Investigation of Cognitive Flexibility, Fatigue, and Depression According to Sleep Quality in Older Adults

Abstract

Objectives: This study aimed to investigate cognitive flexibility, fatigue, and depression according to sleep quality in older adults. Materials and Methods: The research included 144 older adults. The sleep quality of the individuals was measured with the Pittsburgh Sleep Quality Index (PSQI). Individuals were divided into two groups as older adults with good sleep quality and poor sleep quality according to this index score. Cognitive flexibility was assessed using the Stroop TBAG Form, depression with the Beck Depression Inventory, and fatigue with the Fatigue Severity Scale. Results: It was observed that individuals had similar demographic characteristics and health behaviors (p>0.05). It was found that individuals with good sleep quality had higher Montreal Cognitive Assessment Scale scores and shorter completion times for all cards in the Stroop TBAG form (p<0.05). Depression and fatigue levels were found to be significantly higher in the group with poor sleep quality (p<0.05). Conclusion: The study showed that older adults with poor sleep quality had lower levels of cognitive flexibility and higher levels of depression and fatigue. These results highlight the need to assess sleep quality in the management of cognitive decline, depression, and fatigue in older adults.

Keywords

• sleep quality
• cognitive flexibility
• fatigue
• depression
• older adults

Yaşlı Yetişkinlerde Uyku Kalitesine Göre Bilişsel Esneklik, Yorgunluk ve Depresyonun İncelenmesi

Abstract

Amaç: Bu çalışmada yaşlı yetişkinlerde uyku kalitesine göre bilişsel esneklik, yorgunluk ve depresyonun incelenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 144 yaşlı yetişkin katılmıştır. Katılımcıların uyku kaliteleri Pittsburgh Uyku Kalitesi İndeksi’yle ölçülmüştür. Bireyler bu indeks puanına göre iyi uyku kalitesine sahip yaşlılar ve kötü uyku kalitesine sahip yaşlılar olmak üzere iki gruba ayrılmıştır. Bilişsel esneklik Stroop TBAG Formu ile, depresyon Beck Depresyon Envanteri ile ve yorgunluk Yorgunluk Şiddeti Ölçeği kullanılarak değerlendirilmiştir. Bulgular: Bireylerin benzer demografik özelliklere ve sağlık davranışlarına sahip olduğu görülmüştür (p>0,05). Uyku kalitesi iyi olan bireylerin Stroop TBAG formundaki tüm kartları tamamlama sürelerinin daha kısa ve Montreal Bilişsel Değerlendirme puanlarının daha yüksek olduğu gözlenmiştir (p<0,05). Depresyon ve yorgunluk düzeyleri uyku kalitesi kötü olan bireylerde anlamlı şekilde daha yüksek gözlenmiştir (p<0,05). Sonuç: Çalışma sonucunda uyku kalitesi kötü olan yaşlı yetişkinlerde bilişsel esneklik düzeylerinin daha düşük, depresyon ve yorgunluk düzeylerinin ise daha yüksek olduğu gösterildi. Bu sonuçlar, yaşlı yetişkinlerde bilişsel gerileme, depresyon ve yorgunluk sorunlarının yönetiminde uyku kalitesinin de değerlendirilmesi gerekliliğini vurgulamaktadır.

