Long duration treatment of chronic insomnia in elderly shows poor cognition
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20254429Keywords:
Cognition, Drug therapy, Insomnia, Long duration, Memory, Old ageAbstract
Background: Chronic insomnia is a common, underlined condition during old age. Long duration therapy for chronic insomnia leads to show symptoms of difficulty in day time functioning and other risk factors among geriatric population.
Methods: An observational, cross-section study was conducted in the out patient department of geriatric medicine, Sir Sunderlal Hospital, BHU, Varanasi, to see the association of cognitive functions on old age chronic insomnia patients under long duration drug therapy. The chronic insomnia patients (age >60 years) under long duration therapy (not less than twelve months) were screened for sleep quality and cognitive performance simultaneously with Pittsburgh sleep quotient index (PSQI) and Addenbrooke’s cognitive examination test, both in Hindi version.
Results: Chronic insomnia was seen in high prevalence of 26% among old age population. Cognitive performance was significantly decreased in working memory in chronic insomnia subjects compared to their healthy counterparts (0.85±0.55, 1.71±0.53), other domains like orientation and coordination also showed symptoms of mild cognitive impairment, difficulty in day time functioning and other co morbidities among geriatric population. Chronic insomnia was significantly associated with concomitant diseases which include diabetes, hypertension, and arthritis. Based in a clinically significant study, 23% of patients with chronic insomnia did not perceive the ailment, and 32% more elderly women had insomnia than men of the same age.
Conclusions: The study suggested the elderly population should be evaluated routinely for long-term use of hypnotic medications for chronic insomnia. The non pharmacological therapies may be included during treatment of geriatric population like maintenance of sleep hygiene; melatonin and bright light therapy.
Metrics
References
Diagnostic and Statistical Mental Disorders, Fifth Edition (DSM‑5). Arlington, VA: American Psychiatric Association; 2013.
International Classification of Sleep Disorders, Diagnostic and Coding Manual. 2nd edn. Westchester, IL: American Academy of Sleep Medicine; 2005.
The International Classification of Sleep Disorders- 3rd edn (ICSD‑3). Darien, IL: American Academy of Sleep Medicine; 2014: 131-136.
Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rössler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep. 2008;31:473‑80. DOI: https://doi.org/10.1093/sleep/31.4.473
Schutte‑Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4:487‑504. DOI: https://doi.org/10.5664/jcsm.27286
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatr Res. 1989;28(2):193-213. DOI: https://doi.org/10.1016/0165-1781(89)90047-4
Roy SK, Bhattacharjee AK, Chakraborti C, Singh R. Prevalence of insomnia in urban population of west Bengal: a community based cross sectional study. Int J Med Public Health. 2015;5:293‑6. DOI: https://doi.org/10.4103/2230-8598.165953
Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, et al. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night. Sleep. 1997;20(4):267-77.
Quinhones MS, Gomes MDM. Sleep in normal and pathological ageing: clinical and physiopathological aspects. Rev Bras Neurol. 2011;47(1):31-42.
Mazzotti DR, Guindalini C, Sosa AL, Ferri CP, Tufik S. Prevalence and correlates for sleep complaints in older adults in low and middle income countries: a 10/66 Dementia Research Group study. Sleep Med. 2012;13(6):697-702. DOI: https://doi.org/10.1016/j.sleep.2012.02.009
Buysse DJ, Reynolds III CF, Kupfer DJ, Thorpy MJ, Bixler E, Manfredi R, et al. Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial. Sleep. 1994;17(7):630-7. DOI: https://doi.org/10.1093/sleep/17.7.630
Blümel JE, Cano A, Mezones‑Holguin E, Barón G, Bencosme A, Benítez Z, et al. A multinational study of sleep disorders during female mid‑life. Maturitas. 2012;72:359‑66. DOI: https://doi.org/10.1016/j.maturitas.2012.05.011
Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep related disorders among a healthy population in South India. Neurol India 2012;60:68‑74. DOI: https://doi.org/10.4103/0028-3886.93601
Xu M, Bélanger L, Ivers H, Guay B, Zhang J, Morin CM. Comparison of subjective and objective sleep quality in menopausal and non‑menopausal women with insomnia. Sleep Med. 2011;12:65‑9. DOI: https://doi.org/10.1016/j.sleep.2010.09.003
Rybarczyk B, Lund HG, Garroway AM, Mack L. Cognitive behavioral therapy for insomnia in older adults: Background evidence, and overview of treatment protocol. Clin Gerontol. 2013;36:70‑93. DOI: https://doi.org/10.1080/07317115.2012.731478
Aurora RN, Kristo DA, Bista SR, Rowley JA, Zak RS, Casey KR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults- an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012;35:1039-62. DOI: https://doi.org/10.5665/sleep.1988
Morphy H, Dunn KM, Lewis M, Boardman HF, Croft PR. Epidemiology of insomnia: a longitudinal study in a UK population. Sleep. 2007;30(3):274-80.
