Effect of a Multimodal Lifestyle Intervention on Sleep and Cognitive Function in Older Adults with Probable Mild Cognitive Impairment and Poor Sleep: A Randomized Clinical Trial

Article type: Research Article

Authors: Falck, Ryan S.^{a; b; e} | Davis, Jennifer C.^c | Best, John R.^{a; b; e} | Chan, Patrick C.Y.^{a; b; e} | Li, Linda C.^d | Wyrough, Anne B.^{a; b; e} | Bennett, Kimberly J.^{a; b; e} | Backhouse, Daniel^{a; b; e} | Liu-Ambrose, Teresa^{a; b; e; *}

Affiliations: [a] Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada | [b] Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada | [c] Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada | [d] Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada | [e] Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada

Correspondence: [*] Correspondence to: Professor Teresa Liu-Ambrose, University of British Columbia, Department of Physical Therapy, Faculty of Medicine, Aging, Mobility, and Cognitive Neuroscience Lab, Vancouver Coastal Health Research Institute, 212 –2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada. E-mail: [email protected].

Abstract: Background:Poor sleep is common among older adults with mild cognitive impairment (MCI) and may contribute to further cognitive decline. Whether multimodal lifestyle intervention that combines bright light therapy (BLT), physical activity (PA), and good sleep hygiene can improve sleep in older adults with MCI and poor sleep is unknown. Objective:To assess the effect of a multimodal lifestyle intervention on sleep in older adults with probable MCI and poor sleep. Methods:This was a 24-week proof-of-concept randomized trial of 96 community-dwelling older adults aged 65–85 years with probable MCI (<26/30 on the Montreal Cognitive Assessment) and poor sleep (>5 on the Pittsburgh Sleep Quality Index [PSQI]). Participants were allocated to either a multimodal lifestyle intervention (INT); or 2) education + attentional control (CON). INT participants received four once-weekly general sleep hygiene education classes, followed by 20-weeks of: 1) individually-timed BLT; and 2) individually-tailored PA promotion. Our primary outcome was sleep efficiency measured using the MotionWatch8© (MW8). Secondary outcomes were MW8-measured sleep duration, fragmentation index, wake-after-sleep-onset, latency, and PSQI-measured subjective sleep quality. Results:There were no significant between-group differences in MW8 measured sleep efficiency at 24-weeks (estimated mean difference [INT –CON]: 1.18%; 95% CI [–0.99, 3.34]), or any other objective-estimate of sleep. However, INT participants reported significantly better subjective sleep quality at 24-weeks (estimated mean difference: –1.39; 95% CI [–2.72, –0.06]) compared to CON. Conclusion:Among individuals with probable MCI and poor sleep, a multimodal lifestyle intervention improves subjective sleep quality, but not objectively estimated sleep.

Keywords: Bright light therapy, chronotherapy, mild cognitive impairment, older adults, physical activity, sleep, sleep hygiene

Keywords: ClinicalTrials.gov, NCT02926157, Registered on 6 October 2016

DOI: 10.3233/JAD-200383

Journal: Journal of Alzheimer's Disease, vol. 76, no. 1, pp. 179-193, 2020