Effect of emotional and neutral declarative memory consolidation on sleep architecture.

The relationship between emotional or neutral declarative memory consolidation and sleep architecture was investigated. Thirty university students (21 females) viewed negative, neutral, or positive pictures and rated their valence and arousal in the evening. Participants performed a recognition test 1 h later and then underwent overnight polysomnography. Their post-encoding sleep architecture was compared to a baseline night. Participants returned 6 days following encoding for a second recognition test. Results showed no group (Negative, Neutral, Positive) differences in recognition 1 h or 6 days following encoding. Stage 2 sleep spindle density decreased across all groups following encoding, and recognition after 6 days was positively correlated with Stage 2 sleep spindle density on both nights. There was no change in REM density in any of the groups. This is the first investigation into phasic sleep microarchitecture changes following emotional and neutral declarative learning. Future investigations may benefit from more salient emotional stimuli.

Validating an automated sleep spindle detection algorithm using an individualized approach.

The goal of the current investigation was to develop a systematic method to validate the accuracy of an automated method of sleep spindle detection that takes into consideration individual differences in spindle amplitude. The benchmarking approach used here could be employed more generally to validate automated spindle scoring from other detection algorithms. In a sample of Stage 2 sleep from 10 healthy young subjects, spindles were identified both manually and automatically. The minimum amplitude threshold used by the Prana (PhiTools, Strasbourg, France) software spindle detection algorithm to identify a spindle was subject-specific and determined based upon each subject's mean peak spindle amplitude. Overall sensitivity and specificity values were 98.96 and 88.49%, respectively, when compared to manual scoring. Selecting individual amplitude thresholds for spindle detection based on systematic benchmarking data may validate automated spindle detection methods and improve reproducibility of experimental results. Given that interindividual differences are accounted for, we feel that automatic spindle detection provides an accurate and efficient alternative approach for detecting sleep spindles.

Changes in the density of stage 2 sleep spindles following motor learning in young and older adults.

The purpose of this study was to compare the changes that occur in sleep architecture following the acquisition of a simple motor learning task in young and older adults. Subjects included 14 young (range = 17-24 years) and 14 older (range = 62-79 years) adults, all of whom were in good health. Using in-home recording systems, sleep architecture (sleep stages and the density of Stage 2 sleep spindles) was examined before and after learning the pursuit rotor. To control for possible age differences in baseline motor performance and spindle density, both absolute and relative (percent change) measures were examined. Both groups improved significantly on the pursuit rotor task at Retest (1 week later); however, the magnitude of absolute improvement was larger in the young group than in the older group. There was no group difference when a relative measure of improvement (percent increase across sessions) was used. The density of Stage 2 sleep spindles increased significantly following task Acquisition in the young group but not in the older group. These age differences failed to reach significance when change was measured as a percentage of baseline level of spindle density. The increase in spindle density was correlated with performance level during acquisition in the young group but not the older group. The results of the present study are largely consistent with previous studies on sleep and memory in young adults and suggest that more detailed examination of this relationship in older adults is warranted.

Cognitive impairment no dementia - neuropsychological and neuroimaging characterization of an amnestic subgroup.

