Clinical Investigation Of Sleep Disorders And Related Factors In Alzheimer’s Disease

Objective: To describe the characteristic of sleep disorders in patients with Alzheimer’s disease and discuss the relationship between sleep disorder and cognitive function, psychiatric symptoms, living abilities and the caregiver burden.Methods:33patients with Alzheimer’s disease were recruited from clinics of Shandong Provincial Hospital. Collect the demographic information in detail. Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) were used to measure the cognitive function and the degree of dementia. Activity of Daily Living Scale (ADL) and Zarit Burden Interview (ZBI) were used to evaluate the living activity and caregiver burden. Neuropsychiatric Inventory Questionnaire (NPI-Q) and Cornell Scale for Depression in Dementia (CSDD) were used to measure the psychiatric symptoms. PSQI and Epworth sleepiness scale (ESS) were used to evaluate the sleep disorders of the patients. The data were analyzed with software SPSS version21.0.Results:1. Demographic data of Alzheimer’s diseaseThe incidence of sleep disorder in patients with AD is51.5%. There is no significant difference in age, gender, height, weight, BMI, smoking and drinking history, education years, course of disease of patients with or without sleep disorder.2、Cognitive impairment in patients with different degrees of dementia There’s a reduction of MMSE score as the aggravation of dementia. In MCI period of AD, orientation, recall, repetition and graphing capability have a significant damage, while immediate memory, naming ability, executive capacity are affected in later period.3. The distribution and severity of the psychiatric symptoms in patients with AD.27patients (81.8%) have at least one kind of psychiatric symptoms, and20caregivers (60.6%) have caregiver burdens. All items of psychiatric symptoms in NPI-Q are occurred in AD patients. The most common symptoms are apathy(63.6%), followed by abnormal behaviors(63.6%),sleep/behaviors at night(45.5%) and agitation/aggressivity(36.4%).While euphoria (12.1%) and eating disorders (9.1%) occurred less in AD patients.4、Difference of scale scores in patients with different viabilitiesPatients who cannot take care of themselves have more seriously dementia, depression, psychiatric symptoms, disability, sleep disturbance, daytime sleepiness and caregiver burden(P<0.05).5. Distributions of sleep disorders and the severity in AD patientsAll items in PSQI occurred in AD patients. The most common symptoms are sleep disturbance (57.6%), followed by reduction of sleep efficiency (54.5%) and daytime dysfunction (51.5%), most of which are of mild impairment. The least common item is the using of hypnotic drugs (9.1%).In patients with CDR score of0.5,1,2and3, the proportion of sleep disorders are28.6%,62.5%,57.1%and100.0%in turn. However there is no significant difference of SD in adjacent rank of dementia(P>0.05). In patients with CDR score of0.5,1,2and3, the proportion of daytime sleepiness are0.0%,62.5%,64.3%,50.0%in turn. The proportion of daytime sleepiness in patients with CDR score of1is higher than that with CDR score of0.5(P<0.05).6. Significant testing and relevant analysis of sleep disorders and degree of dementia, cognitive function, psychiatric symptoms, living activities and caregiver burden.The PSQI score is positively related to the scores of CDR, ZBI, NPI, CSDD, ADL, PADL and IADL, and negatively related to MMSE scores. Age, course of disease, education years and BMI show no relation to PSQI. Patients with sleep disorder have significant higher scores of CDR, CSDD, ADL, PADL, IADL, ESS and ZBI.7. Significant testing of different types of sleep disordersPatients with sleep disorders have higher scores of sleep quality, difficulty of falling asleep, total sleep time, daytime dysfunction(P<0.05).8. Related analysis of different types of sleep disorders.8.1The relationship between with sleep disorder and cognitive function: The sleep quality, difficulty of falling asleep, total sleep time and sleep efficiency are significantly related to cognitive functions. In all MMSE items, orientation, immediate memory, attention and calculation power, executive functions, expression ability and graphic ability are negatively related to PSQI scores.8.2The relationship between sleep disorder and psychiatric symptoms: Every item in PSQI is related to psychiatric symptoms. Delusion, apathy, sleep/behavior at night and CSDD are related to sleep disorders.8.3The relationship between sleep disorder and living activities:ADL, PADL, IADL, ZBI are all related to sleep disorders. ADL is positively related to scores of PSQI and sleep efficiency. PADL are only related to PSQI score. IADL is positively related to PSQI and sleep efficiency scores. ZBI are related to difficulty of falling sleep and sleep efficiency.Conclusion: Various kinds of sleep disorders can occur in the process of Alzheimer’s disease. The sleep disorders are closely related to the degree of dementia, cognitive function, living ability and psychiatric symptoms. Also, Sleep disorders aggravate the patients’ caregiver burden.