulatory effects of glucoregulation and sex on postprandial cognition. Milk may improve cognitive performance in school-aged children with higher fasting glucose, and may be the optimal choice for speed among females, whereas juice may be better for accuracy. Future work should utilize designs incorporating glucoregulation and sex, and consider additional biological variables to better understand postprandial cognition and behavior in children.

Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education.

INTRODUCTION: Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal insomnia, but it remains unclear whether treating insomnia also alleviates co-occurring depressive symptoms and depressogenic features. This trial tested whether CBTI improves depressive symptoms, maladaptive thinking, and somatic hyperarousal in postmenopausal women with insomnia; as well as whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious. MATERIALS AND METHODS: Single-site, randomized controlled trial. 117 postmenopausal women (56.34 ± 5.41 years) with peri-or-postmenopausal onset of chronic insomnia were randomized to three treatment conditions: sleep hygiene education control (SHE), SRT, and CBTI. Blinded assessments were performed at baseline, posttreatment, and six-month follow-up. RESULTS: CBTI produced moderate-to-large reductions in depressive symptoms, whereas SRT produced moderate reductions but not until six months posttreatment. Treatment effects on maladaptive thinking were mixed. CBTI and SRT both produced large improvements in dysfunctional beliefs about sleep, but weaker influences on presleep cognitive arousal, rumination, and worry. Presleep somatic arousal greatly improved in the CBTI group and moderately improved in the SRT group. Improvements in depression, maladaptive thinking, and hyperarousal were linked to improved sleep. SHE produced no durable treatment effects. CONCLUSIONS: CBTI and SRT reduce depressive symptoms, dysfunctional beliefs about sleep, and presleep somatic hyperarousal in postmenopausal women, with CBTI producing superior results. Despite its cognitive emphasis, cognitive arousal did not respond strongly or durably to CBTI. NAME: Behavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov. REGISTRATION: NCT01933295.

Hyperarousal and sleep reactivity in insomnia: current insights.

Hyperarousal is a key component in all modern etiological models of insomnia disorder. Overall patterns in the literature suggest that over-active neurobiological and psychological systems contribute to difficulty sleeping. Even so, mixed results regarding the specific mechanisms linking hyperarousal to sleep disturbance limit current etiological conceptualizations. Similar basal arousal profiles between individuals with high vs low risk for insomnia in the absence of stress exposure suggest that dysregulated stress "response" rather than general hyperarousal may be a more pertinent marker of risk. In this report, we discuss evidence for hyperarousal in insomnia and explore the role of sleep reactivity. A trait characteristic, sleep reactivity is the degree to which stress disrupts sleep, manifesting as difficulty falling and staying asleep. Premorbid sleep reactivity has been shown to identify individuals at risk for future insomnia disorder, such as highly reactive sleepers (whose sleep systems are sensitive to stress) who are at elevated disease risk. Research points to genetics, family history of insomnia, gender, and environmental stress as factors that influence sleep reactivity. Importantly, stress-related cognitive-emotional reactivity (e.g., rumination, worry) may exploit the vulnerability of a highly reactive sleep system. We propose that sleep reactivity and cognitive-emotional reactivity may share a bidirectional relationship, conferring an insalubrious environment for sleep in response to stress. Future research on sleep reactivity is needed to identify its neurobiology, characterize its relationship with cognitive-emotional reactivity, and explore the potential clinical utility of sleep reactivity in treatment planning.

Using coffee to compensate for poor sleep: Impact on vigilance and implications for workplace performance.

Poor sleep negatively impacts vigilance and is associated with reduced well-being and work productivity. While many individuals depend on caffeine to counteract the cognitive consequences of poor sleep and restore optimal work performance, few studies have naturalistically evaluated this strategy. This study examined the effects of coffee on vigilance, comparing individuals based on recent sleep quality. Sixty-nine participants completed two randomized, counterbalanced trials consisting of 237 ml water or coffee (100 mg caffeine), followed by a continuous performance test assessing vigilance at 30, 90, and 120 min. While coffee improved and stabilized reaction time at all three assessments regardless of recent sleep history, its effects on omission and commission errors were seen only at 90 min; coffee increased commission errors and only partially reduced omission errors in individuals reporting poor sleep quality. The use of coffee to combat poor sleep may therefore be detrimental in situations requiring inhibitory control.

