title: Excessive sleepiness is predictive of cognitive decline in the elderly.
abstract: OBJECTIVE
  To examine the association of sleep complaints reported at baseline (insomnia complaints and excessive daytime sleepiness (EDS)) and medication, with cognitive decline in community-dwelling elderly.
  
  
  METHODS
  An 8-yr longitudinal study.
  
  
  METHODS
  The French Three-City Study.
  
  
  METHODS
  There were 4,894 patients without dementia recruited from 3 French cities and having a Mini-Mental Status Examination (MMSE) score ≥ 24 points at baseline.
  
  
  RESULTS
  Questionnaires were used to evaluate insomnia complaints (poor sleep quality (SQ), difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA)), EDS, and sleep medication at baseline. Cognitive decline was defined as a 4-point reduction in MMSE score during follow-up at 2, 4, and 8 yr. Logistic regression models were adjusted for sociodemographic, behavioral, physical, and mental health variables, and apolipoprotein E genotype. EDS independently increased the risk of cognitive decline (odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.02-1.56), especially for those patients who also developed dementia during the follow-up period (OR = 1.39, 95% CI = 1.00-1.97). The number of insomnia complaints and DMS were negatively associated with MMSE cognitive decline (OR = 0.77, 95% CI = 0.60-0.98 for 3-4 complaints, OR = 0.81, 95% CI = 0.68-0.96, respectively). The 3 other components of insomnia (SQ, DIS, EMA) were not significantly associated with MMSE cognitive decline.
  
  
  CONCLUSIONS
  Our results suggest that EDS may be associated independently with the risk of cognitive decline in the elderly population. Such results could have important public health implications because EDS may be an early marker and potentially reversible risk factor of cognitive decline and onset of dementia.
authors.affiliation: Inserm, U1061, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.forename: Jean
authors.initials: J
authors.lastname: Bouyer
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Ancelin
authors.forename: Claudine
authors.initials: C
authors.lastname: Berr
authors.forename: Alexandra
authors.initials: A
authors.lastname: Foubert-Samier
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.forename: Maurice M
authors.initials: MM
authors.lastname: Ohayon
authors.forename: Alain
authors.initials: A
authors.lastname: Besset
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires