精神医学59巻6号

2017年06月発行

特集 精神医学と睡眠学の接点

認知症と睡眠

著者： 金森正¹ 鈴木貴浩¹ 金野倫子¹ 内山真¹

所属機関： ¹日本大学医学部精神医学系精神医学分野

ページ範囲：P.541 - P.551

文献概要

はじめに
　睡眠障害は認知症で高頻度にみられる行動・心理症状(behavioral and psychological symptoms of dementia；BPSD)のひとつであり，患者の生活の質(quality of life；QOL)の低下や介護者の負担につながることが多いため，実地臨床において早急な対処を迫られることが多い。また，睡眠障害が認知機能障害や認知症発症のリスクとなる可能性についての報告が相次ぎ，認知症の予防や進行の抑制という側面から睡眠障害の重要性についての認識が高まっている。
　本稿では，正常加齢での睡眠の変化，認知症全般における睡眠障害のとらえ方について述べ，代表的な認知症性疾患ごとに睡眠障害の特徴を概説する。さらに不眠症状や睡眠薬，睡眠時無呼吸症候群(sleep apnea syndrome；SAS)といった睡眠に関連した問題と認知症発症のリスクとの関連について最近の知見を展望する。

参考文献

1) Aharon-Peretz J, Masiah A, Pillar T, et al：Sleep-wake cycles in multi-infarct dementia and dementia of the Alzheimer type. Neurology 41：1616-1619, 1991

2) Anderson KN, Hatfield C, Kipps C, et al：Disrupted sleep and circadian patterns in frontotemporal dementia. Eur J Neurol 16：317-323, 2009

3) Bhalsing K, Suresh K, Muthane UB, et al：Prevalence and profile of Restless Legs Syndrome in Parkinson's disease and other neurodegenerative disorders：A case-control study. Parkinsonism Relat Disord 19：426-430, 2013

4) Billioti de Gage S, Bégaud B, Bazin F, et al：Benzodiazepine use and risk of dementia：prospective population based study. BMJ 345：e6231, 2012

5) Billioti de Gage S, Moride Y, Ducruet T, et al：Benzodiazepine use and risk of Alzheimer's disease：case-control study. BMJ 349：g5205, 2014

6) Blackwell T, Yaffe K, Ancoli-Israel S, et al：Poor sleep is associated with impaired cognitive function in older women：the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 61：405-410, 2006

7) Blackwell T, Yaffe K, Ancoli-Israel S, et al：Associations between sleep architecture and sleep-disordered breathing and cognition in older community-dwelling men：the Osteoporotic Fractures in Men Sleep Study. J Am Geriatr Soc 59：2217-2225, 2011

8) Bliwise DL, Mercaldo ND, Avidan AY, et al：Sleep disturbance in dementia with Lewy bodies and Alzheimer's disease：a multicenter analysis. Dement Geriatr Cogn Disord 31：239-246, 2011

9) Boeve BF, Silber MH, Saper CB, et al：Pathophysiology of REM sleep behavior disorder and relevance to neurodegenerative disease. Brain 130：2770-2788, 2007

10) Boland LL, Shahar E, Iber C, et al：Measures of cognitive function in persons with varying degrees of sleep-disordered breathing：the Sleep Heart Health Study. J Sleep Res 11：265-272, 2002

11) Bombois S, Derambure P, Pasquier F, et al：Sleep disorders in aging and dementia. J Nutr Health Aging 14：212-217, 2010

12) Cardinali DP, Vigo DE, Olivar N, et al：Therapeutic application of melatonin in mild cognitive impairment. Am J Neurodegener Dis 1：280-291, 2012

13) Cheng CY, Tsai CF, Wang SJ, et al：Sleep disturbance correlates with white matter hyperintensity in patients with subcortical ischemic vascular dementia. J Geriatr Psychiatry Neurol 26：158-164, 2013

14) Cricco M, Simonsick EM, Foley DJ：The impact of insomnia on cognitive functioning in older adults. J Am Geriatr Soc 49：1185-1189, 2001

