Sleep Patterns in Elementary School Children (Grades 2-5) and Adolescents (Grade 10)

Background: To date, there is limited research examining sleep patterns in elementary school children. Previous researchers focused on parental responses rather than student responses to determine factors that affect sleep. The presented study surveyed sleep patterns and examined external factors affecting total sleep time among elementary school children and adolescents. Methods: Students in grades 2-5 (n=885) and grade 10 (n=190) enrolled in a public school system in the Northeast, completed a district administered survey that included questions on sleep duration and hygiene. Results. Average reported sleep duration decreased with increasing grade level. Children in grades 2-5 woke up earlier (31.7-72.4%) and on their own in comparison to adolescents in grade 10 (6.8%). Significantly shorter sleep durations were associated with having a television (grades 2, 4, 5, p< 0.01) or a cell phone in the room (grades 3, 4; p < 0.05), playing on the computer or video games (grades 3, 4, p<.001) before going to bed. In contrast, students in grade 2, 3, & 4 who reported reading a book before going to bed slept on average 21 minutes more per night (p=.029, .007, .009, respectively). For tenth graders, only consumption of energy drinks led to significant reduction in sleep duration (p<.0001). Conclusion. Sleep is a fundamental aspect in maintaining a healthy and adequate life style. Understanding sleep patterns will assist parents, health care providers, and educators in promoting quality sleep hygiene in school-aged children.Partial funding was provided by BU UROP (Undergraduate Research Opportunities Program)

The effect of Parkinson’s disease subgroups on verbal and nonverbal fluency

BACKGROUND: Parkinson’s disease (PD) leads to deficits in executive function, including verbal and nonverbal fluency, as a result of compromised frontostriatal circuits. It is unknown whether deficits in verbal and nonverbal fluency in PD are driven by certain subgroups of patients, or how strategy use may facilitate performance. PARTICIPANTS: Sixty-five nondemented individuals with PD, including 36 with right-body onset (RPD; 20 with tremor as their initial symptom, 16 nontremor) and 29 with left-body onset (LPD; 14 with tremor as their initial symptom, 15 nontremor), and 52 normal control participants (NC) took part in the study. MEASUREMENTS: Verbal fluency was assessed using the FAS and Animals tests. Nonverbal fluency was assessed using the Ruff Figural Fluency Test. RESULTS: Both RPD and LPD were impaired in generating words and in using clustering and switching strategies on phonemic verbal fluency, whereas different patterns of impairment were found on nonverbal fluency depending on the interaction of side of onset and initial motor symptom (tremor vs. nontremor). Strategy use correlated with number of correct responses on verbal fluency in LPD, RPD, and NC. By contrast, on nonverbal fluency, strategy use correlated with correct responses for RPD and LPD, but not for NC. CONCLUSION: Our findings demonstrate the importance of considering subgroups in PD and analyzing subcomponents of verbal and nonverbal fluency (correct responses, errors, and strategies), which may depend differently on the integrity of dorsolateral prefrontal cortex, inferior frontal cortex, and anterior cingulate cortex.Published versio

Circadian rest-activity rhythms predict cognitive function in early Parkinson's disease independently of sleep

BACKGROUND: Cognitive impairment is a common and debilitating symptom of Parkinson's disease (PD), and its etiology is likely multifactorial. One candidate mechanism is circadian disruption. Although there is evidence of circadian abnormalities in PD, no studies have directly assessed their association with cognitive impairment. OBJECTIVES: Investigate whether circadian rest-activity rhythm is associated with cognitive function in PD independently of sleep. METHODS: Thirty-five participants with PD wore wrist actigraph monitors and completed sleep diaries for 7 to 10 days, then underwent neuropsychological testing. Rest-activity rhythm was characterized using nonparametric circadian rhythm analysis of actigraphy data. Objective sleep parameters were also estimated using actigraphy data. Hierarchical regression models assessed the independent contributions of sleep and rest-activity rhythm to cognitive performance. RESULTS: Less stable day-to-day rest-activity rhythm was associated with poorer executive, visuospatial, and psychomotor functioning, but not with memory. Hierarchical regressions showed that interdaily stability's contribution to cognitive performance was independent of sleep's contributions. Whereas sleep contributed to executive function, but not psychomotor or visuospatial performance, rest-activity rhythm stability significantly contributed to variance in all three of these domains, uniquely accounting for 14.4% to 17.6% of their performance variance. CONCLUSIONS: Our findings indicate that circadian rest-activity rhythm is associated with cognitive impairment independently of sleep. This suggests the possible utility of rest-activity rhythm as a biomarker for circadian function in PD. Future research should explore interventions to stabilize behavioral rhythms in order to strengthen circadian function, which, in turn, may reduce cognitive impairment in PD.R00 HL102241 - NHLBI NIH HHS; R01 AG048108 - NIA NIH HHSAccepted manuscrip

