Sleep and aging

The goal of this article is to focus on some aspects that the authors consider relevant for clinical practice and for defining a future research agenda and not so much to give a complete review on all aspects of sleep and aging. The world population is aging, and the aging population is rapidly changing. There are important differences among younger-old and older-old persons, with sex specificity. New lifestyles, work, and familial and social habits can alter circadian rhythms, even in elderly persons. In the last 2 decades, sleep deficiency and hypersomnolence became important concerns of everyday life. These problems are having a “human impact” (), a relatively new concept that is a synthesis between health and social impact. This concept can be applicable to problems such as the environment and climate and can be used to develop programs and decisions on human health and welfare. In aging, “subjective” and “objective” sleep characteristics show several differences between men and women. Such aspects need to be deeply investigated for tailoring diagnostic and therapeutic interventions according to sex and gender. Studies have focused on the relationship between sleep and the preclinical phases of neurodegenerative diseases and dementia. Sleep disturbances may be present at the earliest stages of neurodegeneration or neuroinflammation: growing epidemiological data have demonstrated that sleep disturbances can be considered a risk factor for dementia. Greater attention to sleep since midlife and among older adults can offer new opportunities for multidomain interventions for the prevention of neurodegenerative disorders and other chronic conditions

PAP use in mild cognitive impairment to delay progression to dementia

No abstract availabl

Assessing neuro-motor recovery in a stroke survivor with high-resolution EEG, robotics and Virtual Reality

One post-stroke patient underwent neuro-motor rehabilitation of one upper limb with a novel system combining a passive robotic device, Virtual Reality training applications and high resolution electroencephalography (HR-EEG). The outcome of the clinical tests and the evaluation of the kinematic parameters recorded with the robotic device concurred to highlight an improved motor recovery of the impaired limb despite the age of the patient, his compromised motor function, and the start of rehabilitation at the 3rd week post stroke. The time frequency and functional source analysis of the HR-EEG signals permitted to quantify the functional changes occurring in the brain in association with the rehabilitation motor tasks, and to highlight the recovery of the neuro-motor function

Sleep-disordered breathing and the risk of Alzheimer's disease

Sleep-disordered breathing is highly prevalent in the elderly population. Obstructive sleep apnea (OSA) represents the most common sleep disorder among the adult and elderly population. Recently, OSA diagnosis has been associated with an increased risk of developing cognitive decline and dementia, including vascular dementia and Alzheimer's disease (AD). Subsequently, there have been studies on AD biomarkers investigating cerebrospinal fluid, blood, neuroimaging, and nuclear medicine biomarkers in patients with OSA. Furthermore, studies have attempted to assess the possible effects of continuous positive airway pressure (CPAP) treatment on the cognitive trajectory and AD biomarkers in patients with OSA. This review summarizes the findings of studies on each AD biomarker (cognitive, biofluid, neuroimaging, and nuclear medicine imaging) in patients with OSA, also accounting for the related effects of CPAP treatment. In addition, the hypothetical model connecting OSA to AD in a bi-directional interplay is analyzed. Finally, the sex-based differences in prevalence and clinical symptoms of OSA between men and women have been investigated in relation to AD risk. Further studies investigating AD biomarkers changes in patients with OSA and the effect of CPAP treatment should be auspicated in future for identifying strategies to prevent the development of AD

Miglior Poster alla prima edizione del congresso All4AD – Alliance for Alzheimer’s disease and other Dementias