15) Dugger BN, Boeve BF, Murray ME, et al：Rapid eye movement sleep behavior disorder and subtypes in autopsy-confirmed dementia with Lewy bodies. Mov Disord 27：72-78, 2012

16) Evans LK：Sundown syndrome in institutionalized elderly. J Am Geriatr Soc 35：101-108, 1987

17) Ferman TJ, Smith GE, Boeve BF, et al：DLB fluctuations：specific features that reliably differentiate DLB from AD and normal aging. Neurology 62：181-187, 2004

18) Foley DJ, Masaki K, White L, et al：Sleep-disordered breathing and cognitive impairment in elderly Japanese-American men. Sleep 26：596-599, 2003

19) Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, et al：Insomnia and daytime cognitive performance：a meta-analysis. Sleep Med Rev 16：83-94, 2012

20) Foster RG, Roenneberg T：Human responses to the geophysical daily, annual and lunar cycles. Curr Biol 18：R784-R794, 2008

21) Fuh JL, Wang SJ, Cummings JL：Neuropsychiatric profiles in patients with Alzheimer's disease and vascular dementia. J Neurol Neurosurg Psychiatry 76：1337-1341, 2005

22) 降籏隆二，今野千里，鈴木正泰，他：一般成人における不眠症状と性差について．女性心身医学 19：103-109, 2014

23) Gray SL, Dublin S, Yu O, et al：Benzodiazepine use and risk of incident dementia or cognitive decline：prospective population based study. BMJ 352：i90, 2016

24) Guarnieri B, Adorni F, Musicco M, et al：Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders：a multicenter Italian clinical cross-sectional study on 431 patients. Dement Geriatr Cogn Disord 33：50-58, 2012

25) Hita-Yañez E, Atienza M, Cantero JL：Polysomnographic and subjective sleep markers of mild cognitive impairment. Sleep 36：1327-1334, 2013

26) Holth JK, Patel TK, Holtzman DM：Sleep in Alzheimer's Disease-Beyond Amyloid. Neurobiology of Sleep and Circadian Rhythms. Volume 2. Elsevier, Amsterdam, pp4-14, 2017

27) Huang Y, Potter R, Sigurdson W et al：Effects of age and amyloid deposition on Aß dynamics in the human central nervous system. Arch Neurol 69：51-58, 2012

28) Imfeld P, Bodmer M, Jick SS, et al：Benzodiazepine Use and Risk of Developing Alzheimer's Disease or Vascular Dementia：A Case-Control Analysis. Drug Saf 38：909-919, 2015

29) Kang JE, Lim MM, Bateman RJ, et al：Amyloid-beta dynamics are regulated by orexin and the sleep-wake cycle. Science 326：1005-1007, 2009

30) Kondratova AA, Kondratov RV：The circadian clock and pathology of the ageing brain. Nat Rev Neurosci 13：325-335, 2012

31) Mander BA, Marks SM, Vogel JW, et al：ß-amyloid disrupts human NREM slow waves and related hippocampus-dependent memory consolidation. Nat Neurosci 18：1051-1057, 2015

32) Manni R, Terzaghi M：Sleep-disordered breathing in dementia with Lewy bodies. Curr Neurol Neurosci Rep 15：7, 2015

33) McCarter SJ, St Louis EK, Boeve BF：Sleep disturbances in frontotemporal dementia. Curr Neurol Neurosci Rep 16：85, 2016

34) McKeith IG, Dickson DW, Lowe J, et al：Diagnosis and management of dementia with Lewy bodies：third report of the DLB Consortium. Neurology 65：1863-1872, 2005

35) Merlino G, Piani A, Gigli GL, et al：Daytime sleepiness is associated with dementia and cognitive decline in older Italian adults：a population-basedstudy. Sleep Med 11：372-377, 2010

36) Mishima K, Hishikawa Y, Okawa M：Randomized, dim light controlled, crossover test of morning bright light therapy for rest-activity rhythm disorders in patients with vascular dementia and dementia of Alzheimer's type. Chronobiol Int 15：647-654, 1998

