For dementia prevention, sleep quality in midlife matters more

By Suzanne Leigh


Sleep actogram by Yue Leng, Kristine Yaffe, Kristen Knutson; Neurology; ©2024 American Academy of Neurology

A new study led by UC San Francisco reveals that quality of sleep, not quantity, may play a part in the development of dementia decades before symptoms start.

Unlike previous research that has primarily focused on sleep disturbance and cognitive impairment in late life, the 526 participants at the start of this study had an average age of 40.

And while most earlier studies have relied on subjective measures of sleep quality, the researchers used a wrist activity monitor to record bedtime “sleep fragmentation,” which took into account the amount of time participants were immobile and the amount of time they were moving.

The study was published in the journal Neurology on Jan. 3, 2024.

After tracking the participants’ sleep habits and evaluating their cognitive performance years later, the researchers found no association between cognition and sleep duration, in analyzing both self-reports and data from the wrist activity monitors.

In contrast, those with higher levels of fragmented sleep were found to be up to three times as likely to score below average in cognitive testing as those with lower levels of fragmented sleep, when adjusted for factors like education, depression, body mass index, diabetes and hypertension.

photo of Yue Leng, PhD

Yue Leng, PhD

“Since Alzheimer’s disease pathology begins to accumulate in the brain many years before symptoms onset, it’s possible that sleep disturbances identified in late life – close to the time when memory loss becomes apparent – is actually the consequence of this pathology that has been developing silently over the years,” said first author Yue Leng, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences, and the Weill Institute for Neurosciences.

“Given the long, symptom-free window of Alzheimer’s disease and the high prevalence of sleep problems, the understanding of midlife sleep disturbances has significant public health implications.”

Currently 1 in 9 Americans aged 65 and older suffer from Alzheimer’s. However, recent studies show that up to 40% of cases may be prevented or delayed by making health changes, including practicing good sleep hygiene.

A toll on executive function

The participants were part of CARDIA (Coronary Artery Risk Development In young Adults), a National Institutes of Health study. Over half were female; 56% were white and the remainder were Black. Their sleep habits were assessed over a three day-period on two occasions, approximately one year apart, and cognitive testing took place about 11 years later.

The researchers divided the participants’ sleep quality scores into three groups: those with higher, moderate and lower levels of sleep fragmentation. Participants in the higher group were 2.10 to 2.97 times more likely to score below average on four tests measuring executive function, as well as working memory, processing speed and global cognition, compared to those in the lower group.

Surprisingly, a fifth test, quantifying verbal memory, did not show differences between these two groups.

“This confirms previous studies of older adults suggesting a strong association between sleep disorders and executive function, which might be due to the influence of sleep on the prefrontal cortex area, the seat of executive function, rather than verbal memory,” Leng said.

Kristine Yaffe, MD

Kristine Yaffe, MD

No difference was found in cognitive scores between those with moderate sleep fragmentation compared with lower sleep fragmentation. Cognitive performance and sleep fragmentation did not differ by race or sex. There was no association between cognition and sleep quality when it was measured subjectively.

“This research contributes to a body of literature that underscores the need to evaluate modifiable risk factors associated with cognitive aging,” said senior author Kristine Yaffe, MD, of the UCSF Departments of Psychiatry and Behavioral Sciences, Neurology, and Epidemiology and Biostatistics.

“Future research is needed to study the link between sleep disturbances and cognition at different stages of life and to identify whether there are critical life periods when sleep is more strongly associated with cognition,” added Yaffe, who is a member of the first team of experts to determine that 30% of dementia risk is preventable. “This might open up new opportunities for the prevention of Alzheimer’s in late life.”

Co-Authors: Kristen Knutson, PhD, of UCSF and Mercedes R. Carnethon, PhD, of Northwestern University.

Funding: The CARDIA study is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268 201800005I, HHSN268201800006I and HHSN268201800007I from the National Heart, Lung, and Blood Institute (NHLBI). The CARDIA Cognitive Function ancillary study is supported by NHLBI grant R01 HL122658. The authors report no relevant disclosures.

Read the study

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About UCSF Psychiatry and Behavioral Sciences

The UCSF Department of Psychiatry and Behavioral Sciences and the Langley Porter Psychiatric Institute are among the nation's foremost resources in the fields of child, adolescent, adult, and geriatric mental health. Together they constitute one of the largest departments in the UCSF School of Medicine and the UCSF Weill Institute for Neurosciences, with a mission focused on research (basic, translational, clinical), teaching, patient care, and public service.

UCSF Psychiatry and Behavioral Sciences conducts its clinical, educational, and research efforts at a variety of locations in Northern California, including the UCSF Nancy Friend Pritzker Psychiatry Building; UCSF Langley Porter Psychiatric Hospital; UCSF Medical Centers at Parnassus Heights, Mission Bay, and Mount Zion; UCSF Benioff Children’s Hospitals in San Francisco and Oakland; Zuckerberg San Francisco General Hospital and Trauma Center; the San Francisco VA Health Care System; UCSF Fresno; and numerous community-based sites around the San Francisco Bay Area.

About the UCSF Weill Institute for Neurosciences

The UCSF Weill Institute for Neurosciences, established by the extraordinary generosity of Joan and Sanford I. "Sandy" Weill, brings together world-class researchers with top-ranked physicians to solve some of the most complex challenges in the human brain.

The UCSF Weill Institute leverages UCSF’s unrivaled bench-to-bedside excellence in the neurosciences. It unites three UCSF departments—Psychiatry and Behavioral Sciences, Neurology, and Neurological Surgery—that are highly esteemed for both patient care and research, as well as the Neuroscience Graduate Program, a cross-disciplinary alliance of nearly 100 UCSF faculty members from 15 basic-science departments, as well as the UCSF Institute for Neurodegenerative Diseases, a multidisciplinary research center focused on finding effective treatments for Alzheimer’s disease, frontotemporal dementia, Parkinson’s disease, and other neurodegenerative disorders.

About UCSF

The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.