title: Impaired quality and efficiency of sleep impairs cognitive functioning in Addison's disease.
abstract: Standard replacement therapy for Addison's disease (AD) does not restore a normal circadian rhythm. Periods of sub- and supra- physiological cortisol levels experienced by patients with AD likely induce disrupted sleep. Given that healthy sleep plays an important role in memory consolidation, the novelty of the current study was to characterise, using objective measures, the relationship between sleep and memory in patients with AD, and to examine the hypothesis that poor sleep is a biological mechanism underlying memory impairment in those patients.
  
  
  
  We used a within-subjects design. Ten patients with AD and 10 matched healthy controls completed standardised neuropsychological tests assessing declarative memory (Rey Auditory Verbal Learning Test) and procedural memory (Finger Tapping Task) before and after a period of actigraphy-measured sleep, and before and after a period of waking.
  
  
  
  Relative to healthy controls, patients with AD experienced disrupted sleep characterised by poorer sleep efficiency and more time spent awake. Patients also showed impaired verbal learning and memory relative to healthy controls (p=0.007). Furthermore, whereas healthy controls' declarative memory performance benefited from a period of sleep compared to waking (p=0.032), patients with AD derived no such benefit from sleep (p=0.448). Regarding the procedural memory task, analyses detected no significant between-group differences (all p's<0.065), and neither group showed significant sleep-enhanced performance.
  
  
  
  We demonstrated, using actigraphy and standardized measures of memory performance, an association between sleep disturbances and cognitive deficits in patients with AD. These results suggest that, in patients with AD, the source of memory deficits is, at least to some extent, disrupted sleep patterns that interfere with optimal consolidation of previously-learned declarative information. Hence, treating the sleep disturbances that are frequently experienced by patients with AD may improve their cognitive functioning.
authors.affiliation: ACSENT Laboratory, Department of Psychology, University of Cape Town, South Africa; Centre for Higher Education Development, University of Cape Town, South Africa. Electronic address: m.henry@uct.ac.za.
authors.forename: Michelle
authors.initials: M
authors.lastname: Henry
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Cape Town, South Africa.
authors.forename: Ian Louis
authors.initials: IL
authors.lastname: Ross
authors.affiliation: ACSENT Laboratory, Department of Psychology, University of Cape Town, South Africa.
authors.forename: Pedro Sofio Abril
authors.initials: PSA
authors.lastname: Wolf
authors.affiliation: ACSENT Laboratory, Department of Psychology, University of Cape Town, South Africa.
authors.forename: Kevin Garth Flusk
authors.initials: KGF
authors.lastname: Thomas
mesh_terms: D056044:Actigraphy; D000224:Addison Disease / Q000503:physiopathology / Q000523:psychology*; D000328:Adult; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000503:physiopathology / Q000523:psychology*; D014706:Verbal Learning / Q000502:physiology*
keywords: Addison’s disease; Cortisol; Memory; Sleep