37) Molano J, Boeve B, Ferman T, et al：Mild cognitive impairment associated with limbic and neocortical Lewy body disease：a clinicopathological study. Brain 133：540-556, 2010

38) Ohayon MM, Carskadon MA, Guilleminault C, et al：Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals：developing normative sleep values across the human lifespan. Sleep 27：1255-1273, 2004

39) Pao WC, Boeve BF, Ferman TJ, et al：Polysomnographic findings in dementia with Lewy bodies. Neurologist 19：1-6, 2013

40) Peter-Derex L, Yammine P, Bastuji H, et al：Sleep and Alzheimer's disease. Sleep Med Rev 19：29-38, 2015

41) Rebok GW, Rovner BW, Folstein MF：Sleep disturbance and Alzheimer's disease：Aging(Milano)3：193-196, 1991

42) Riemersma-van der Lek RF, Swaab DF, Twisk J, et al：Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities：a randomized controlled trial. JAMA 299：2642-2655, 2008

43) Rongve A, Boeve BF, Aarsland D：Frequency and correlates of caregiver-reported sleep disturbances in a sample of persons with early dementia. J Am Geriatr Soc 58：480-486, 2010

44) Satlin A, Volicer L, Stopa EG, et al：Circadian locomotor activity and core-body temperature rhythms in Alzheimer's disease. Neurobiol Aging 16：765-771, 1995

45) Sforza E, Roche F, Thomas-Anterion C, et al：Cognitive function and sleep related breathing disorders in a healthy elderly population：the SYNAPSE study. Sleep 33：515-521, 2010

46) Spira AP, Blackwell T, Stone KL, et al：Sleep-disordered breathing and cognition in older women. J Am Geriatr Soc 56：45-50, 2008

47) 鈴木貴浩，金野倫子，内山真：認知症と睡眠．ねむりとマネージメント 3：15-19, 2016

48) Tsapanou A, Gu Y, Manly J, et al：Daytime Sleepiness and Sleep Inadequacy as Risk Factors for Dementia. Dement Geriatr Cogn Dis Extra 5：286-295, 2015

49) Uchiyama M, Isse K, Tanaka K, et al：Incidental Lewy body disease in a patient with REM sleep behavior disorder. Neurology 45：709-712, 1995

50) 内山真：高齢者の睡眠構造とその変化について．Aging ＆ Health：67(3)：12-15, 2013

51) 内山真，金野倫子，鈴木貴浩，他：高齢者における睡眠の問題とフレイル．老年精神医学雑誌 27：511-520, 2016

52) van Someren EJ, Hagebeuk EE, Lijzenga C, et al：Circadian rest-activity rhythm disturbances in Alzheimer's disease. Biol Psychiatry 40：259-270, 1996

53) Vitiello MV, Borson S：Sleep disturbances in patients with Alzheimer's disease：epidemiology, pathophysiology and treatment. CNS Drugs 15：777-796, 2001

54) Wilfling D, Junghans A, Marshall, et al：Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane Library 2015. DOI：10.1002/14651858. CD01188

55) Witting W, Kwa IH, Eikelenboom P, et al：Alterations in the circadian rest-activity rhythm in aging and Alzheimer's disease. Biol Psychiatry 27：563-572, 1990

56) Xu J, Wang LL, Dammer EB, et al：Melatonin for sleep disorders and cognition in dementia：a meta-analysis of randomized controlled trials. Am J Alzheimers Dis Other Demen 30：439-447, 2015

57) Yaffe K, Laffan AM, Harrison SL, et al：Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 306：613-619, 2011

58) Yesavage J, Bliwise D, Guilleminault C, et al：Preliminary communication：intellectual deficit and sleep-related respiratory disturbance in the elderly. Sleep 8：30-33, 1985

59) Zhong G, Naismith SL, Rogers NL, et al：Sleep-wake disturbances in common neurodegenerative diseases：a closer look at selected aspects of the neural circuitry. J Neurol Sci 307：9-14, 2011