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The Troubling Link Between Poor Sleep and Dementia

With the incidence of dementia increasing in Canada, there has been a heightened focus on quality of life for older adults and caregivers, as well as interventions that can help to prevent or alleviate symptoms of dementia, such as proper nutrition and strong social connections. One important area of care that seems to receive relatively little attention, however, is sleep. The medical literature is replete with studies showing a link between poor sleep and factors frequently associated with dementia. For example, a 2014 study appearing in the journal Sleep, a joint publication of the Sleep Research Society and the American Academy of Sleep Medicine, suggests that poor sleep quality is associated with the subsequent development of cognitive decline. In particular, fragmented sleep and lower sleep efficiency were associated with an increase in the likelihood of clinically significant decline in executive function which, with respect to the test the study’s authors used, is akin in magnitude to a five year increase in age.

The reference to diminished executive function in the Sleep study is significant when it comes to dementia. Executive function is thought to emanate primarily from the frontal lobes of the brain. This area is responsible for a variety of functions, and is implicated in our high level thinking skills, including our ability to anticipate outcomes, form concepts and adapt to change. Executive function also involves judgment, decision making, concentration and other cognitive functions. As damage from a condition affecting the brain, including dementia, progresses to the frontal lobes, a person may struggle with issues involving executive function, which can diminish that person’s ability to handle tasks such as the management of finances.

Insight such as that provided in the Sleep study has serious consequences for older adults not only from a medical perspective, but from a legal perspective, particularly when it comes to assessing decisional capacity. At law, every person is presumed capable of making decisions unless and until that presumption is rebutted. A person cannot be found to be generally capable. Instead, we assess decisional capacity based on standards or factors that are applied and considered in the context of the particular time, situation and task at hand. Broadly speaking, capacity to make a decision is demonstrated by an ability to understand all the information that is relevant to a decision, as well as its possible implications. These abilities are associated with executive function. This means that poor sleep, to the extent that it hastens or worsens cognitive decline, might lead to an increase in individuals being deemed by law to lack the capacity to make particular decisions, or to be found as such earlier than they otherwise might have been. The consequences of poor sleep, then, are potentially life-altering.

Beyond acting as yet another reminder of the importance of a good night’s rest, the possible impact of poor sleep quality on cognitive function and dementia serves to remind us of the myriad factors that can contribute to a person’s decisional capacity and general wellbeing. Sleep is just one element affecting our overall functioning. With the escalated prevalence of dementia in our society, it is clear that we must enhance the time and attention we afford to quality of care. To this end, Ontario has recently increased funding to the Alzheimer Society of Ontario’s “Finding Your Way” program to improve training and services. This type of assistance constitutes an encouraging development and a much needed support as we seek to improve and refine our approach to dementia care.

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