Sleep Mediates Age-Related Executive Function for Older Adults with Limited Cognitive Reserve

Abstract Objective: Sleep quantity and quality are associated with executive function (EF) in experimental studies, and in individuals with sleep disorders. With advancing age, sleep quantity and quality decline, as does the ability to perform EF tasks, suggesting that sleep disruption may contribute to age-related EF declines. This cross-sectional cohort study tested the hypothesis that poorer sleep quality (i.e., the frequency and duration of awakenings) and/or quantity may partly account for age-related EF deficits. Method: Community-dwelling older adults (N = 184) completed actigraphic sleep monitoring then a range of EF tasks. Two EF factors were extracted using exploratory structural equation modeling. Sleep variables did not mediate the relationship between age and EF factors. Post hoc moderated mediation analyses were conducted to test whether cognitive reserve compensates for sleep-related EF deficits, using years of education as a proxy measure of cognitive reserve. Results: We found a significant interaction between cognitive reserve and the number and frequency of awakenings, explaining a small (approximately 3%), but significant amount of variance in EF. Specifically, in individuals with fewer than 11 years of education, greater sleep disturbance was associated with poorer EF, but sleep did not impact EF in those with more education. There was no association between age and sleep quantity. Conclusions: This study highlights the role of cognitive reserve in the sleep–EF relationship, suggesting individuals with greater cognitive reserve may be able to counter the impact of disturbed sleep on EF. Therefore, improving sleep may confer some protection against EF deficits in vulnerable older adults.

[1]  D. McFarland.  Factor-Analytic Evidence for the Complexity of the Delis–Kaplan Executive Function System (D-KEFS) , 2020, Assessment.

[2]  R. Martins,et al.  Sleep disruption explains age-related prospective memory deficits: implications for cognitive aging and intervention , 2018, Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition.

[3]  A. Ballesio.  Executive functions impairments in insomnia: a systematic review and meta-analysis , 2017 .

[4]  Silviya P. Doneva,et al.  Poorer attentional ability in adults who stutter – evidence from the Test of Everyday Attention (TEA) , 2017 .

[5]  R. Schoevers,et al.  The relationship between depression and executive function and the impact of vascular disease burden in younger and older adults , 2017, Age and ageing.

[6]  M. Walker,et al.  Sleep and Human Aging , 2017, Neuron.

[7]  K. Reid,et al.  Sleep Variability Among Older Adults With Insomnia: Associations With Sleep Quality and Cardiometabolic Disease Risk , 2017, Behavioral sleep medicine.

[8]  Bedda L. Rosario,et al.  Sleep-Wake Differences in Relative Regional Cerebral Metabolic Rate for Glucose among Patients with Insomnia Compared with Good Sleepers. , 2016, Sleep.

[9]  J. Krueger,et al.  Sleep function: Toward elucidating an enigma. , 2016, Sleep medicine reviews.

[10]  John Trinder,et al.  Beyond the mean: A systematic review on the correlates of daily intraindividual variability of sleep/wake patterns. , 2016, Sleep medicine reviews.

[11]  J. Best,et al.  Measuring sleep quality in older adults: a comparison using subjective and objective methods , 2015, Front. Aging Neurosci..

[12]  Michael K. Scullin,et al.  Sleep, Cognition, and Normal Aging , 2015, Perspectives on psychological science : a journal of the Association for Psychological Science.

[13]  Teresa Liu-Ambrose,et al.  Buying time: a rationale for examining the use of circadian rhythm and sleep interventions to delay progression of mild cognitive impairment to Alzheimer’s disease , 2014, Front. Aging Neurosci..

[14]  Kristine Yaffe,et al.  Connections between sleep and cognition in older adults , 2014, The Lancet Neurology.

[15]  Sarah G. Woo,et al.  Role of sleep continuity and total sleep time in executive function across the adult lifespan. , 2014, Psychology and aging.

[16]  Sam K. Y. Sim,et al.  Sleep duration and age-related changes in brain structure and cognitive performance. , 2014, Sleep.

[17]  J. Solet,et al.  Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. , 2013, Sleep.

[18]  Howard J. Rosen,et al.  NIH EXAMINER: Conceptualization and Development of an Executive Function Battery , 2013, Journal of the International Neuropsychological Society.

[19]  A. Noda,et al.  Poor sleep quality impairs cognitive performance in older adults , 2013, Journal of sleep research.

[20]  A. Hayes.  Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach , 2013 .

[21]  R. Bucks,et al.  Neurocognitive function in obstructive sleep apnoea: A meta‐review , 2013, Respirology.

[22]  John G. Lynch,et al.  Spotlights, Floodlights, and the Magic Number Zero: Simple Effects Tests in Moderated Regression , 2012 .

[23]  Y. Stern.  Cognitive reserve in ageing and Alzheimer's disease , 2012, The Lancet Neurology.

[24]  A. Palmer,et al.  A latent variable approach to executive control in healthy ageing , 2012, Brain and Cognition.

[25]  Derk-Jan Dijk,et al.  Amplitude Reduction and Phase Shifts of Melatonin, Cortisol and Other Circadian Rhythms after a Gradual Advance of Sleep and Light Exposure in Humans , 2012, PloS one.

[26]  C. Morin,et al.  Insomnia and daytime cognitive performance: a meta-analysis. , 2012, Sleep medicine reviews.

[27]  Daniel J Buysse,et al.  The consensus sleep diary: standardizing prospective sleep self-monitoring. , 2012, Sleep.

[28]  A. Miyake,et al.  The Nature and Organization of Individual Differences in Executive Functions , 2012, Current directions in psychological science.

[29]  S. Ancoli-Israel,et al.  Association of sleep characteristics and cognition in older community-dwelling men: the MrOS sleep study. , 2011, Sleep.