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders.

Sleep reactivity is the trait-like degree to which stress exposure disrupts sleep, resulting in difficulty falling and staying asleep. Individuals with highly reactive sleep systems experience drastic deterioration of sleep when stressed, whereas those with low sleep reactivity proceed largely unperturbed during stress. Research shows that genetics, familial history of insomnia, female gender and environmental stress influence how the sleep system responds to stress. Further work has identified neurobiological underpinnings for sleep reactivity involving disrupted cortical networks and dysregulation in the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Sleep reactivity is most pathologically and clinically pertinent when in excess, such that high sleep reactivity predicts risk for future insomnia disorder, with early evidence suggesting high sleep reactivity corresponds to severe insomnia phenotypes (sleep onset insomnia and short sleep insomnia). High sleep reactivity is also linked to risk of shift-work disorder, depression and anxiety. Importantly, stress-related worry and rumination may exploit sensitive sleep systems, thereby augmenting the pathogenicity of sleep reactivity. With the development of cost-effective assessment of sleep reactivity, we can now identify individuals at risk of future insomnia, shift-work disorder and mental illness, thus identifying a target population for preventive intervention. Given that insomniacs with high sleep reactivity tend to present with severe insomnia phenotypes, patient sleep reactivity may inform triaging to different levels of treatment. Future research on sleep reactivity is needed to clarify its neurobiology, characterize its long-term prospective associations with insomnia and shift-work disorder phenotypes, and establish its prognostic value for mental illness and other non-sleep disorders.

Lower Aerobic Endurance Linked to History of Depression in Multiple Sclerosis: Preliminary Observations.

BACKGROUND: Despite the demonstrated benefits of exercise in multiple sclerosis (MS), this population shows low rates of physical activity. Understanding barriers to exercise in persons with MS is important. The current study examined the relationship between lifetime history of depression, current depressive symptoms, and aerobic endurance in persons with relapsing-remitting MS to determine whether depression might be one such barrier. METHODS: Thirty-one participants with relapsing-remitting MS self-reported current depressive symptoms and history of depression. Aerobic endurance was assessed via 2-Minute Step Test. RESULTS: Linear regression demonstrated that lifetime history of depression predicted lower aerobic fitness whereas current depressive symptoms did not. CONCLUSIONS: Findings suggest a possible role of lifetime depression as a barrier to exercise in MS and highlight the importance of effective treatment of depression in this population to reduce its potential impact on exercise adherence.

Baseline glucoregulatory function moderates the effect of dairy milk and fruit juice on postprandial cognition in healthy young adults.

PURPOSE: Few studies have examined acute cognitive effects of dairy products. Prior work suggests baseline glucoregulatory function may moderate the relationship between macronutrient profile and postprandial cognition. This study examined the role of glucoregulatory function in postprandial cognition after milk, fruit juice, and a water control. We hypothesized juice would improve cognition in those with lower fasting glucose, while milk would improve cognition in those with higher fasting glucose. DESIGN: 86 non-diabetic, non-hypoglycemic young adults attended three 8 AM testing sessions after fasting overnight. Fasting glucose was assessed via fingerstick at each session. Participants consumed 8 oz of 1% milk (12 g carbohydrates), apple juice (29 g carbohydrates), or water in a randomized, counterbalanced order, and completed repeatable standard and running memory continuous performance (SCPT-vigilance; RMCPT-working memory) and go/no-go (GNG-inhibitory control) tasks 30, 90, and 120 min post-ingestion. RESULTS: Participants with fasting glucose above 107.69 mg/dL made significantly fewer GNG commission errors overall after milk versus water, while the converse was observed when fasting glucose was below 70.85 mg/dL (p = 0.003). At 30 min, participants with fasting glucose above 105.80 mg/dL made significantly more RMCPT correct responses per minute after milk versus juice, while the opposite occurred when fasting glucose was below 76.85 mg/dL (p = 0.006). For both tasks, differences greatened as fasting glucose increased or decreased beyond these upper and lower bounds, respectively. CONCLUSIONS: Consideration of baseline glucoregulatory function is crucial when assessing postprandial cognition, even in non-diabetic and non-hypoglycemic samples. Dairy milk may improve cognition in persons with higher fasting glucose.

