title: Sleep disturbances are key symptoms of very early stage Alzheimer disease with behavioral and psychological symptoms: a Japan multi-center cross-sectional study (J-BIRD).
abstract: Sleep disturbances in Alzheimer disease (AD) may affect behavioral and psychological symptoms of dementia (BPSD). Our aim was to elucidate the associations between sleep disturbances and other BPSD at different stages of AD.
  
  
  
  This investigation was part of a multicenter-retrospective study in Japan (J-BIRD). Eligible for final analyses were 684 AD patients. Global severity of dementia was estimated using the Clinical Dementia Rating (CDR) scale. BPSD were assessed using the Neuropsychiatric Inventory (NPI). We analyzed the relationships between sleep disturbances and BPSD at different stages of AD according to the CDR score.
  
  
  
  Among the 684 AD patients, 146 (21.3%) had sleep disturbances. Patients with very early AD (CDR 0.5) and sleep disturbances had significantly more BPSD than those without sleep disturbances, as indicated by the higher prevalence of the following four NPI items: anxiety, euphoria, disinhibition, and aberrant motor behavior. In AD at CDR 2, (moderate AD) only one NPI item (irritability) was affected, while none was affected at CDR 1 (mild AD) and 3 (severe AD). Multiple regression analyses were performed in those with AD having various CDR scores. At CDR 0.5, the presence of sleep disturbances was associated with a high total NPI score (β = 0.32, p < 0.001). However, other factors, including cognitive decline, age, gender, and years of education, were not significantly associated with the NPI score. At CDR 1 and 2, no factor was significantly related to BPSD.
  
  
  
  Sleep disturbances were strongly associated with other BPSD in the very early stage of AD. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.|Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.|The Sleep Medical Center of Osaka University Hospital, Suita, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Kabeshita
authors.affiliation: Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.|Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.|The Sleep Medical Center of Osaka University Hospital, Suita, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.|Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kanemoto
authors.affiliation: Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sato
authors.affiliation: Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshiyama
authors.affiliation: Department of Rehabilitation Medicine, Akita Prefectural Centre of Rehabilitation and Psychiatric Medicine, Daisen, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Shimomura
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan.
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Mori
authors.affiliation: Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kashibayashi
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Hibiki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hatada
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nishio
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, Ehime University, Toon, Japan.|Zaidan-Niihama Hospital, Niihama, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Komori
authors.affiliation: Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Departments of Neurology and Cognitive Disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Department of Community and Geriatric Nursing, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanimukai
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.|Aino University, Ibaraki, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Takeda
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Mori
authors.affiliation: Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan.|Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Psychiatry, Department of Integrated Medicine, Division of Internal Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kazui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology*; D001007:Anxiety / Q000523:psychology; D001526:Behavioral Symptoms / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D000068079:Motor Disorders / Q000523:psychology; D009483:Neuropsychological Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000523:psychology*
keywords: Alzheimer disease; Clinical Dementia Rating scale; behavioral and psychological symptoms; severity of dementia; sleep disturbance