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. 2019 Aug 1;42(8):zsz114.
doi: 10.1093/sleep/zsz114.

Association between insomnia disorder and cognitive function in middle-aged and older adults: a cross-sectional analysis of the Canadian Longitudinal Study on Aging

Nathan E Cross  1   2   3   4 , Julie Carrier  1   4   5 , Ronald B Postuma  4   5   6 , Nadia Gosselin  4   5   7 , Lisa Kakinami  2   8 , Cynthia Thompson  5 , Florian Chouchou  1   2   9 , Thien Thanh Dang-Vu  1   2   3   4
Affiliations

Association between insomnia disorder and cognitive function in middle-aged and older adults: a cross-sectional analysis of the Canadian Longitudinal Study on Aging

Nathan E Cross et al. Sleep. .

Abstract

Objectives: This study examined the differences in cognitive function between middle-aged and older adults with insomnia disorder, insomnia symptoms only (ISO) or no insomnia symptoms (NIS), in the context of other health and lifestyle factors.

Methods: Twenty-eight thousand four hundred eighty-five participants >45 years completed questionnaires, physical examinations, and neuropsychological testing across domains of processing speed, memory, and executive functions. An eight-question instrument assessed participants' sleep, defining subjects with insomnia symptoms, probable insomnia disorder (PID), or NIS. The associations between these three groups and cognitive performance were examined with linear regression models adjusted for lifestyle and clinical factors.

Results: PID was identified in 1,068 participants (3.7% of the sample) while 7,813 (27.5%) experienced ISO. Participants with PID exhibited greater proportions of adverse medical and lifestyle features such as anxiety, depression, and diabetes than both other groups. Analyses adjusting for age, sex, education, as well as medical and lifestyle factors demonstrated that adults with PID exhibited declarative memory deficits (Rey Auditory Verbal Learning Test) compared with ISO or NIS. Adults with insomnia symptoms exhibited better performance on a task of mental flexibility than both other groups.

Conclusions: These findings suggest that insomnia disorder in middle-aged and older adults is associated with poorer health outcomes and worse memory performance than adults with insomnia symptoms alone or without any sleep complaints, even after adjustment for comorbidities. The assessment of longitudinal data within this cohort will be critical to understand if insomnia disorder may increase the risk of further cognitive decline.

Keywords: CLSA; aging; cognition; cohort; insomnia.

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Figures

Figure 1.
Figure 1.
Percentage of adults reporting PID or ISO across age brackets. *p < 0.05; **p < 0.01; ***p < 0.001.
Figure 2.
Figure 2.
Decision tree regression model for performance on the delayed recall phase of the RAVLT in PID. Each node of the tree reflects the mean score on the test and percentage of the sample for each group split by the preceding variable.
See this image and copyright information in PMC

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