MoCA Domain-Specific Pattern of Cognitive Impairment in Stroke Patients Attending Intensive Inpatient Rehabilitation: A Prospective Study.

A domain-specific perspective to cognitive functioning in stroke patients may predict their cognitive recovery over time and target stroke rehabilitation intervention. However, data about domain-specific cognitive impairment after stroke are still scarce. This study prospectively investigated the domain-specific pattern of cognitive impairments, using the classification proposed by the Montreal Cognitive Assessment (MoCA), in a cohort of 49 stroke patients at admission (T0), discharge (T1), and six-month follow-up (T2) from subacute intensive rehabilitation. The predictive value of T0 cognitive domains cognitive impairment at T1 and T2 was also investigated. Patients' cognitive functioning at T0, T1, and T2 was assessed through the MoCA domains for executive functioning, attention, language, visuospatial, orientation, and memory. Different evolutionary trends of cognitive domain impairments emerged across time-points. Patients' impairments in all domains decreased from T0 to T1. Attention and executive impairments decreased from T0 to T2 (42.9% and 26.5% to 10.2% and 18.4%, respectively). Conversely, altered visuospatial, language, and orientation increased between T1 and T2 (16.3%, 36.7%, and 40.8%, respectively). Additionally, patients' global cognitive functioning at T1 was predicted by the language and executive domains in a subacute phase (p = 0.031 and p = 0.001, respectively), while in the long term, only attention (p = 0.043) and executive (p = 0.019) domains intervened. Overall, these results confirm the importance of a domain-specific approach to target cognitive recovery across time in stroke patients.

False memories formation after a retention period spent asleep or awake in individuals with insomnia and good sleepers: a polysomnographic study.

False memories are a possible by-product of sleep-related memory consolidation processes when delayed testing is performed after a retention interval spent asleep. To date, the effect of a retention period spent asleep or awake on false memories formation has been addressed only in healthy subjects, while neglecting sleep-disordered populations. In the present study, we investigated this effect in 17 insomniacs and 15 good sleepers through the Deese-Roediger-McDermott paradigm. In both groups, the encoding phase was followed by an 8-h retention period spent in polysomnography monitored sleep (S-condition) or wake (WK-condition). We observed that, at free recall, insomniacs produced more false recalls in the WK-condition compared to the S-condition, whereas the good sleepers showed more false recalls in S-condition than in the WK-condition. Moreover, false recalls were higher in good sleepers than in insomniacs in the S-condition. Both groups produced more veridical recalls in the S-condition than in the WK-condition. For recognition, hits (correctly recognised words) were more numerous in the S-condition than in the WK-condition. Our results confirm previous data on sleep-related false memories production in good sleepers. Additionally, they show that, in insomniacs, false memories production is reduced after a sleep relative to remaining awake. These data suggest that false memories formation, reflecting adaptive memory reshaping processes going on during sleep, could occur at awakening as long as the sleep episode is efficient enough. A notable methodological issue was also identified, in that the Deese-Roediger-McDermott paradigm can be useful to investigate sleep-dependent memory processes for false memories only when a more cognitively demanding task is employed (i.e., free-recall instead of recognition tasks).

Habitual Videogame Playing Does Not Compromise Subjective Sleep Quality and Is Associated with Improved Daytime Functioning.

Research on the effects of videogames (VGs) on health has produced mixed results. Here, we assess the relationships of VG playing with sleep; chronotype; sleepiness; and levels of depression, anxiety, and stress; and how they are modulated by the level of exposure to VGs. Four hundred-and two adult participants (age = 26.2 ± 7.84; 227 F) completed an online survey including questions on VG use and a set of standardized questionnaires. The sample was divided into three groups: habitual gamers (HGs, 42.2%), nonhabitual gamers (NHGs, 36.5%), and non-gamers (NGs, 21.3%). No between-group differences emerged in sleepiness (Epworth Sleepiness Scale) or Pittsburgh Sleep Quality Index measures except the sleep disturbances subscore, which was higher in NHGs. HGs showed delayed bed- and risetimes and higher eveningness (reduced Morningness-Eveningness Questionnaire). HGs and NHGs showed higher depression subscores (Depression Anxiety Stress Scale) but remained in the subclinical range. Moreover, hours/week of VG playing predicted delayed sleep timing, lower daytime dysfunction, and lower sleepiness. Our data suggest that VG playing does not necessarily compromise sleep quality and may even benefit daytime functioning, underlining the need to reconsider the relationships between VG use and health by taking into account possible modulating factors such as habitual VG exposure.

Sleep Continuity, Stability and Cyclic Organization Are Impaired in Insomniacs: A Case-Control Study.

The possibility of distinguishing insomniacs from good sleepers based on polysomnography (PSG) remains an open question. While these groups show modest differences in traditional PSG parameters, some studies suggest that finer measures may be more useful. Here we assess differences between good sleepers (GS), poor sleepers (PS) and insomniacs (IN) in classical PSG measures as well as in sleep continuity, stability and cyclic organization. PSG-monitored sleep (two nights) of 17 IN (diagnosed through a standard clinical interview; Pittsburgh Sleep Quality Index (PSQI) ≥ 5, Insomnia Severity Index (ISI) > 14) was compared to that of 33 GS (PSQI < 5) and 20 PS (PSQI ≥ 5, ISI ≤ 14). Compared to GS, IN were impaired in sleep macrostructure (sleep latency, sleep efficiency, WASO%) and in continuity, stability and organization, whereas PS only showed disrupted continuity and stability. Spindle parameters were comparable between IN and GS, but the former displayed enhanced power in fast frequency bands. Our findings support the hypothesis of a continuum between individuals with self-reported poor sleep and insomniacs. Further, they add to extant data on impaired sleep continuity, stability and organization in poor sleepers and elderly individuals, underlining the utility of including these measures in standard sleep assessments.

False memories formation is increased in individuals with insomnia.

Previous studies suggest that sleep can influence false memories formation. Specifically, acute sleep loss has been shown to promote false memories production by impairing memory retrieval at subsequent testing. Surprisingly, the relationship between sleep and false memories has only been investigated in healthy subjects but not in individuals with insomnia, whose sleep is objectively impaired compared to healthy subjects. Indeed, this population shows several cognitive impairments involving prefrontal functioning that could affect source monitoring processes and contribute to false memories generation. Moreover, it has been previously reported that subjects with insomnia differentially process sleep-related versus neutral stimuli. Therefore, the aim of the present study was to compare false memories production between individuals with insomnia symptoms and good sleepers, and to evaluate the possible influence of stimulus category (neutral versus sleep-related) in the two groups. The results show that false memories are globally increased in participants reporting insomnia symptoms compared to good sleepers. A reduction in source monitoring ability was also observed in the former group, suggesting that an impairment of this executive function could be especially involved in false memories formation. Moreover, our data seem to confirm that false memories production in individuals with insomnia symptoms appears significantly modulated by stimulus category.

Changes in dream features across the first and second waves of the Covid-19 pandemic.

Research during the Covid-19 pandemic has highlighted its significant impact on dreaming. Here we address changes in dream features both during the first wave, when the Italian government imposed a total lockdown, and the second wave (autumn 2020), when a partial lockdown was effected. In April 2020 (total lockdown), 1,622 participants (Mage  = 34.1 ± 13.6 years; 1171F) completed an online survey including the Pittsburgh Sleep Quality Index and a set of questions on dream features and their possible changes relative to the month preceding the lockdown (pre-total lockdown). In November 2020 (partial lockdown), 214 participants (Mage  = 36.78 ± 14.2 years; 159F) from the previous sample completed the same survey. Approximately half of the subjects reported increased or decreased dream frequency (30.5% and 21.8%), length (27.1% and 15.8%) and vividness (31.5% and 17.1%) during total lockdown as well as during partial lockdown (frequency: 30.3% and 13.5%; length: 23.3% and 12.6%; vividness: 31.6% and 24.1%). Dream affect became significantly more negative in total lockdown relative to pre-total lockdown and in partial lockdown relative to pre-partial lockdown (both p < .001). Both in total lockdown and partial lockdown, increased negative dream emotionality significantly predicted changes in dream frequency, length and vividness, and was significantly predicted, in turn, by worsened sleep quality. Our data confirm that dream features are significantly affected by major life changes such as those imposed by a pandemic. The fact that between lockdowns negative dream affect returned almost to baseline level suggests that dream emotionality is closely related to lifestyle and wake-time emotional changes. Also, our findings point to a modulating role of sleep quality on dream emotionality.

High sleep fragmentation parallels poor subjective sleep quality during the third wave of the Covid-19 pandemic: An actigraphic study.

