Abstract Details

Title Nighttime Behavior in Cognitively Intact Patients with Pathologically Confirmed AD Are Associated with Rapid Cognitive Decline

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) S23 - Aging and Dementia: Biomarkers and Clinical Trials (5:18 PM-5:30 PM)

Poster/Presentation
Number 010

Objective To determine the association of sleep disturbances at baseline with the rate of cognitive deterioration in cognitively intact subjects with autopsy-confirmed Alzheimer’s disease (AD) neuropathology.

Background The temporal relationship between sleep disturbances, AD pathology, and related cognitive impairment remains controversial.

Design/Methods The National Alzheimer’s Disease Coordinating Center (NACC) datasets were used to compare the rate of cognitive decline between subjects with [(+)NTB] or without [(-)NTB] nighttime behaviors (NTB) at baseline as assessed by the Neuropsychiatric Inventory Questionnaire Quick Version (NPI-Q). Cognitive impairment was determined by the Mini-Mental Status Examination (MMSE) total score. Included subjects had an initial MMSE score ≥ 24 at the first NACC clinical visit indicative of absent cognitive impairment at baseline, and also had MMSE scores available at follow-up visits. The rate of cognitive decline was determined based on the individual’s annual MMSE score change over the total clinical visits made. All subjects had primary neuropathologic diagnosis of Alzheimer’s pathology as determined by both high CERAD score and Braak stage.

Results 404 subjects from the NACC dataset were included. In subjects with autopsy-confirmed AD pathology with no initial cognitive impairment, the rate of cognitive decline was greater in (+)NTB compared to (-)NTB (p = 0.016). This significant difference was restricted to APOE e4 carriers (p = 0.049), subjects with cerebral amyloid angiopathy (p = 0.020), and subjects with additional ischemic, hemorrhagic or vascular pathology (p = 0.015). There was no difference between (+)NTB and (-)NTB in the prevalence of factors that determine the rate of cognitive decline, suggesting that NTB itself is responsible for the effect observed.

Conclusions NPI-Q assessed nighttime behaviors, a surrogate for sleep disturbances, are associated with more rapidly declining cognition in subjects with Alzheimer’s neuropathology. In addition, this relationship is enhanced in carriers of APOE e4, cerebral amyloid angiopathy, or vascular pathology.

Authors/Disclosures
Adrienne L. Atayde (St. Michael's Hospital) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
David G. Munoz, MD (University of Toronto)	No disclosure on file

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