Related Experiment Video

Updated: Jul 12, 2025

Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression

Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression

Published on: April 26, 2024

Prevalence and Risk of Behavioral Symptoms among Patients with Insomnia and Alzheimer's Disease: A Retrospective

Farid Chekani¹, Sean P Fleming¹, Kirti Mirchandani²

¹Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA.

Journal of the American Medical Directors Association

|October 25, 2023

Abstract

Objectives:

This study evaluated the prevalence and patterns of behavioral symptoms, including agitation/aggression (AA), psychotic symptoms (PS), anxiety/mood disorders (MD), and delirium among patients with Alzheimer's disease (AD) and their association with diagnosed insomnia.

Design:

A retrospective cohort analysis was conducted using the MarketScan Multi-State Medicaid Database 2016-2020.

Setting And Participants:

Patients aged ≥50 with newly diagnosed AD (N = 56,904) were identified during 2017-2019 and categorized into insomnia and non-insomnia groups based on billing codes recorded in medical and pharmacy claims.

Methods:

The index date was defined as the earliest date of diagnosis/medication of insomnia. The new diagnosis of AD had to be established within 12 months before (baseline) or 3 months after the index date. Point prevalence of behavioral symptoms was estimated during baseline and the 12-month follow-up period. Propensity score matching was performed to match patients with and without insomnia. Multivariable conditional logistic regression was used to assess the risk of diagnosis of behavioral symptoms among insomnia and non-insomnia groups.

Results:

The study cohort included 7808 patients with newly diagnosed AD (mean age = 79.4, SD = 9.6 years). The point prevalence of behavioral symptoms was as follows: among those with insomnia (n = 3904), in the baseline, AA = 9.0%, PS = 12.5%, and MD = 57.8%, and during the follow-up, AA = 13.9%, PS = 16.3%, and MD = 72.1%; among those without insomnia (n = 3904), in the baseline, AA = 6.2%, PS = 9.2%, and MD = 41.4%; and during the follow-up, AA = 7.4%, PS = 10.4%, and MD = 49.2%. The likelihood of being diagnosed with any behavioral symptoms in the follow-up period was significantly higher among patients with insomnia than those without [adjusted odds ratio (OR), 2.7; 95% confidence interval (CI), 2.4-3.1].

Conclusions And Implications:

In patients with AD, prevalence of behavioral symptoms and likelihood of being diagnosed with behavioral symptoms were significantly higher among patients with diagnosed insomnia. Further investigation is needed to understand the relationship between insomnia and behavioral symptoms in patients with AD.

Keywords:

Alzheimer's disease behavioral symptoms insomnia

More Related Videos

A Chronic Sleep Fragmentation Model using Vibrating Orbital Rotor to Induce Cognitive Deficit and Anxiety-Like Behavior in Young Wild-Type Mice

A Chronic Sleep Fragmentation Model using Vibrating Orbital Rotor to Induce Cognitive Deficit and Anxiety-Like Behavior in Young Wild-Type Mice

Published on: September 22, 2020

A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment

A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment

Published on: January 11, 2020

Related Concept Videos

Insomnia

Insomnia

Insomnia is a prevalent sleep disorder characterized by difficulty falling asleep, frequent awakenings during the night, and waking up too early without being able to return to sleep. People with insomnia often experience these disruptions at least three nights a week for at least one month. Chronic insomnia, which lasts for at least three months, can lead to increased anxiety, which in turn can worsen sleep difficulties, creating a cycle of sleeplessness and stress.
Multiple factors contribute...

Alzheimer's Disease: Overview

Alzheimer's Disease: Overview

Alzheimer's Disease (AD) is a continually advancing neurodegenerative disorder, distinguished by escalating memory loss, cognitive dysfunction, and dementia. The disease unfolds in three stages: preclinical, mild cognitive impairment (MCI), and dementia. Its onset is insidious, and the progression gradual, with the cause not well explained by other disorders.
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ...

Alzheimer's Disease: Treatment

Alzheimer's Disease: Treatment

Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...

Management of Insomnia

Management of Insomnia

The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...

REM Sleep Behavior Disorder

REM Sleep Behavior Disorder

REM Sleep Behavior Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis that normally occurs during the REM phase of sleep. This absence allows individuals to physically act out their dreams, which are often vivid and disturbing. Common behaviors exhibited during episodes include kicking, punching, and yelling. These actions can be dangerous, potentially leading to injuries for the person with RBD or their bed partner.
RBD is significantly associated with...

Sleepwalking and Sleep Talking

Sleepwalking and Sleep Talking

Somnambulism, commonly known as sleepwalking, involves individuals engaging in activities ranging from simple walking to more complex behaviors such as driving. Sleepwalking typically occurs during the slow-wave sleep stages 3 and 4 early in the night when the person is not dreaming, contradicting the myth that sleepwalkers are acting out their dreams.
Factors that increase the likelihood of sleepwalking include sleep deprivation and alcohol consumption. Contrary to common beliefs, it is safe...

Articles linked to this work by shared authors, journal, and citation graph.

Comorbidity and polypharmacy burden among people living with HIV in the United States stratified by age, sex, and race: updated evidence from a contemporary cohort.

HIV research & clinical practice·2026

Prevalence and Severity of Potential Drug-Drug Interactions in People Living with HIV on Antiretroviral Therapy in the United States.

Infectious diseases and therapy·2026

Long‑Term Effectiveness and Safety of Doravirine‑Based Antiretroviral Regimens in Virologically Suppressed People with HIV: The French Dat'AIDS Cohort.

Infectious diseases and therapy·2026

Sleep Disturbance in Opioid Use Disorder: Systematic Review of Insomnia Prevalence and Sedative-Hypnotic Utilization.

Substance use & misuse·2026

Healthcare Utilization and Costs in People Living with HIV and Neuropsychiatric Disorders in the United States.

Advances in therapy·2026

Iron-Catalyzed Stereoselective Synthesis of Dihydrobenzofurans from O-Tethered Enynes and DDQ-Mediated Oxidative Annulation to Dibenzofurans.

Organic letters·2026

See all related articles