Cognitive-behavioural therapy improves sleep in patients with mild cognitive impairment

1. In patients with mild cognitive impairment, empowerment-based cognitive behavioural therapy was shown to improve sleep and cognition after 6 months.

2. Patients receiving cognitive behavioural therapy had a greater reduction in insomnia and greater improvement in global cognition when compared to patients receiving standard care.

Evidence Rating Level: 1 (Excellent)

Mild cognitive impairment (MCI) is a transitional stage between normal aging and dementia. Sleep disturbance is an important risk factor for progression to further cognitive impairment. Non-pharmacological sleep-promoting interventions such as cognitive behavioural therapy (CBT) have been shown to improve sleep outcomes. However, the effectiveness of CBT in patients with MCI is unknown. This pilot study aimed to test the feasibility and effectiveness of CBT in improving sleep and cognition in persons with MCI.

The 60 study participants were recruited from elderly community centres in Hong Kong and all had MCI and chronic sleep problems meeting DSM-5 criteria. Participants with confirmed dementia, impaired communication, history of psychiatric or sleep disorders of organic causes, shift workers, or those known to use hypnotics or other medications that affect sleep in the past 2 weeks were excluded. 30 patients were randomized to the control group, where they received usual care. The 30 patients in the intervention group, received empowerment-based CBT delivered over 12 weeks. Group sessions outlined sleep education, with additional support on behavioural maintenance. The Pittsburg Sleep Quality Index (PSQI) was used subjectively to evaluate the quality of sleep while the Insomnia Severity Index (ISI-C) was used to determine perceived severity and distress from insomnia. A Fitbit wristband was given to participants to objectively measure sleep patterns including total time in bed, total sleep time, and sleep efficiency. A battery of neuropsychological tests evaluated global cognition. The primary outcome measures were the PSQI, ISI-C, and various tests for neurocognition.

After 6 months, the intervention group showed greater improvement in sleep quality and reduced insomnia severity as well as improvement in global cognition, processing speed, and attention when compared to the control group. Participants also reported high satisfaction with the design, content, and organization of the intervention, further demonstrating the feasibility of CBT. The study is limited by its convenience sample and predominant female population. Nonetheless, as a pilot study, it demonstrates that CBT can be effectively used to improve sleep in patients with MCI.

Click here to read this study in Journal of Sleep Research

Image: PD

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