Extended napping in seniors may signal dementia

By Suzanne Leigh

Older person sleeping on a couch

A new study, led by UCSF and Harvard Medical School together with Brigham and Women’s Hospital, departs from the theory that daytime napping in older people serves merely to compensate for poor nighttime sleep and may also foreshadow Alzheimer’s disease and other dementias.

Daytime napping among older people is a normal part of aging – but it may also foreshadow Alzheimer’s disease and other dementias. And once dementia or its usual precursor, mild cognitive impairment, are diagnosed, the frequency and/or duration of napping accelerates rapidly, according to a new study.

The study, led by UC San Francisco and Harvard Medical School together with Brigham and Women’s Hospital, its teaching affiliate, departs from the theory that daytime napping in older people serves merely to compensate for poor nighttime sleep. Instead, it points to work by other UCSF researchers suggesting that dementia may affect the wake-promoting neurons in key areas of the brain, the researchers state in their paper published March 17 in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association.

“We found the association between excessive daytime napping and dementia remained after adjusting for nighttime quantity and quality of sleep,” said co-senior author Yue Leng, MD, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences.

“This suggested that the role of daytime napping is important itself and is independent of nighttime sleep,” said Leng, who partnered with Kun Hu, PhD, of Harvard Medical School, in senior-authoring the paper.

Watch-like devices, annual evaluations used to measure naps, cognition

In the study, the researchers tracked data from 1,401 seniors, who had been followed for up to 14 years by the Rush Memory and Aging Project at the Rush Alzheimer’s Disease Center in Chicago. The participants, whose average age was 81 and of whom approximately three-quarters were female, wore a watch-like device that tracked mobility. Each prolonged period of non-activity from 9 a.m. to 7 p.m. was interpreted as a nap.

The device was worn every year continuously for up to 14 days, and once a year each participant underwent a battery of neuropsychological tests to evaluate cognition. At the start of the study, 75.7% of participants had no cognitive impairment, while 19.5% had mild cognitive impairment and 4.1% had Alzheimer’s disease.

For participants who did not develop cognitive impairment, daily daytime napping increased by an average 11 minutes per year. The rate of increase doubled after a diagnosis of mild cognitive impairment to a total of 24 minutes and nearly tripled to a total of 68 minutes after a diagnosis of Alzheimer’s disease.

When the researchers looked at the 24% of participants who had normal cognition at the start of the study but developed Alzheimer’s six years later, and compared them with those whose cognition remained stable, they found differences in napping habits. Participants who napped more than an hour a day had a 40% higher risk of developing Alzheimer’s than those who napped less than an hour a day; and participants who napped at least once a day had a 40% higher risk of developing Alzheimer’s than those who napped less than once a day.

The research confirms the results of a 2019 study, of which Leng was the first author, that found older men who napped two hours a day had higher odds of developing cognitive impairment that those who napped less than 30 minutes a day. The current study builds on these findings by evaluating both daytime napping and cognition each year, hence addressing directionality, Leng notes.

Loss of wake-promoting neurons may account for longer naps

According to the researchers, increase in napping may be explained by a further 2019 study, by other UCSF researchers, comparing the postmortem brains of people with Alzheimer’s disease to those without cognitive impairment. Those with Alzheimer’s disease were found to have fewer wake-promoting neurons in three brain regions. These neuronal changes appear to be linked to tau tangles – a hallmark of Alzheimer’s, characterized by increased activity of enzymes causing the protein to misfold and clump.

“It is plausible that our observed associations of excessive daytime napping at baseline, and increased risk for Alzheimer’s disease during follow-up, may reflect the effect of Alzheimer’s disease pathology at preclinical stages,” the authors noted.

The study shows for the first time that napping and Alzheimer’s disease “seem to be driving each other’s changes in a bi-directional way,” said Leng, who is also affiliated with the UCSF Weill Institute for Neurosciences. “I don’t think we have enough evidence to draw conclusions about a causal relationship, that it’s the napping itself that caused cognitive aging, but excessive daytime napping might be a signal of accelerated aging or cognitive aging process,” she said.

“It would be very interesting for future studies to explore whether intervention of naps may help slow down age-related cognitive decline.”

Authors: First authors are Peng Li, PhD, and Lei Gao, MBBS, of Brigham and Women’s Hospital and Harvard Medical School. Co-authors are Xi Zheng, Ma Cherrysse Ulsa, Hui-Wen Yang, PhD, and Arlen Gaba of Brigham and Women’s Hospital; Kristine Yaffe, MD, of UCSF; Lei Yu, PhD, David A. Bennett, MD, and Aron S. Buchman, MD, of Rush University Medical Center.

Funding: Research was supported by the National Institutes of Health (RF1AG064312, RF1AG059867, R01AG56352, R01AG17917, T32GM007592, R03AG067985 and R00AG056598), and the BrightFocus Foundation Alzheimer’s Research Program (A2020886S).

Read the paper

Further reading

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 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.