title: Is insomnia associated with deficits in neuropsychological functioning? Evidence from a population-based study.
abstract: OBJECTIVE
  People with insomnia complain of cognitive deficits in daily life. Results from empirical studies examining associations between insomnia and cognitive impairment, however, are mixed. Research is needed that compares treatment-seeking and community-based insomnia study samples, measures subjective as well as objective cognitive functioning, and considers participants' pre-insomnia cognitive function.
  
  
  METHODS
  We used data from the Dunedin Study, a representative birth cohort of 1,037 individuals, to examine whether insomnia in early midlife was associated with subjective and objective cognitive functioning. We also tested whether individuals with insomnia who reported seeking treatment for their sleep problems (treatment-seekers) showed greater impairment than other individuals with insomnia (non-treatment-seekers). The role of key confounders, including childhood cognitive ability and comorbid health conditions, was evaluated.
  
  
  METHODS
  Insomnia was diagnosed at age 38 according to DSM-IV criteria. Objective neuropsychological assessments at age 38 included the WAIS-IV IQ test, the Wechsler Memory Scale, and the Trail-Making Test. Childhood cognitive functioning was assessed using the Wechsler Intelligence Scale for Children-Revised (WISC-R).
  
  
  RESULTS
  A total of 949 cohort members were assessed for insomnia symptoms and other study measures at age 38. Although cohort members with insomnia (n = 186, 19.6%) had greater subjective cognitive impairment than their peers at age 38, they did not exhibit greater objective impairment on formal testing. Treatment-seekers, however, exhibited significant objective impairment compared to non-treatment-seekers. Controlling for comorbidity, daytime impairment, and medications slightly decreased this association. Childhood cognitive deficits antedated the adult cognitive deficits of treatment-seekers.
  
  
  CONCLUSIONS
  Links between insomnia and cognitive impairment may be strongest among individuals who seek clinical treatment. Clinicians should take into account the presence of complex health problems and lower premorbid cognitive function when planning treatment for insomnia patients.
authors.affiliation: Center for Developmental Science, University of North Carolina at Chapel Hill, Chapel Hill, NC.|Department of Psychology & Neuroscience, Duke University, Durham, NC.|Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: Sidra
authors.initials: S
authors.lastname: Goldman-Mellor
authors.affiliation: Department of Psychology & Neuroscience, Duke University, Durham, NC.|Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC.|Social, Genetic & Developmental Psychiatry Center, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Avshalom
authors.initials: A
authors.lastname: Caspi
authors.affiliation: Department of Psychology, Goldsmiths, University of London, London, UK.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Gregory
authors.affiliation: Department of Psychology & Neuroscience, Duke University, Durham, NC.|Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: HonaLee
authors.initials: H
authors.lastname: Harrington
authors.affiliation: Dunedin Multidisciplinary Health and Development Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Richie
authors.initials: R
authors.lastname: Poulton
authors.affiliation: Department of Psychology & Neuroscience, Duke University, Durham, NC.|Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC.|Social, Genetic & Developmental Psychiatry Center, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Moffitt
mesh_terms: D000328:Adult; D002648:Child; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D015331:Cohort Studies; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D014888:Wechsler Scales
keywords: Insomnia; cognitive; neuropsychological