The Role of Cognitive Impairment, Physical Disability, and Chronic Conditions in the Association of Sleep Duration With All-Cause Mortality Among Very Old Adults

Introduction: Short sleep duration has been associated with increased risk of cardiovascular and cerebrovascular disease (CVD), cognitive impairment (CI) and mortality. However, the role of sleep duration in predicting mortality in the context of CVD and CI is still not well-understood. Hypothesis: Short sleep duration is a key effect modifier of the relationship between CI associated with CVD and all-cause mortality. Methods: We addressed this hypothesis in the Penn State Adult Cohort, a random, general population sample of 1,741 middle-aged adults who were studied in the sleep lab and followed-up for 15y. An in-lab, 8-hour polysomnography was performed to ascertain sleep duration. CI associated with CVD was defined by the presence of hypertension, diabetes, heart disease and/or stroke with impaired higher-order, executive cognitive functioning, including slow processing speed. We tested the interaction between sleep duration and CI associated with CVD on all-cause mortality with multiple logistic regression while adjusting for sex, age, race, obesity, smoking, cholesterol, depression, insomnia, dementia, and sleep apnea. Results: The odds of mortality associated with CI-alone, CVD-alone, and CI associated with CVD were 1.3 (95% CI: 0.7-2.4), 1.7 (95% CI: 1.1-2.8), and 4.6 (95% CI: 2.8-7.7), respectively. As shown in Figure 1, the interaction between CI associated with CVD and sleep duration was significant (p < .01), indicating that the probability of mortality increased significantly as a function of shorter sleep duration in individuals with CI associated with CVD. Conclusion: We found that objective sleep duration modifies the relationship between CI associated with CVD and all-cause mortality in a dose-response manner. Short sleep duration in individuals with probable vascular cognitive impairment (VCI) may serve as a biomarker of the severity of central autonomic dysfunction. Future studies should examine whether improving sleep reduces the odds of mortality in individuals with VCI.

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The Role of Demographic and Life Style Variables in Utilizing Cognitive Support for Episodic Remembering among very Old Adults

The Journals of Gerontology Series B ◽

10.1093/geronb/50b.4.p219 ◽

1995 ◽

Vol 50B (4) ◽

pp. P219-P227 ◽

Cited By ~ 22

Author(s):

R. D. Hill ◽

A. Wahlin ◽

B. Winblad ◽

L. Backman

Keyword(s):

Life Style ◽

Cognitive Support ◽

Very Old ◽

Old Adults

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Initial level and rate of change in grip strength predict all-cause mortality in very old adults

Age and Ageing ◽

10.1093/ageing/afx087 ◽

2017 ◽

Vol 46 (6) ◽

pp. 970-976 ◽

Cited By ~ 14

Author(s):

Antoneta Granic ◽

Karen Davies ◽

Carol Jagger ◽

Richard M. Dodds ◽

Thomas B L Kirkwood ◽

...

Keyword(s):

Grip Strength ◽

Initial Level ◽

Rate Of Change ◽

Very Old ◽

Old Adults ◽

All Cause Mortality

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Post-intensive care syndrome as a predictor of mortality in patients with critical illness: A cohort study

PLoS ONE ◽

10.1371/journal.pone.0244564 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0244564

Author(s):

Naoya Yanagi ◽

Kentaro Kamiya ◽

Nobuaki Hamazaki ◽

Ryota Matsuzawa ◽

Kohei Nozaki ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Cognitive Impairment ◽

Critical Illness ◽

Physical Disability ◽

Cox Regression ◽

Apache Ii Score ◽

All Cause Mortality ◽

Patient Health ◽

Post Intensive Care Syndrome

Introduction The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. Materials and methods In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. Results Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 – 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). Conclusion While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.

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Objective short sleep duration increases the risk of all-cause mortality associated with possible vascular cognitive impairment

Sleep Health ◽

10.1016/j.sleh.2019.09.003 ◽

2020 ◽

Vol 6 (1) ◽

pp. 71-78 ◽

Cited By ~ 2

Author(s):

Julio Fernandez-Mendoza ◽

Fan He ◽

Susan L. Calhoun ◽

Alexandros N. Vgontzas ◽

Duanping Liao ◽

...

Keyword(s):

Cognitive Impairment ◽

Sleep Duration ◽

Vascular Cognitive Impairment ◽

Short Sleep Duration ◽

Short Sleep ◽

All Cause Mortality

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The role of physical and psychological variables in predicting the outcome of hospitalization in very old adults

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2010.11.023 ◽

2011 ◽

Vol 53 (2) ◽

pp. 146-151 ◽

Cited By ~ 2

Author(s):

Christina Bryant ◽

Henry Jackson ◽

David Ames

Keyword(s):

Psychological Variables ◽

Very Old ◽

Old Adults

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Associations of Wellbeing Levels, Changes, and Within-Person Variability With Late-Life All-Cause Mortality Across 12 Years: Contrasting Hedonic vs. Eudaimonic Wellbeing Among Very Old Adults

Frontiers in Psychology ◽

10.3389/fpsyg.2021.750891 ◽

2022 ◽

Vol 12 ◽

Author(s):

Oliver Karl Schilling ◽

Markus Wettstein ◽

Hans-Werner Wahl

Keyword(s):