Keywords

• Uyku kalitesi
• bilişsel esneklik
• yorgunluk
• depresyon
• yaşlı yetişkinler

References

1. Ağargün, M. Y., Kara, H., & Anlar, O. (1996). Pittsburgh uyku kalitesi indeksinin geçerliği ve güvenirliği. Türk Psikiyatri Dergisi, 7(2), 107-115.
2. Ahn, J., & Kim, M. (2023). Effects of aerobic exercise on global cognitive function and sleep in older adults with mild cognitive impairment: a systematic review and meta-analysis. Geriatric Nursing, 51, 9-16.
3. Aktürk, Z., Dağdeviren, N., Türe, M., & Tuğlu, C. (2005). Birinci basamak için Beck Depresyon Tarama Ölçeği’nin Türkçe çeviriminin geçerlik ve güvenirliği. Turkish Journal of Family Practice, 9(3), 117-122.
4. Amer, M. S., Hamza, S. A., El Akkad, R. M., & Abdel Galeel, Y. I. (2013). Does self-reported sleep quality predict poor cognitive performance among elderly living in elderly homes? Aging & Mental Health, 17(7), 788-792. https://doi.org/10.1080/13607863.2013.790930
5. Arentson-Lantz, E. J., Deer, R. R., Kokonda, M., Wen, C. L., Pecha, T. A., Carreon, S. A., Ngyen, T. M., Volpi, E., & Nowakowski, S. (2022). Improvements in sleep quality and fatigue are associated with improvements in functional recovery following hospitalization in older adults. Frontiers in Sleep, 1, 1011930. https://doi.org/10.3389/frsle.2022.1011930
6. Ballesio, A., Aquino, M. R. J. V., Kyle, S. D., Ferlazzo, F., & Lombardo, C. (2019). Executive functions in insomnia disorder: a systematic review and exploratory meta-analysis. Frontiers in Psychology, 10, 101. https://doi.org/10.3389/fpsyg.2019.00101
7. Buchmann, N., Spira, D., Norman, K., Demuth, I., Eckardt, R., & Steinhagen-Thiessen, E. (2016). Sleep, muscle mass and muscle function in older people: a cross-sectional analysis based on data from the Berlin Aging Study II (BASE-II). Deutsches Ärzteblatt International, 113(15), 253. https://doi.org/10.3238/arztebl.2016.0253
8. Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4