A preliminary examination of gut microbiota, sleep, and cognitive flexibility in healthy older adults.

OBJECTIVES: Inadequate sleep increases the risk for age-related cognitive decline and recent work suggests a possible role of the gut microbiota in this phenomenon. Partial sleep deprivation alters the human gut microbiome, and its composition is associated with cognitive flexibility in animal models. Given these findings, we examined the possible relationship among the gut microbiome, sleep quality, and cognitive flexibility in a sample of healthy older adults. METHODS: Thirty-seven participants (age 64.59 ± 7.54 years) provided a stool sample for gut microbial sequencing and completed the Pittsburgh Sleep Quality Index and Stroop Color Word Test as part of a larger project. RESULTS: Better sleep quality was associated with better Stroop performance and higher proportions of the gut microbial phyla Verrucomicrobia and Lentisphaerae. Stroop Word and Color-Word performance correlated with higher proportions of Verrucomicrobia and Lentisphaerae. Partial correlations suggested that the relationship between Lentisphaerae and Stroop Color-Word performance was better accounted for by sleep quality; sleep quality remained a significant predictor of Color-Word performance, independent of the Lentisphaerae proportion, while the relationship between Lentisphaerae and Stroop performance was non-significant. Verrucomicrobia and sleep quality were not associated with Stroop Word performance independent of one another. CONCLUSIONS: The current findings suggest a possible relationship among sleep quality, composition of the gut microbiome, and cognitive flexibility in healthy older adults. Prospective and experimental studies are needed to confirm these findings and determine whether improving microbiome health may buffer against sleep-related cognitive decline in older adults.

The Moderating Role of Insulin-Like Growth Factor 1 in the Relationship Between Cognitive and Aerobic Endurance Change.

BACKGROUND: Improvements in cognition often accompany fitness improvements in older adults, and research suggests insulin-like growth factor 1 (IGF-1) may influence this association. No prior work has examined this in mild cognitive impairment (MCI). We predicted that IGF-1 would moderate the relationship between cognition and aerobic endurance improvement, such that greater baseline IGF-1 would accompany a stronger relationship between cognition and aerobic endurance change. METHOD: Twenty-seven individuals with MCI completed assessments of aerobic endurance (2-minute step test [2MST]) and global cognition (Modified Mini-Mental State [3MS]) before and after a 6-month period of twice-weekly exercise. Serum IGF-1 levels were assessed at baseline via fasted blood draw. The Johnson-Neyman technique determined whether baseline IGF-1 levels moderated the relationship between changes in aerobic endurance (Δ2MST) and cognition (Δ3MS). RESULTS: A significant interaction was found; however, Δ2MST was inversely associated with Δ3MS in individuals with above-average serum IGF-1 levels; this relationship was strengthened as IGF-1 increased and was not seen when IGF-1 was below average. CONCLUSION: The relationship between cognitive and aerobic endurance change varies as a function of IGF-1 in persons with MCI. Additional work is needed to clarify the mechanisms of these findings.

Delirium Detection and Impact of Comorbid Health Conditions in a Post-Acute Rehabilitation Hospital Setting.

Misdiagnosis and under-detection of delirium may occur in many medical settings. This is important to address as delirium clearly increases risk of morbidity and mortality in such settings. This study assessed whether Veterans who screened positive on a delirium severity measure (Memorial Delirium Assessment Scale; MDAS) differed from those with and without corresponding medical documentation of delirium in terms of cognitive functioning, psychiatric/medical history, and medication use. A medical record review of 266 inpatients at a VA post-acute rehabilitation unit found that 10.9% were identified as delirious according to the MDAS and/or medical records. Of the Veterans who screened positive on the MDAS (N = 19), 68.4% went undetected by medical screening. Undetected cases had a higher number of comorbid medical conditions as measured by the Age-Adjusted Charlson Index (AACI) scores (median = 9, SD = 3.15; U = 5.5, p = .003) than medically documented cases. For Veterans with a score of 7 or greater on the AACI, the general relative risk for delirium was 4.46. Delirium is frequently under-detected in a post-acute rehabilitation unit, particularly for Veterans with high comorbid illness. The relative risk of delirium is up to 4.46 for those with high medical burden, suggesting the need for more comprehensive delirium screening in these patients.