Studies on sleep during the Covid-19 pandemic have mostly been conducted during the first wave of contagion (spring 2020). To follow up on two Italian studies addressing subjective sleep features during the second wave (autumn 2020), here we assess sleep during the third wave (spring 2021) in a sample of healthy adults from Campania (Southern Italy). Actigraphic data (on 2 nights) and the Pittsburgh Sleep Quality Index were collected from 82 participants (40 F, mean age: 32.5 ± 11.5 years) from 11 March to 18 April 2021, when Campania was classified as a "red zone", i.e. it was subjected to strict restrictions, only slightly looser than those characterizing the first national lockdown (spring 2020). Although objective sleep duration and architecture appeared in the normal range, the presence of disrupted sleep was indexed by a relevant degree of sleep fragmentation (number of awakenings ≥ 1 min: 12.7 ± 6.12; number of awakenings ≥ 5 min: 3.04 ± 1.52), paralleled by poor subjective sleep quality (Pittsburgh Sleep Quality Index global score: 5.77 ± 2.58). These data suggest that the relevant subjective sleep impairments reported during the first wave could have relied on subtle sleep disruptions that were undetected by the few objective sleep studies from the same period. Taken together with sleep data on previous phases of the pandemic, our findings show that the detrimental effects on sleep determined by the initial pandemic outbreak have not abated across the subsequent waves of contagion, and highlight the need for interventions addressing sleep health in global emergencies.

Dissociated profiles of sleep timing and sleep quality changes across the first and second wave of the COVID-19 pandemic.

Previous work showed a significant impact of the COVID-19 pandemic on Italians' sleep both during the first wave, when a total lockdown (TL) was imposed, and during the second wave, when a partial lockdown (PL) was mandated (autumn 2020). Here we complement these data by describing the profile of sleep across four time-points: the first and second lockdown (TL, PL) and the months preceding them (pre-TL, pre-PL). An online survey was completed by 214 participants (Mage = 36.78 ± 14.2 y; 159 F) during TL and again during PL. All sleep-related questions (including items of the Pittsburgh Sleep Quality Index) required a double answer, one referred to the current lockdown and one to the month preceding the lockdown. Bedtime and rise time were delayed in TL and then advanced in pre-PL and PL. Similarly, time in bed increased in TL and then decreased in pre-PL and PL. Sleep quality worsened in the two lockdowns compared to the preceding periods and the proportion of poor sleepers correspondingly increased in both lockdowns. Sleep habits and quality displayed different profiles across phases of the pandemic. Sleep timing was altered during the first lockdown and then returned towards baseline (likely due to normalized working schedules). Instead, sleep quality, which markedly worsened during both lockdowns, appears particularly sensitive to changes in life habits and psychological factors, independently of sleep habits. Our findings also point to a possible role of acute and chronic stress (experienced during the first and second wave, respectively) in modulating sleep changes across the pandemic waves.

The Effects of the COVID19-Related Lockdown Are Modulated by Age: An Italian Study in Toddlers and Pre-Schoolers.

Although the issue has been repeatedly explored, data on the impact of the COVID-19 pandemic on children's sleep quality are inconsistent. To clarify these discrepancies, here we investigate possible age-related differences. During the lockdown, 112 parents of toddlers (0-3 years, N = 61) and pre-schoolers (4-5 years, n = 51) completed an online survey including the Children's Sleep Habits Questionnaire (CSHQ). Sleep-related items required an additional retrospective judgment, referring to the pre-pandemic period. During the lockdown, sleep schedules were delayed in both age groups whereas sleep quality (CSHQ total scores) improved in pre-schoolers but not in toddlers. Between-groups comparisons revealed that, prior to the lockdown, pre-schoolers showed worse sleep quality than toddlers, whereas this difference disappeared during home confinement. Also, pre-schoolers' sleep timing was advanced before the lockdown and delayed during the lockdown relative to toddlers'. Our data highlight a significant modulation of age on the impact of the pandemic crisis on sleep, with pre-schoolers experiencing greater effects than toddlers. This profile suggests that factors affecting sleep features have different weights at different ages: sleep patterns would be mainly determined by developmental factors (i.e., biological drive) in younger children, whereas environmental factors (e.g., major lifestyle changes) would have a stronger effect on older ones.

The Effects of Sleep Quality on Dream and Waking Emotions.