9. Chen, J., Chen, X., Mao, R., Fu, Y., Chen, Q., Zhang, C., & Zheng, K. (2023). Hypertension, sleep quality, depression, and cognitive function in elderly: A cross-sectional study. Frontiers in Aging Neuroscience, 15, 1051298. https://doi.org/0.3389/fnagi.2023.1051298
10. Diekelmann, S. (2014). Sleep for cognitive enhancement. Frontiers in Systems Neuroscience, 8, 46. https://doi.org/10.3389/fnsys.2014.00046
11. Djamshidian, A., O'Sullivan, S. S., Lees, A., & Averbeck, B. B. (2011). Stroop test performance in impulsive and non impulsive patients with Parkinson's disease. Parkinsonism & Related Disorders, 17(3), 212-214. https://doi.org/10.1016/j.parkreldis.2010.12.014
12. Ehlers, C. L., Reed, T. K., & Henriksen, S. J. (1986). Effects of corticotropin-releasing factor and growth hormone-releasing factor on sleep and activity in rats. Neuroendocrinology, 42(6), 467-474. https://doi.org/10.1159/000124489
13. Endeshaw, Y. (2019). Self-reported insomnia symptom, sleep duration and the risk of recurrent falls among older men and women. European Geriatric Medicine, 10, 303-312. https://doi.org/10.1007/s41999-018-00158-w
14. Fang, H., Tu, S., Sheng, J., & Shao, A. (2019). Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment. Journal of Cellular and Molecular Medicine, 23(4), 2324-2332. https://doi.org/10.1111/jcmm.14170
15. Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5(1), 363-389. https://doi.org/10.1146/annurev.clinpsy.032408.153621
16. Gadie, A., Shafto, M., Leng, Y., & Kievit, R. A. (2017). How are age-related differences in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults. BMJ Open, 7(7), e014920. https://doi.org/10.1136/bmjopen-2016-014920
17. Goldman, S. E., Ancoli-Israel, S., Boudreau, R., Cauley, J. A., Hall, M., Stone, K. L., Rubin, S. M., Satterfield, S., Simonsick, E. M., Newman, A. B., for the Health, A., & Body Composition, S. (2008). Sleep Problems and Associated Daytime Fatigue in Community-Dwelling Older Individuals. The Journals of Gerontology: Series A, 63(10), 1069-1075. https://doi.org/10.1093/gerona/63.10.1069
18. Gonendik, Z. A., Mujdeci, B., Karakurt, S. E., & Dere, H. H. (2021). Assessment of Stroop Color Word Interference Test-TBAG form performance in subjects with tinnitus. European Archives of Oto-Rhino-Laryngology, 278(5), 1403-1409. https://doi.org/10.1007/s00405-020-06221-2
19. Guan, Q., Hu, X., Ma, N., He, H., Duan, F., Li, X., Luo, Y., & Zhang, H. (2020). Sleep quality, depression, and cognitive function in non-demented older adults. Journal of Alzheimer’s Disease, 76(4), 1637-1650. https://doi.org/10.3233/JAD-190990
20. Hardy, S. E., & Studenski, S. A. (2010). Qualities of fatigue and associated chronic conditions among older adults. Journal of Pain and Symptom Management, 39(6), 1033-1042. https://doi.org/10.1016/j.jpainsymman.2009.09.026
21. Holsboer, F., & Ising, M. (2010). Stress hormone regulation: biological role and translation into therapy. Annual Review of Psychology, 61(1), 81-109. https://doi.org/10.1146/annurev.psych.093008.100321
22. Honn, K., Hinson, J., Whitney, P., & Van Dongen, H. (2019). Cognitive flexibility: a distinct element of performance impairment due to sleep deprivation. Accident Analysis & Prevention, 126, 191-197. https://doi.org/10.1016/j.aap.2018.02.013
23. Jaqua Ecler, E., Hanna, M., Labib, W., Moore, C., & Matossian, V. (2023) Common Sleep Disorders Affecting Older Adults. The Permanente Journal, 27(1), 122-132. https://doi.org/10.7812/TPP/22.114
24. Karakaş, S., Erdoğan, E., Sak, L., Soysal, A. Ş., Ulusoy, T., Ulusoy, İ. Y., & Alkan, S. (1999). Stroop Testi TBAG Formu: Türk kültürüne standardizasyon çalışmaları, güvenirlik ve geçerlik. Klinik Psikiyatri, 2(2), 75-88.
25. Li, M., Wang, N., & Dupre, M. E. (2022). Association between the self-reported duration and quality of sleep and cognitive function among middle-aged and older adults in China. Journal of Affective Disorders, 304, 20-27. https://doi.org/10.1016/j.jad.2022.02.039
26. Ma, Y., Liang, L., Zheng, F., Shi, L., Zhong, B., & Xie, W. (2020). Association between sleep duration and cognitive decline. JAMA Network Open, 3(9), e2013573-e2013573. https://doi.org/10.1001/jamanetworkopen.2020.13573