Old Age ◽

Structural Equation ◽

Structural Equation Models ◽

Oldest Old ◽

Residual Lifetime ◽

Very Old ◽

Old Adults ◽

All Cause Mortality ◽

Mortality Predictors ◽

Eudaimonic Wellbeing

Advanced old age has been characterized as a biologically highly vulnerable life phase. Biological, morbidity-, and cognitive impairment-related factors play an important role as mortality predictors among very old adults. However, it is largely unknown whether previous findings confirming the role of different wellbeing domains for mortality translate to survival among the oldest-old individuals. Moreover, the distinction established in the wellbeing literature between hedonic and eudaimonic wellbeing as well as the consideration of within-person variability of potentially relevant mortality predictors has not sufficiently been addressed in prior mortality research. In this study, we examined a broad set of hedonic and eudaimonic wellbeing indicators, including their levels, their changes, as well as their within-person variability, as predictors of all-cause mortality in a sample of very old individuals. We used data from the LateLine study, a 7-year longitudinal study based on a sample of n = 124 individuals who were living alone and who were aged 87–97 years (M = 90.6, SD = 2.9) at baseline. Study participants provided up to 16 measurement occasions (mean number of measurement occasions per individual = 5.50, SD = 4.79) between 2009 and 2016. Dates of death were available for 118 individuals (95.2%) who had deceased between 2009 and 2021. We ran longitudinal multilevel structural equation models and specified between-person level differences, within-person long-term linear change trends, as well as the “detrended” within-person variability in three indicators of hedonic (i.e., life satisfaction and positive and negative affect) and four indicators of eudaimonic wellbeing (i.e., purpose in life, autonomy, environmental mastery, and self-acceptance) as all-cause mortality predictors. Controlling for age, gender, education, and physical condition and testing our sets of hedonic and eudaimonic indictors separately in terms of their mortality impact, solely one eudaimonic wellbeing indicator, namely, autonomy, showed significant effects on survival. Surprisingly, autonomy appeared “paradoxically” related with mortality, with high individual levels and intraindividual highly stable perceptions of autonomy being associated with a shorter residual lifetime. Thus, it seems plausible that accepting dependency and changing perceptions of autonomy over time in accordance with objectively remaining capabilities might become adaptive for survival in very old age.

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Abstract MP23: Interplay of Cognitive Impairment and Short Sleep Duration on Cardiovascular and Cerebrovascular Mortality

Circulation ◽

10.1161/circ.141.suppl_1.mp23 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Julio Fernandez-Mendoza ◽

Fan He ◽

Susan L Calhoun ◽

Duanping Liao ◽

Alexandros N Vgontzas ◽

...

Keyword(s):

Cognitive Impairment ◽

Sleep Duration ◽

Mental Health Problems ◽

Middle Age ◽

Experimental Studies ◽

Health Problems ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk ◽

All Cause Mortality

Introduction: Epidemiological and experimental studies have shown that short sleep duration is associated with cognitive impairment as well as cardiovascular (CVD) and cerebrovascular (CBV) diseases. However, its role in predicting CVD/CBV mortality is still not well-established, particularly using objective sleep measures. Hypothesis: Polysomnography (PSG)-measured short sleep duration modifies the increased risk of CVD/CBV mortality associated with cognitive impairment in middle-age. Methods: We addressed this hypothesis in the Penn State Adult Cohort, a random, population-based sample studied in the sleep laboratory (N=1,524, 48.9±13.4y, 54% women) and followed-up after 20.5 ± 5.7 years to ascertain their cause of death. Cognitive impairment (n=155) was ascertained using a comprehensive neuropsychological battery including Mini-Mental State Examination, Symbol Digit Modalities Test, Trail Making Test parts A and B, Benton Visual Retention Test and Thurstone Word Fluency Test. PSG total sleep time classified subjects as normal (≥6 h) and short (<6 h) sleepers. Out of the 563 subjects who were deceased as of December 31, 2018, 244 died of CVD/CBV. Cox proportional hazards regression controlling for age, sex, race, education, obesity, sleep apnea, mental health problems and physical health problems, including hypertension, diabetes, heart disease and stroke at baseline, was used to assess the association between cognitive impairment and mortality. Results: Cognitive impairment was associated with an increased risk of all-cause mortality [(HR: 1.72 (1.35-2.06)], which was significantly modified by objective sleep duration (p-interaction=0.01). The association between cognitive impairment and all-cause mortality was significantly stronger among subjects who slept < 6 hours [HR: 2.00 (1.54-2.59)] than among those who slept ≥ 6 hours [HR: 1.00 (0.59-1.67)]. Despite the smaller sample size, we observed a similar pattern (p-interaction=0.18) that the association between cognitive impairment and CVD/CBV mortality was stronger among subjects who slept < 6 hours [HR: 2.09 (1.43-3.05)] than among those who slept ≥ 6 hours [HR: 1.24 (0.60-2.57)]. Conclusions: The risk of mortality associated with cognitive impairment in middle-age is significantly increased in adults with objective short sleep duration. Middle-aged adults who sleep objectively short may be more vulnerable to the effect of clinical and subclinical cerebrovascular morbidity on cognitive impairment and, thus, early death from CVD/CBV.

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