[30]  K. Crowley,et al.  Sleep and Sleep Disorders in Older Adults , 2011, Neuropsychology Review.

[31]  Duanping Liao,et al.  Insomnia with objective short sleep duration is associated with deficits in neuropsychological performance: a general population study. , 2010, Sleep.

[32]  C. Marra,et al.  The independent contribution of executive functions to health related quality of life in older women , 2010, BMC geriatrics.

[33]  Ian B Hickie,et al.  Sleep Well, Think Well: Sleep-Wake Disturbance in Mild Cognitive Impairment , 2010, Journal of geriatric psychiatry and neurology.

[34]  M. Nevitt,et al.  Bone mineral density and prevalent osteoarthritis of the hip in older men for the Osteoporotic Fractures in Men (MrOS) Study Group , 2010, Osteoporosis International.

[35]  Daniel J Buysse,et al.  Self-reported sleep quality predicts poor cognitive performance in healthy older adults. , 2009, The journals of gerontology. Series B, Psychological sciences and social sciences.

[36]  R. Lipton,et al.  The Relation Between Cognitive Functioning and Self-Reported Sleep Complaints in Nondemented Older Adults: Results From the Bronx Aging Study , 2007, Behavioral sleep medicine.

[37]  J. Cauley,et al.  Poor sleep is associated with impaired cognitive function in older women: the study of osteoporotic fractures. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[38]  Meredeth A Rowe,et al.  Sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in community-dwelling older adults. , 2005, The journals of gerontology. Series B, Psychological sciences and social sciences.

[39]  Kristopher J Preacher,et al.  SPSS and SAS procedures for estimating indirect effects in simple mediation models , 2004, Behavior research methods, instruments, & computers : a journal of the Psychonomic Society, Inc.

[40]  C. Guilleminault,et al.  Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. , 2004, Sleep.

[41]  J. Fisk,et al.  Age-Related Impairment in Executive Functioning: Updating, Inhibition, Shifting, and Access , 2004, Journal of clinical and experimental neuropsychology.

[42]  M. Vitiello,et al.  Age-related sleep change: Gender and estrogen effects on the subjective-objective sleep quality relationships of healthy, noncomplaining older men and women. , 2004, Journal of psychosomatic research.

[43]  J. J. Ryan,et al.  Scoring Reliability on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) , 2003, Assessment.

[44]  C. Pollak,et al.  The role of actigraphy in the study of sleep and circadian rhythms. , 2003, Sleep.

[45]  C. Anderson,et al.  Prefrontal cortex: links between low frequency delta EEG in sleep and neuropsychological performance in healthy, older people. , 2003, Psychophysiology.

[46]  Max Hirshkowitz,et al.  Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. , 2003, Sleep.

[47]  D. Dinges,et al.  The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. , 2003, Sleep.

[48]  Roberto Cabeza,et al.  Aging Gracefully: Compensatory Brain Activity in High-Performing Older Adults , 2002, NeuroImage.

[49]  J. Hobson,et al.  The prefrontal cortex in sleep , 2002, Trends in Cognitive Sciences.

[50]  R. Spitzer,et al.  The PHQ-9: A new depression diagnostic and severity measure , 2002 .

[51]  E. Stepanski,et al.  The effect of sleep fragmentation on daytime function. , 2002, Sleep.

[52]  D. Gozal,et al.  Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits , 2002, Journal of sleep research.

[53]  E Libman,et al.  How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate? , 2000, Journal of psychosomatic research.

[54]  M. J. Emerson,et al.  The Unity and Diversity of Executive Functions and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis , 2000, Cognitive Psychology.

[55]  이정희,et al.  Controlled Oral Word Association Test , 2000, Definitions.

[56]  A. Tröster,et al.  Action (verb naming) fluency as an executive function measure: convergent and divergent evidence of validity , 1999, Neuropsychologia.

[57]  K. Strohl,et al.  Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome , 1999, Annals of Internal Medicine.

[58]  G. Iverson.  Interpretation of mini‐mental state examination scores in community‐dwelling elderly and geriatric neuropsychiatry patients , 1998, International journal of geriatric psychiatry.

[59]  D J Kupfer,et al.  Effects of gender and age on the levels and circadian rhythmicity of plasma cortisol. , 1996, The Journal of clinical endocrinology and metabolism.

[60]  A. Baddeley.  Exploring the Central Executive , 1996 .

[61]  D. J. Mullaney,et al.  Automatic sleep/wake identification from wrist activity. , 1992, Sleep.

[62]  S. Folstein,et al.  “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician , 1975 .

[63]  D. Dijk,et al.  Self-reported sleep duration and cognitive performance in older adults: a systematic review and meta-analysis. , 2016, Sleep medicine.

[64]  Stuart J. Ritchie,et al.  Education is associated with higher later life IQ scores, but not with faster cognitive processing speed. , 2013, Psychology and aging.

[65]  Andreas Schleicher.  Education at a Glance OECD Indicators 2012 SPAIN Under embargo until 11 September , at 11 : 00 am Paris time , 2012 .

[66]  M. Luszcz,et al.  Executive Function and Cognitive Aging , 2011 .

[67]  C. Morin,et al.  Cognitive performance and sleep quality in the elderly suffering from chronic insomnia. Relationship between objective and subjective measures. , 2003, Journal of psychosomatic research.

[68]  Luciane L. de Souza,et al.  Further validation of actigraphy for sleep studies. , 2003, Sleep.

[69]  C. Morin,et al.  Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults. , 2000, The journals of gerontology. Series B, Psychological sciences and social sciences.

[70]  R. Reitan,et al.  The Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation , 1993 .

[71]  M. Schlossberg.  The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. , 1986 .