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into waking and dream emotional experience remains unclear. We have previously described a discontinuity between wakefulness and dreaming, with a prevalence of positive emotions in wakefulness and negative emotions during sleep. Here we aim to investigate whether this profile may be affected by poor sleep quality. Twenty-three 'Good Sleepers' (GS) and 27 'Poor Sleepers' (PS), identified through the Pittsburgh Sleep Quality Index (PSQI) cut-off score, completed three forms of the modified Differential Emotions Scale, assessing, respectively, the frequency of 22 emotions over the past 2 weeks, their intensity during dreaming and during the previous day. The ANOVA revealed a different pattern of emotionality between groups: GS showed high positive emotionality in wakefulness (both past 2 weeks and 24 h) with a significant shift to negative emotionality in dreams, while PS showed evenly distributed emotional valence across all three conditions. No significant regression model emerged between waking and dream affect. In the frame of recent hypotheses on the role of dreaming in emotion regulation, our findings suggest that the different day/night expression of emotions between groups depends on a relative impairment of sleep-related processes of affect regulation in poor sleepers. Moreover, these results highlight the importance of including sleep quality assessments in future dream studies.

Changes in sleep timing and subjective sleep quality during the COVID-19 lockdown in Italy and Belgium: age, gender and working status as modulating factors.

Italy and Belgium have been among the first western countries to face the Coronavirus disease 2019 (COVID-19) emergency, imposing a total lockdown over the entire national territories. These limitations have proven effective in slowing down the spread of the infection. However, the benefits obtained in public health have come with huge costs in terms of social, economic, and psychological well-being. In the current study, we aimed to investigate how the period of home confinement affected self-reported sleep characteristics in Italians and Belgians, with special regard to sleep timing and subjective quality. Using an online survey we collected data from 2272 participants, 1622 Italians (Mage = 34.1 ± 13.6 years, 1171 F), and 650 Belgian (Mage = 43.0 ± 16.8 years, 509 F). Participants reported their sleep pattern (eg, bedtime, risetime) and perceived sleep quality during and, retrospectively, before the lockdown. During the lockdown, sleep timing was significantly delayed, time spent in bed increased, and sleep quality was markedly impaired in both Italians and Belgians. The most vulnerable individuals appeared to be women, subjects experiencing a more negative mood, and those perceiving the pandemic situation as highly stressful. However, the two samples differed in the subgroups most affected by the changes, possibly because of the different welfare systems of the two countries. In fact, in the Italian sample sleep quality and timing underwent significant modifications especially in unemployed participants, whereas in the Belgian sample this category was the one who suffered less from the restrictions. Considering that the novel coronavirus has spread across the whole globe, involving countries with different types of health and welfare systems, understanding which policy measures have the most effective protective role on physical and mental health is of primary importance.

Sleep continuity, stability and organization in good and bad sleepers.

The relationship between objective and subjective sleep quality is still debated. Here, we investigate differences in objective sleep parameters in habitual subjective good sleepers and bad sleepers with the aim of evaluating sleep continuity, stability and organization as possible determinants of subjective sleep quality. In total, 38 subjects (good sleepers, N = 18; bad sleepers, N = 20) underwent two nights of sleep recording. Traditional sleep parameters displayed no between-groups differences. Conversely, bad sleepers showed lower sleep continuity (awakenings frequency), stability (e.g. arousals and state transitions frequency) and organization (e.g. number of sleep cycles and time spent in cycles). Our findings point to the involvement of these measures in determining habitual sleep quality perception and suggest the possibility to include them in standard sleep assessments.

Learning Monologues at Bedtime Improves Sleep Quality in Actors and Non-Actors.

Several studies show that pre-sleep learning determines changes in subsequent sleep, including improvements of sleep quality. Our aims were to confirm this finding using a more ecological task (learning a theatrical monologue) and to investigate whether the effect is modulated by expertise. Using a mixed design, we compared polysomnographic recordings of baseline sleep (BL, 9-h TIB) to those of post-training sleep (TR, with the same TIB but preceded by the training session), in one group of actors (N = 11) and one of non-actors (N = 11). In both groups, TR appears reorganized and re-compacted by the learning session, as shown, among others, by a significant decrease of WASO%, awakenings, arousals, and state transitions and by a trend towards an increased number of complete cycles and total cycle time. Concerning memory performance, the number of synonyms produced was significantly higher in the morning relative to immediate recall. No between-groups differences emerged either for sleep or memory variables. Our data confirm pre-sleep learning's beneficial effect on sleep quality in an ecological context. While expertise appears not to influence memory-related sleep mechanisms, results on morning recall support the recent view that sleep's role in memory processes consists in trace "transformation" for adaptive purposes, rather than rote consolidation.

Prevalence and Determinants of Bad Sleep Perception among Italian Children and Adolescents.