BACKGROUND/AIMS: Cognitive impairment no dementia (CIND) describes individuals whose cognitive functioning falls below normal but who do not meet dementia criteria. An important goal within CIND is to identify subgroups that will predictably progress to Alzheimer disease. CIND with amnestic deficits has been associated with high risk of Alzheimer disease but has until now been investigated on a retrospective basis. In this study a prospectively defined amnestic CIND group was characterized on a detailed neuropsychological test battery and on structural magnetic resonance imaging (MRI) measures. METHODS: Amnestic CIND was defined as meeting at least 1 but not all DSM-IV-TR criteria for dementia, scoring > or =1 SD below norms on Rey Auditory Verbal Learning Test delayed recall, having a Clinical Dementia Rating score of 0.5 and a Mini-Mental State Exam score > or =24. This cross-sectional study compared subjects meeting these criteria (n = 25) to age- and education-matched controls (n = 26). The neuropsychological battery included memory and nonmemory measures that were analyzed as continuous variables and dichotomized into impaired (> or =1 SD below controls) versus nonimpaired. MRI scans were evaluated with a global-brain volumetric measure [brain fractional ratio (BFR)] and with visually based medial temporal lobe atrophy (MTA) ratings. RESULTS: Amnestic CIND had neuropsychological impairment in the episodic memory domain and also in nonmemory domains. There were 80% of CIND subjects with multidomain impairment. The most clear-cut nonmemory impairment was in the verbal ability domain, with 64% of subjects affected and a moderate effect size (d = 0.7). On MRI, BFR was lower (74.5 +/- 4.6 vs. 75.5 +/- 4.4) and MTA higher (72 vs. 38% with MTA > or =1) in CIND than in control subjects. BFR correlated with MTA (r = -0.45) and with a composite memory score (r = 0.296). CONCLUSION: A prospective amnestic CIND grouping appears to identify individuals with a multidomain pattern of neuropsychological impairment and with both medial temporal lobe and global brain atrophy.

Age differences in the variability and distribution of sleep spindle and rapid eye movement densities.

The present study had two main objectives. The first objective was to compare the sleep architecture of young and older adults, with an emphasis on sleep spindle density and REM density. The second objective was to examine two aspects of age differences that have not been considered in previous studies: age differences in the variability of sleep measures as well as the magnitude of age differences in phasic events across the distribution of values (i.e., at each decile rather than a single measure of location such as the mean or median. A total of 24 young (mean age=20.75 ± 1.78 years) and 24 older (mean age=71.17 ± 6.15 years) adults underwent in-home polysomnography. Whole-night spindle density was significantly higher in young adults than older adults. The two age groups did not differ significantly in whole-night REM density, although significant increases in REM density across the night were observed in both age groups. These results suggest that spindle density is more affected by age than REM density. Although age differences were observed in the degree of absolute variability (older adults had significantly larger variances than young adults for sleep efficiency and time spent awake after sleep onset), a similar pattern was also observed within the two age groups: the four sleep measures with the lowest degrees of relative variability were the same and included time spent in REM and Stage 2 sleep, total sleep time, and sleep efficiency. The distributional analysis of age differences in sleep spindle density revealed that the largest age differences were initially observed in the middle of the distributions, but as the night progressed, they were seen at the upper end of the distributions. The results reported here have potential implications for the causes and functional implications of age-related changes in sleep architecture.

Utility of an effect size analysis for communicating treatment effectiveness: a case study of cholinesterase inhibitors for Alzheimer's disease.

OBJECTIVES: To highlight the utility of using an effect size analysis to communicate the effectiveness of treatment interventions. DESIGN: Secondary analysis. SETTING: Previously published systematic review on cholinesterase inhibitors (ChEIs) in Alzheimer's disease. PARTICIPANTS: Individuals with mild to moderate Alzheimer's disease. INTERVENTION: Six-month randomized controlled trials involving a placebo group and a ChEI group (donepezil, galantamine, or rivastigmine). MEASUREMENTS: Cognitive function was assessed according to performance on the cognition subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog). Global Function was quantified using the Clinician's Interview-Based Impression of Change-Plus (CIBIC-Plus). Harm was defined as withdrawal from a trial because of an adverse event. Several effect size indices were computed based on these domains: the success rate difference (SRD), the harm rate difference (HRD), the number needed to treat (NNT) or harm (NNH), and the area under the curve (AUC). Harm:benefit ratios were also computed to compare effect size indices across domains of function. RESULTS: In terms of benefit, the NNT for cognition ranged from 4 to 14 (corresponding AUC values: 0.64-0.54), and the NNT for global function ranged from 6 to 100 (corresponding AUC 0.59-0.51). In terms of harm, the NNH ranged from 6 to 20 (corresponding AUC 0.58-0.53). Only one of the four studies had favorable harm:benefit ratios in both the cognition and global function domains. CONCLUSION: Effect size indices should be reported in clinical trials because they provide important insight into the clinical meaningfulness of results. Additional benefit is gained by comparing effect size indices across domains of function to reveal harm:benefit ratios.

