Background/Aims: Hypocretin promotes wakefulness and modulates REM sleep. Alterations in the hypocretin system are increasingly implicated in dementia. We evaluated relationships among hypocretin, dementia biomarkers, and sleep symptoms in elderly participants, most of whom had dementia. Methods: One-hundred twenty-six adults (mean age 66.2 ± 8.4 years) were recruited from the Emory Cognitive Clinic. Diagnoses were Alzheimer disease (AD; n = 60), frontotemporal dementia (FTD; n = 21), and dementia with Lewy bodies (DLB; n = 20). We also included cognitively normal controls (n = 25). Participants and/or caregivers completed sleep questionnaires and lumbar puncture was performed for cerebrospinal fluid (CSF) assessments. Results: Except for sleepiness (worst in DLB) and nocturia (worse in DLB and FTD) sleep symptoms did not differ by diagnosis. CSF hypocretin concentrations were available for 87 participants and normal in 70, intermediate in 16, and low in 1. Hypocretin levels did not differ by diagnosis. Hypocretin levels correlated with CSF total τ levels only in men (r = 0.34; p = 0.02). Lower hypocretin levels were related to frequency of nightmares (203.9 ± 29.8 pg/mL in those with frequent nightmares vs. 240.4 ± 46.1 pg/mL in those without; p = 0.05) and vivid dreams (209.1 ± 28.3 vs. 239.5 ± 47.8 pg/mL; p = 0.014). Cholinesterase inhibitor use was not associated with nightmares or vivid dreaming. Conclusion: Hypocretin levels did not distinguish between dementia syndromes. Disturbing dreams in dementia patients may be related to lower hypocretin concentrations in CSF.
Dement Geriatr Cogn Disord Extra 2021;11:19–25

中文翻译：

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痴呆综合征中的脑脊液伪君子和噩梦

背景/目的： Hypocretin 促进清醒和调节 REM 睡眠。伪君子系统的改变越来越多地与痴呆症有关。我们评估了老年参与者的伪君子、痴呆生物标志物和睡眠症状之间的关系，其中大多数人患有痴呆。方法：从 Emory 认知诊所招募了 126 名成年人（平均年龄 66.2 ± 8.4 岁）。诊断为阿尔茨海默病（AD； n = 60）、额颞叶痴呆（FTD； n = 21）和路易体痴呆（DLB； n = 20）。我们还包括认知正常的对照组（ n= 25)。参与者和/或护理人员完成了睡眠问卷，并进行了腰椎穿刺以进行脑脊液 (CSF) 评估。结果：除了嗜睡（在 DLB 中最严重）和夜尿（在 DLB 和 FTD 中最严重），睡眠症状没有因诊断而异。87 名参与者的 CSF 伪君子浓度可用，其中 70 人正常，16 人中等，1 人低。伪君子水平不因诊断而异。仅在男性中，伪君子水平与 CSF 总 τ 水平相关（r = 0.34；p = 0.02）。较低的伪君子水平与噩梦的频率有关（经常做噩梦的人为 203.9 ± 29.8 pg/mL，没有做噩梦的人为 240.4 ± 46.1 pg/mL；p= 0.05）和生动的梦境（209.1 ± 28.3 vs. 239.5 ± 47.8 pg/mL；p = 0.014）。胆碱酯酶抑制剂的使用与噩梦或生动的梦境无关。结论： Hypocretin 水平不能区分痴呆综合征。痴呆症患者的令人不安的梦可能与脑脊液中较低的伪君子浓度有关。
Dement Geriatr Cogn Disord Extra 2021；11:19–25