Although sleep problems at young ages are well investigated, the prevalence of bad sleepers and the determinants of sleep quality perception remain unexplored in these populations. For this purpose, we addressed these issues in a sample of children (n = 307), preadolescents (n = 717), and adolescents (n = 406) who completed the School Sleep Habits Survey, addressing sleep quality perception, sleep habits, sleep features, daytime behavior and sleep disturbances, circadian preference, and dreaming. The sample was split in "good sleepers" and "bad sleepers", based on the answer to the question item assessing overall subjective sleep quality. Being a bad sleeper was reported by 11.7% of the sample, with significant between-groups differences (children: 8.3%; preadolescents: 11.3%; adolescents: 15.3%; p = 0.01). At all ages, relative to good sleepers, bad sleepers showed higher eveningness, sleepiness, and depression, longer sleep latency, more frequent insufficient sleep, nocturnal awakenings, sleep-wake behavioral problems, and unpleasant dreams (all p's ≤ 0.01). Sleep quality perception was predicted: in children, by depressed mood, eveningness, and unpleasant dreams (all p's ≤ 0.01); in preadolescents, by sleep latency, awakening frequency, depressed mood, sufficiency of sleep, and unpleasant dreams (all p's < 0.01); in adolescents, by awakening frequency, depressed mood, and sufficiency of sleep (all p's < 0.001). In children, bad subjective sleep quality appears to be mainly determined by daytime psychological features, for example, depressed mood, whereas at later ages, sleep characteristics, such as frequent awakenings, add to the former determinants. This could depend on (a) the appearance, with increasing age, of objective sleep modifications and (b) a greater attention paid by adolescents to their sleep characteristics.

Relationships between Dream and Previous Wake Emotions Assessed through the Italian Modified Differential Emotions Scale.

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into wake and dream emotional experience remains unclear. Here, we aimed to assess dream emotions and their relationships with wake emotions through the modified Differential Emotions Scale (Fredrickson, 2003), which includes a broad array of both positive and negative emotions. The scale has been first validated on 212 healthy Italian participants, in two versions: a WAKE-2wks form, assessing the frequency of 22 emotions over the past 2 weeks, and a WAKE-24hr form, assessing their intensity over the past 24 h. Fifty volunteers from the wider sample completed the WAKE-24hr mDES for several days until a dream was recalled, and dream emotions were self-reported using the same scale. A bifactorial structure was confirmed for both mDES forms, which also showed good validity and reliability. Though Positive and Negative Affect (average intensity of positive and negative items, PA, and NA, respectively) were balanced in dreams, specific negative emotions prevailed; rmANOVA showed a different pattern (prevalence of PA and positive emotions) in wake (both WAKE-2wks and WAKE-24hr), with a decrease of PA and an increase of NA in the dream compared to previous wake. No significant regression model emerged between waking and dream affect, and exploratory analyses revealed a stable proportion of PA and NA (with prevailing PA) over the 3 days preceding the dream. Our findings highlight a discontinuity between wake and dream affect and suggest that positive and negative emotions experienced during wake may undertake distinct sleep-related regulation pathways.

The effect of complex cognitive training on subsequent night sleep.

Using a nap design, we have recently shown that training at a complex cognitive task at bedtime improves objective sleep quality by reducing sleep fragmentation. In order to extend our findings to nighttime sleep, here we assess the impact of a multi-componential cognitive task at bedtime on the subsequent sleep episode of subjects reporting habitual bad sleep, allegedly characterized by high sleep fragmentation. In a within-subjects design, 20 subjective bad sleepers underwent polysomnographic recording in three conditions: (a) baseline sleep (BL); (b) post-training sleep (TR), preceded by a complex ecological task, i.e. a modified version of the word game Ruzzle; (c) post-active control sleep (AC), preceded by a control task. Sleep in TR was more organized (higher number of cycles and longer time spent in cycles) and showed lower microarousal frequency than in AC and BL. As for sleep continuity (total and brief awakening frequency) and other stability measures (state transition and functional uncertainty period frequency, time in functional uncertainty), both TR and AC showed significant improvements compared with BL. Arousal frequency was also reduced in TR relative to BL. Our results show a clear impact of cognitive training on subsequent night sleep, basically consisting of an increase in sleep continuity, stability and organization. In our sample of bad sleepers, these post-training changes end up representing a notable sleep improvement, also consistently reflected in subjective sleep quality perception. Therefore, ecological pre-sleep cognitive training should be further studied as an easily accessible complementary approach in standard therapies for sleep-disordered populations.