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GCRC Success Story

Turtle on a Fencepost?. Hartford Postdoctoral FellowGCRC Pilot FundsBeverly Healthcare CorporationHartford Faculty Research ScholarCON Intramural GrantK23 Career Development Award (NIH)TBIRC Pilot Funds. . Sleep Fragmentation and Attention in Persons with Alzheimer's Disease . Sleep and Functional Status. .

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GCRC Success Story

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    1. GCRC Success Story Catherine S. Cole DNSc, APRN, BC Assistant Professor College of Nursing/UAMS

    4. Hartford Postdoctoral Fellow GCRC Pilot Funds Beverly Healthcare Corporation Hartford Faculty Research Scholar CON Intramural Grant K23 Career Development Award (NIH) TBIRC Pilot Funds Sleep Fragmentation and Attention in Persons with Alzheimer’s Disease

    5. Sleep and Functional Status. Purpose Describe the relationship of sleep to functional status. Method Two nights of polysomnography (n = 25) in the nursing home. Functional status (Nursing Home Physical Performance Test). Findings Mean Age = 83.4, MMSE=13.2 Mean time in bed 528.7 (sd=56.4) Total sleep time 369.6 (sd=73.7) Mean number of spontaneous wakings was 14.8 (sd=6.5) Correlations between functional status time in bed (p=.011) total sleep time (p=.010) Participants with ? time in bed and ?minutes of nighttime sleep demonstrated ?function. Support: John A Hartford Foundation; R01NRAG07771.

    6. What effect does disturbed sleep have on cognition in persons with AD? In about 23% of persons with AD neuronal deterioration results in behavioral state instability. ?Nighttime wakefulness. ?Daytime alertness. Impaired cognition. Could disturbed sleep from other causes have additive adverse effects on cognition? How can we separate the confound of Alzheimer’s disease and disturbed sleep on cognition?

    7. Sleep & Cognition in Residents of Long Term Care (Feasibility) Specific Aims: Describe sample Well characterized sample? Dementia severity? MMSE > 15? Describe sleep disturbances. Method: Secondary data analysis.

    8. Findings: Specific Aim 1 80 participants in the dataset at the time of analysis. 57 unspecified dementia. 23 AD. Mean MMSE 12. No severity rating. Specific Aim 2 Mean minutes of nighttime sleep 369.83. Mean sleep efficiency was 71%. Mean 46.3 awakenings per night.

    9. Conclusions: Although sleep fragmentation is a striking problem in long term care facilities, it was not feasible to study sleep and attention in this setting due to difficulties in recruiting a well defined sample and measuring attention in persons with more severe AD.

    10. Feasibility Study: Sleep and Cognition in the Community Specific Aims: Evaluate feasibility of the community setting. Methods: Secondary analysis. Findings: Frequently disrupted sleep due to environmental factors pets ringing telephones electrical interference (60 Hertz) family member’s presence reduced anxiety. Conclusions: It would be preferable to conduct the proposed study in a controlled laboratory environment with a caregiver in attendance.

    11. GCRC Protocol 0405: Tone Induced Sleep Fragmentation This experiment was designed to mimic 1 type of sleep fragmentation seen in long term care facilities due to environmental noise. Tones (via audiometer) were repeated periodically throughout the night to cause the participant to awaken (limited to 85 decibels). Cognition was measured before and after 1 night of sleep fragmentation.

    12. Questions: 1) Will people with AD tolerate the earphone needed for the tone-induced sleep fragmentation method? 2) Can a sleep technician recognize awakenings and arousals after tones in real time? 3) What percent of tones produce an awakening? 4) What percent of persons with AD can complete the cognitive tests?

    13. The Effect of Sleep Fragmentation on Attention in Persons with AD (PWAD). Specific aims: Pilot an experimental method using sound to induce sleep fragmentation in PWAD. Design: Repeated measures. Results: Tones: 33 / Behavioral awakenings: 27. Tones from 70-85 dB produced arousals.

    14. Data Collection Schedule

    15. Participants

    16. Participant’s Sleep

    17. Sleep Fragmentation I didn’t have a significant difference in the number of wakenings between time one and time two p = .061. I didn’t have a significant difference in the number of wakenings between time one and time two p = .061.

    18. Findings 1) People with AD were able to tolerate the earphone. 2) We were able to score a sleep study in real time. 3) Only approximately 50% of the tones resulted in awakenings. 4) 100% of the participants were able to complete the cognitive tests.

    19. Additional questions: 1) Did we really have good sleepers in this group of participants? Even self reported “good sleepers” had an average of 31 awakenings on night one of this study. The average apnea/hypopnea index was 7.4 2) Is subjective report of sleep adequate to establish inclusion criteria? 3) Should the cut-off for inclusion be lowered to an apnea/hypopnea index of 5 instead of 10?

    20. The Effect of Sleep Fragmentation on Attention in AD

    21. Next Steps: K23 Sleep Fragmentation and Attention in AD. TBIRC Pilot Feasibility Study: Reaction Time in the Home for Persons with Alzheimer’s Disease. R15 AREA Submitted Feasibility Study: Attention Measures in Persons with Alzheimer’s Disease.

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