Sleep system sensitization: evidence for changing roles of etiological factors in insomnia.

OBJECTIVES: To test for sensitization of the sleep system in response to insomnia development and major life stress. In addition, to evaluate the impact on depression and anxiety associated with sleep system sensitization. METHODS: A longitudinal study with three annual assessments. The community-based sample included 262 adults with no history of insomnia or depression who developed insomnia one year after baseline (67.6% female; 44.0 ± 13.4 yr). Measures included the Ford Insomnia Response to Stress Test to assess sleep reactivity, Quick Inventory of Depressive Symptomatology, and Beck Anxiety Inventory. Insomnia classification was based on DSM-IV criteria. Sleep system sensitization was operationally defined as significant increases in sleep reactivity. RESULTS: Sensitization of the sleep system was observed from baseline to insomnia onset at 1-yr follow-up among insomniacs with low premorbid vulnerability (p < 0.001), resulting in 68.3% of these individuals re-classified as highly sleep reactive. Major life stress was associated with greater sleep system sensitization (p = 0.02). Results showed that sleep reactivity at 2-yr follow-up remained elevated among those with low premorbid vulnerability, even after insomnia remission (p < 0.01). Finally, analyses revealed that increases in sleep reactivity predicted greater depression (p < 0.001) and anxiety (p < 0.001) at insomnia onset. The impact of sensitization on depression was stable at 2-yr follow-up (p = 0.01). CONCLUSIONS: Evidence supports sensitization of the sleep system as a consequence of insomnia development and major life stress among individuals with low premorbid sleep reactivity. Sleep system sensitization may serve as a mechanism by which insomnia is perpetuated. Harmful effects of the sensitization process may increase risk for insomnia-related depression and anxiety.

The Anxiolytic Effects of Cognitive Behavior Therapy for Insomnia: Preliminary Results from a Web-delivered Protocol.

Though the efficacy of cognitive behavior therapy for insomnia (CBTI) is well-established, the paucity of credentialed providers hinders widespread access. Further, the impact of alternatives such as web-delivered CBTI has not been adequately tested on common insomnia comorbidities such as anxiety. Therefore, we assessed the impact of an empirically validated web-delivered CBTI intervention on insomnia and comorbid anxiety symptoms. A sample of 22 adults (49.8±13.5 yo; 62.5% female) with DSM-5 based insomnia were randomized to either an active CBTI treatment group (n = 13) or an information-control (IC) group (n = 9). Participants in the CBTI group underwent a standard CBTI program delivered online by a 'virtual' therapist, whereas the IC group received weekly 'sleep tips' and general sleep hygiene education via electronic mail. All participants self-reported sleep parameters, including sleep onset latency (SOL), insomnia symptoms per the Insomnia Severity Index (ISI), and anxiety symptoms per the Beck Anxiety Inventory (BAI) at both baseline as well as follow- up assessment one week post-treatment. There were no significant differences between the CBTI and IC groups on baseline measures. The CBTI group showed significantly larger reductions in BAI scores (t = 2.6; p < .05; Cohen's d = .8) and ISI scores (t = 2.1; p < .05; Cohen's d = .9) at follow-up than did the IC group. Further, changes in SOL from baseline (62.3±44.0 minutes) to follow-up (22.3±14.4 minutes) in the CBTI group were also significantly greater (t = 2.3; p < .05; Cohen's d = .9) than in the IC group (baseline: 55.0±44.2 minutes; follow-up: 50.±60.2 minutes). This study offers preliminary evidence that a web-delivered CBTI protocol with minimal patient contact can improve comorbid anxiety symptoms among individuals with insomnia.