I disturbi del sonno sono comuni nei soggetti con demenza di Alzheimer (AD) e a corpi di Lewy (DLB). La loro identificazione, soprattutto del disturbo del comportamento in sonno REM (RBD), criterio core per DLB dal 2017, è importante per il miglioramento dell’accuratezza diagnostica, soprattutto in casi non candidabili ad approfondimenti con biomarcatori. Obiettivo dello studio è la valutazione di pazienti con diagnosi di AD, DLB o incerta tra AD/DLB, affetti da almeno un disturbo del sonno di rilievo clinico e, alla luce dei risultati, l’eventuale rivalutazione della diagnosi del tipo di demenza. Da luglio 2018 sono stati screenati 29 pazienti e 12 (età tra 67 e 84 anni) sono stati sottoposti a due notti di video-polisonnografia (vPSG). All’arruolamento, il 42% aveva una diagnosi di AD, il 25% di DLB e il 33% incerta tra AD/DLB. Il 25% dei soggetti presentava eccessiva sonnolenza diurna, il 58% cattiva qualità di sonno, l'83% alto rischio di apnee in sonno (OSA) e il 75% un possibile RBD. In vPSG sono stati osservati risvegli confusionali in 5 soggetti, PLMD in 7 e OSA in 9. RBD è stato confermato in 10 soggetti e di conseguenza in 2 soggetti precedentemente AD è stata formulata diagnosi di DLB e in 4 soggetti AD/DLB, 3 sono stati diagnosticati DLB e 1 AD. I soggetti con CDR 2 rispetto a quelli con CDR 1 presentavano una diminuzione di sonno REM e fasi di sonno REM "dissociato" (p = .048 e p = .027, rispettivamente). Il sonno delle persone con AD e DLB è molto disturbato, spesso più di un disturbo del sonno è presente e con il progredire della malattia il sonno REM si modifica. La vPSG contribuisce alla diagnosi del tipo di demenza in soggetti non candidabili ad altre indagini di neuroimaging e/o liquorali

REM sleep behavior disorder and other sleep disturbances in Alzheimer's disease, dementia with Lewy bodies and in dementia cases of uncertain classification

Objectives/Introduction: Sleep disorders are common in persons with Alzheimer´s disease (AD) and dementia with Lewy bodies (DLB). Their identification, especially of REM sleep behavior disorder (RBD), a core clinical feature for DLB diagnosis, is an important support to improve diagnostic accuracy between these two types of dementia and optimize therapeutic strategies. Methods: In this ongoing study, consecutive patients with AD, DLB or uncertain diagnosis between AD/DLB and mild-to-moderate dementia severity are screened for sleep disturbances. Recruited patients undergo two consecutive full-night video-polysomnographies (vPSG). Patients diagnosed with moderate to severe obstructive sleep apnea (OSA) after the first vPSG are treated with positive airway pressure (PAP) ventilation during the second vPSG. Results: To date, 31 patients have been screened and 13 recruited (60% men; mean age 77 ± 2 years; 46% Clinical Dementia Rating score [CDR] 1 and 54% CDR 2). At enrollment, 54% had a diagnosis of AD, 23% of DLB and 23% of AD/DLB. 69% of patients complained of poor sleep quality, while only 15% of excessive daytime sleepiness. 77% presented a high risk for OSA, 70% a clinically possible RBD and 38% restless legs syndrome. VPSG analysis confirmed OSA in 9 patients, periodic limb movements in 7 and confusional arousals in 4. 86% of OSA patients used PAP treatment for at least 5 hours during the second vPSG. RBD was confirmed in 10 patients. Based on these findings and according to current DLB diagnostic criteria, 5 patients previously diagnosed with AD and 2 patients AD/DLB were diagnosed with DLB. Moreover, CDR 2 patients presented a decrease in percentage of REM sleep and atypical REM sleep phases (predominant delta activity) as compared to CDR 1 patients (p = 0.048 and p = 0.027, respectively). Conclusions: Our preliminary findings show a high comorbidity of vPSG-confirmed RBD with other primary sleep disorders (OSA in particular) in dementia patients. Both in AD and DLB, with the progression of cognitive decline, standard REM sleep scoring becomes complex. VPSG remains the gold standard for the diagnosis of RBD and its mimics and it is a useful tool for improving dementia diagnostic accuracy