Relation of Subjective Quality of Life to Motor Symptom Profile in Parkinson's Disease

Parkinson's disease (PD) presents with extensive heterogeneity in symptomatology, inviting examination of disease subtypes. One significant categorization is by whether patients present at onset with tremor as the dominant symptom (TD) or with nontremor symptoms (NTD). We examined differences in quality of life between TD and NTD patients using the Parkinson's Disease Questionnaire-39 (PDQ-39), correlating performance with aspects of motor function as indexed by the Unified Parkinson's Disease Rating Scale (UPDRS). Participants included 35 nondemented individuals (19 TD, 16 NTD) matched on clinical and demographic characteristics. NTD had significantly lower overall PDQ-39 scores, particularly for the mobility subscale. Several UPDRS subscale scores significantly correlated with quality of life, especially for NTD. Further, the correlations were driven by nontremor type symptoms, even in TD patients. Determining reliable subtypes of PD may aid in prognosis and treatment optimization, thereby enhancing quality of life in afflicted individuals

Sleep in Parkinson's disease: an examination of clinical correlates and cognition using actigraphy

Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.Sleep-related deficits are common in Parkinson's disease (PD) and significantly affect quality of life. The etiology of sleep problems is not well understood as they may arise from disease-related pathology or from factors such as motor dysfunction or medications. They may also affect the integrity of cognitive processes. In other disorders, actigraphy has emerged as an alternative to polysomnography to measure sleep, raising the question of its ability to capture sleep quality in PD. Study #1 evaluated the validity of actigraphy by examining its association with self-report in 30 patients with PD and 14 normal control participants (NC). For NC, actigraphic sleep variables were not related to any self-reported measures of sleep, a finding consistent with previous reports of over-reporting of sleep problems in older adults. In PD patients these correlations were significant, suggesting that actigraphy is an appropriate method of measuring sleep quality in PD. Study #2 investigated factors associated with sleep disturbance using actigraphy and questionnaire measures in 35 PD patients. Motor symptom severity and dopaminergic medication dosages were significantly related to sleep quality. Other factors affecting sleep were disease subtypes, with non-tremor onset patients reporting worse sleep quality than tremor-onset patients, and gender, with men having worse sleep quality and more excessive daytime sleepiness than women. Actigraphy identified individuals with possible REM behavior disorder, a sleep disorder that is implicated in early detection of PD. Study #3 investigated the association between actigraphic sleep measures and cognition in 36 PD patients and 18 NC participants. Executive dysfunction was predicted by sleep efficiency and not by motor symptom severity, medication dosage or disease duration. For memory, by contrast, motor symptom severity and disease duration but not sleep quality predicted performance. For psychomotor function, none of the variables significantly predicted performance. The relation of sleep and cognition in PD varied with gender and motor symptom subtypes. Taken together, these studies show actigraphy to be a valid method of assessing sleep quality in non-demented PD patients, indicate the relation of sleep to motor symptom severity, medication, gender, and disease subtypes, and demonstrate that sleep disturbances in PD significantly predict cognitive functioning

The progression of cognition, psychiatric symptoms, and functional abilities in dementia with lewy bodies and alzheimer disease

Background Although dementia with Lewy bodies (DLB) may be one of most common forms of dementia, relatively little is known about its cognitive and functional course. Objective To compare change over time in general cognitive status, memory test performance, psychiatric symptoms, neurological signs, and functional abilities in patients with probable DLB and probable Alzheimer disease (AD). Design Twenty-eight patients who met diagnostic criteria for DLB were recruited into the study from 3 sites. Patients with AD (n =3D 55) were selected from a larger cohort and matched 2 to 1 to the patients with DLB on age and baseline global cognitive status. Patients were followed up at 6-month intervals for an average of 6.2 visits and assessed at each visit with tests of global cognitive functioning and verbal learning and memory and measures of psychiatric, neurological, and functional status. Results At the baseline evaluation, patients with DLB performed more poorly on a measure of constructional praxis and all measures of functional status. They also had more severe psychiatric symptoms and neurological signs than the AD group. Despite these initial differences, generalized estimating equations applied to regression analyses with repeated measures determined that the only difference between the 2 groups in change in cognitive test performance was on a measure of recognition memory; patients with AD declined, while patients with DLB remained relatively stable. Patients with DLB had relatively stable behavioral symptoms and visual illusions, whereas patients with AD had a significant increase in these symptoms over time. Neurological and functional changes over time were similar in the 2 groups. Conclusions Both baseline and longitudinal differences between patients with DLB and patients with AD were noted; these have implications for clinical diagnosis and treatment