Affiliations: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA | Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
Note:  Correspondence to: Donald L. Bliwise, Ph.D., Department of Neurology, Emory University School of Medicine, 1841 Clifton Road, Room 509, Atlanta, GA 30329, USA. Tel.: +1 404 728 4751; E-mail: [email protected]
Abstract: Background: Sleep disturbance and cognitive impairment are correlated in non-diseased populations, but their association in Parkinson's disease (PD) is uncertain. Prior studies examining measures of cognition in relation to sleep have used either self-report or actigraphically measured sleep and have produced conflicting findings. Objective: In this descriptive study, we correlated measurements of sleep in PD patients derived from the gold-standard measurement, in-lab polysomnography, with an extensive battery of cognitive measures. We hypothesized that poorer sleep would be related to relatively more impaired cognition. Methods: Idiopathic PD patients (n = 34) completed a cognitive battery encompassing three broad domains (executive function, immediate memory and delayed memory), and underwent PSG for two nights. Scores for each domain from individual cognitive measures were converted to z-scores and then averaged to produce a composite score. We used second night PSG data and quantified measures of sleep architecture, sleep continuity, sleep apnea and nocturnal movement (periodic leg movements, PLMS). Results: Lower executive function was associated with higher PLMS after controlling for chronological age, mini-mental state examination scores, and UPDRS motor subscale scores. These results were independent from psychomotor speed. There was a marginally significant positive correlation between the proportion of time spent in REM and immediate recall ability. Measures of sleep continuity and sleep apnea were unrelated to cognition in these patients. Conclusions: PLMS, known to be a frequent feature of PSG-measured sleep in PD, may be an important correlate of impaired executive function in PD. Whether treating this disorder of sleep results in improvement in cognition remains to be determined.
Keywords: Sleep related periodic leg movements, sleep fragmentation, sleep disorders, neurodegenerative diseases, cognition, aging