Kim HM, Gerlach LB, Van T, Yosef M, Conroy DA, Zivin K. Predictors of long-term and high-dose use of zolpidem in veterans. J Clin Psychiatr. 2019;80(2):10621. DOI: https://doi.org/10.4088/JCP.18m12149
Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am. J. Respir. Crit. Care Med; 2001;163:608-13. DOI: https://doi.org/10.1164/ajrccm.163.3.9911064
Léger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in the general population. Curr Med Res Opin. 2008;24:307‑17. DOI: https://doi.org/10.1185/030079907X253771
Zailinawati AH, Mazza D, Teng CL. Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients. Asia Pac Fam Med. 2012;11:9. DOI: https://doi.org/10.1186/1447-056X-11-9
Perlis ML, Smith LJ, Lyness JM, Matteson SR, Pigeon WR, Jungquist CR, et al. Insomnia as a risk factor for onset of depression in the elderly. Behav Sleep Med. 2006;4:104-13. DOI: https://doi.org/10.1207/s15402010bsm0402_3
Billioti De Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ. 2014;349(sep092):g5205. DOI: https://doi.org/10.1136/bmj.g5205
Dyer AH, Murphy C, Lawlor B, Kennelly SP. Cognitive outcomes of long-term benzodiazepine and related drug (BDZR) use in people living with mild to moderate Alzheimer’s disease: NILVAD. J Am Med Dir Assoc. 2020;21(2):194-200. DOI: https://doi.org/10.1016/j.jamda.2019.08.006
Chan TT, Leung WC, Li V, Wong KW, Chu WM, Leung KC, et al. Association between high cumulative dose of benzodiazepine in Chinese patients and risk of dementia: a preliminary retrospective case-control study. Psycho Geriatr. 2017;17(5):310-6. DOI: https://doi.org/10.1111/psyg.12239
Grossi CM, Richardson K, Fox C, Maidment I, Steel N, Loke YK, et al. Anticholinergic and benzodiazepine medication use and risk of incident dementia a UK cohort study. BMC Geriatr. 2019;19(1):276. DOI: https://doi.org/10.1186/s12877-019-1280-2
Shash D, Kurth T, Bertrand M, Dufouil C, Barberger-Gateau P, Berr C, et al. Benzodiazepine, psychotropic medication, and dementia: a population-based cohort study. Alzheimers Dement. 2016;12(5):604-13. DOI: https://doi.org/10.1016/j.jalz.2015.10.006
Desmidt T, Delrieu J, Lebouvier T, Robert G, David R, Balageas A, et al. Benzodiazepine use and brain amyloid load in nondemented older individuals: a florbetapir PET study in the Multidomain Alzheimer Preventive Trial cohort. Neurobiol Aging. 2019;84:61-9. DOI: https://doi.org/10.1016/j.neurobiolaging.2019.08.008
Shih H, Lin C, Tu Y, Chang C, Hsu H, Chi C, et al. An increased risk of reversible dementia may occur after zolpidem derivative use in the elderly population. Medicine. 2015;94(17):e809. DOI: https://doi.org/10.1097/MD.0000000000000809
Dell’Osso B, Lader M. Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal. Eur Psychiatr. 2013;28(1):7-20. DOI: https://doi.org/10.1016/j.eurpsy.2011.11.003
Trifiro G, Spina E. Age-related changes in pharmacodynamics: focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab. 2011;12(7):611-20. DOI: https://doi.org/10.2174/138920011796504473
Imfeld P, Bodmer M, Jick SS, Meier CR. Benzodiazepine use and risk of developing Alzheimer’s disease or vascular dementia: a case-control analysis. Drug Saf. 2015;38(10):909-19. DOI: https://doi.org/10.1007/s40264-015-0319-3