A conceptual framework and ethics analysis for prevention trials of Alzheimer Disease.

As our understanding of the neurobiology of Alzheimer Disease deepens, it has become evident that early intervention is critical to achieving successful therapeutic impact. The availability of diagnostic criteria for preclinical Alzheimer Disease adds momentum to research directed at this goal and even to prevention. The landscape of therapeutic research is thus poised to undergo a dramatic shift in the next 5-10 years, with clinical trials involving subjects at risk for Alzheimer Disease who have few or no symptoms. These trials will also likely rely heavily on genetics, biomarkers, and or risk factor stratification to identify individuals at risk for Alzheimer Disease. Here, we propose a conceptual framework to guide this next generation of pharmacological and non-pharmacological clinical pursuit, and discuss some of the foreseeable ethical considerations that may accompany them.

Neuropsychiatric symptom clusters and functional disability in cognitively-impaired-not-demented individuals.

OBJECTIVE: Previous research has shown that cognitively-impaired-not-demented (CIND) individuals with at least one neuropsychiatric symptom (NPS) have more functional disability than individuals without any NPSs. The objectives of the present study were to determine whether there are consistent clusters of NPS in CIND individuals and whether certain NPS clusters are more strongly associated with measures of functional disability than other NPS clusters in this population. METHODS: This was a cross-sectional baseline study of NPS using the Neuropsychiatric Inventory (NPI) in a national clinic-based observational cohort study (the Canadian Cohort Study of Cognitive Impairment and Related Dementias study). The present investigation focuses on a subset of CIND subjects (73%) whose informant endorsed the presence of at least one NPI item. RESULTS: A hierarchical cluster analysis identified two NPS clusters. One consisted of mood factors (i.e., depression, anxiety, apathy, irritability, and problems with sleep) and the other cluster captured frontal symptoms (i.e., aberrant motor behavior, disinhibition, agitation, and problems with appetite). NPSs grouped within the mood cluster were more common than the frontal cluster (95% of subjects had at least one NPS within the mood cluster versus 53% in the frontal cluster). However, the frontal cluster was more strongly associated with functional disability measures even after controlling for cognitive status (i.e., the Mini-Mental State Exam) and the mood cluster score. CONCLUSION: The frontal cluster of NPSs was more strongly associated with functional disability than the mood cluster.

Changes in sleep architecture following motor learning depend on initial skill level.

Previous research has linked both rapid eye movement (REM) sleep and Stage 2 sleep to procedural memory consolidation. The present study sought to clarify the relationship between sleep stages and procedural memory consolidation by examining the effect of initial skill level in this relationship in young adults. In-home sleep recordings were performed on participants before and after learning the pursuit rotor task. We divided the participants into low- and high-skill groups based on their initial performance of the pursuit rotor task. In high-skill participants, there was a significant increase in Stage 2 spindle density after learning, and there was a significant correlation between the spindle density that occurred after learning and pursuit rotor performance at retest 1 week later. In contrast, there was a significant correlation between changes in REM density and performance on the pursuit rotor task during retest 1 week later in low-skill participants, although the actual increase in REM density failed to reach significance in this group. The results of the present study suggest the presence of a double dissociation in the sleep-related processes that are involved in procedural memory consolidation in low- and high-skill individuals. These results indicate that the changes in sleep microarchitecture that take place after learning depend on the initial skill level of the individual and therefore provide validation for the model proposed by Smith et al. [Smith, C. T., Aubrey, J. B., & Peters, K. R. Different roles for REM and Stage 2 sleep in motor learning. Psychologica Belgica, 44, 79-102, 2004]. Accordingly, skill level is an important variable that needs to be considered in future research on sleep and memory consolidation.