Cholinergic Markers and Cytokines in OSA Patients

The role of inflammation and dysfunction of the cholinergic system in obstructive sleep apnea (OSA) has not exhaustively clarified. Thus, in this study, we explore the non-neuronal cholinergic system and the balance of T helper (Th) 17- and T regulatory (Treg)-related cytokines in OSA patients. The study includes 33 subjects with obstructive sleep apnea and 10 healthy controls (HC). The expression levels of cholinergic system component, RAR-related orphan receptor (RORc), transcription factor forkhead box protein 3 (Foxp3) and cytokines were evaluated. Th17- and Treg-related cytokines, choline levels and acetylcholinesterase (AChE), butyrylcholinesterase (BuChE) activity were quantified in OSA and control subjects. AChE and nicotinic receptor α 7 subunit (α7nAChR) gene expression and serum levels of choline, AChE and BuChE were lower in OSA patients than in the HC group. Compared with the HC group, OSA patients exhibited an increased expression, secretion and serum levels of pro-inflammatory cytokines, a reduced expression, secretion and serum levels of transforming growth factor (TGF)β and reduced Foxp3 mRNA levels. The Th17/Treg-related cytokine ratio was higher in the OSA group. Our results confirm and reinforce the hypothesis that OSA may be considered a systemic inflammatory disease, and that an imbalance of non-neuronal cholinergic and pro/anti-inflammatory cytokines may contribute to development and progression of comorbidities in OSA subjects. The evaluation of Th17/Treg-related cytokine may provide an additional explanation for OSA pathogenesis and clinical features, opening new directions for the OSA management

Supplementary_material_1 - Kitten Scanner reduces the use of sedation in pediatric MRI

<p>Supplementary_material_1 for Kitten Scanner reduces the use of sedation in pediatric MRI by Eleonora Cavarocchi, Ilde Pieroni, Antonio Serio, Lucio Velluto, Biancamaria Guarnieri, and Sandro Sorbi in Journal of Child Health Care</p

Supplementary_material_2 - Kitten Scanner reduces the use of sedation in pediatric MRI

<p>Supplementary_material_2 for Kitten Scanner reduces the use of sedation in pediatric MRI by Eleonora Cavarocchi, Ilde Pieroni, Antonio Serio, Lucio Velluto, Biancamaria Guarnieri, and Sandro Sorbi in Journal of Child Health Care</p

Narcolepsy type 1 features through the lifetime: age impact on clinical and polysomnographic phenotype

Objectives/Introduction: Narcolepsy type 1 (NT1) is a chronic neu- rological disorder typically arising during adolescence and young adulthood. Recent studies demonstrated that NT1 presents with age specific features, especially in children. With this study we aimed to describe and to compare the clinical pictures of NT1 in different ages groups. Methods: In this cross-sectional, multicentre study, 106 consecu- tive untreated NT1 patients were enrolled at the time of diagno- sis and underwent clinical evaluation, a semi structured interview (including the Epworth Sleepiness Scale – ESS), nocturnal video- polysomnography and the multiple sleep latency test (MSLT). Patients were divided into five age groups (childhood, adolescence, adulthood, middle-aged and seniors). Results: The ESS score showed a significant increase with age, while self-reported diurnal total sleep time was lower in elderlies and young adults, with the latter also complaining automatic behav- iors in more than 90% of cases. Children presented more frequent cataplexy attacks (&gt;1/day in 95% of cases). ‘Recalling an emotional event’, ‘meeting someone unexpectedly’, ‘stress’ and ‘anger’ were triggers more frequently reported in adult and elderly patients. Neurophysiological data showed a higher number of SOREMPs at MSLT in adolescents compared to senior patients, and an age- progressive decline in sleep efficiency was observed. Conclusions: Daytime sleepiness, cataplexy features and triggers and nocturnal sleep structure showed age-related difference in NT1 patients; this variability may contribute to diagnostic delay and misdiagnosis. Disclosure: Nothing to disclos