27. Mc Carthy, C. E. (2021). Sleep disturbance, sleep disorders and co-morbidities in the care of the older person. Medical Sciences, 9(2), 31. https://doi.org/10.3390/medsci9020031
28. Ni, Y., Yu, M., & Liu, C. (2024). Sleep disturbance and cognition in the elderly: a narrative review. Anesthesiology and Perioperative Science, 2(3), 26. https://doi.org/10.1007/s44254-024-00066-2
29. Ohara, T., Honda, T., Hata, J., Yoshida, D., Mukai, N., Hirakawa, Y., Shibata, M., Kishimoto, H., Kitazono, T., & Kanba, S. (2018). Association between daily sleep duration and risk of dementia and mortality in a Japanese community. Journal of the American Geriatrics Society, 66(10), 1911-1918. https://doi.org/10.1111/jgs.15446
30. Okuda, M., Noda, A., Iwamoto, K., Nakashima, H., Takeda, K., Miyata, S., Yasuma, F., Ozaki, N., & Shimouchi, A. (2021). Effects of long sleep time and irregular sleep–wake rhythm on cognitive function in older people. Scientific reports, 11(1), 7039. https://doi.org/10.1038/s41598-021-85817-y
31. Opp, M., Obal Jr, F., & Krueger, J. (1989). Corticotropin-releasing factor attenuates interleukin 1-induced sleep and fever in rabbits. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 257(3), R528-R535. https://doi.org/10.1152/ajpregu.1989.257.3.R528
32. Ozturk, E. A., Kocer, B. G., Gundogdu, I., Umay, E., & Cakci, F. A. (2017). Reliability and validity study of a Turkish version of the fatigue severity scale in Parkinson’s disease patients. International Journal of Rehabilitation Research, 40(2), 185-190. https://doi.org/10.1097/MRR.0000000000000224
33. Pappas, J. A., & Miner, B. (2022). Sleep deficiency in the elderly. Clinics in Chest Medicine, 43(2), 273-286. https://doi.org/10.1016/j.ccm.2022.02.005
34. Parra-Díaz, A. B., Aibar-Almazán, A., Martínez-Amat, A., Jiménez-García, J. D., Álvarez-Salvago, F., & Hita-Contreras, F. (2021). Associations of Sleep Quality, Anxiety, and Depression with Cognitive and Executive Functions among Community-Dwelling Women Aged ≥ 65 Years: A Cross-Sectional Study. Healthcare, 9(11), 1599. https://doi.org/10.3390/healthcare9111599
35. Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the elderly: a review. Journal of Clinical Sleep Medicine, 14(6), 1017-1024. https://doi.org/10.5664/jcsm.7172
36. Qian, S., Yong, C., Li, S., Peng, J., Li, X., Ye, Q., ... & Zhou, J. (2025). Bidirectional Relationships Between Sleep Quality and Cognitive Function in Older Chinese Adults: Observational Analysis of SAWA Trial. American Journal of Health Promotion, 39(6), 880-889.
37. Simoes Maria, M., Büla, C., Santos-Eggimann, B., Krief, H., Heinzer, R., & Seematter-Bagnoud, L. (2020). Sleep characteristics and self-rated health in older persons. European Geriatric Medicine, 11, 131-138. https://doi.org/10.1007/s41999-019-00262-5
38. Sindi, S., Kåreholt, I., Johansson, L., Skoog, J., Sjöberg, L., Wang, H.-X., Johansson, B., Fratiglioni, L., Soininen, H., & Solomon, A. (2018). Sleep disturbances and dementia risk: a multicenter study. Alzheimer's & Dementia, 14(10), 1235-1242. https://doi.org/10.1016/j.jalz.2018.05.012
39. Smagula, S. F., Stone, K. L., Fabio, A., & Cauley, J. A. (2016). Risk factors for sleep disturbances in older adults: evidence from prospective studies. Sleep Medicine Reviews, 25, 21-30. https://doi.org/10.1016/j.smrv.2015.01.003
40. Song, D., Zhou, J., Ma, J., Chang, J., Qiu, Y., Zhuang, Z., Xiao, H., & Zeng, L. (2021). Sleep disturbance mediates the relationship between depressive symptoms and cognitive function in older adults with mild cognitive impairment. Geriatric Nursing, 42(5), 1019-1023. https://doi.org/10.1016/j.gerinurse.2021.06.004
41. Song, D., Yu, D., Liu, T., & Wang, J. (2024). Effect of an aerobic dancing program on sleep quality for older adults with mild cognitive impairment and poor sleep: a randomized controlled trial. Journal of the American Medical Directors Association, 25(3), 494-499.
42. Spira, A. P., Covinsky, K., Rebok, G. W., Punjabi, N. M., Stone, K. L., Hillier, T. A., Ensrud, K. E., & Yaffe, K. (2012). Poor sleep quality and functional decline in older women. Journal of the American Geriatrics Society, 60(6), 1092-1098. https://doi.org/10.1111/j.1532-5415.2012.03968.x
43. Suh, S. W., Han, J. W., Lee, J. R., Byun, S., Kwon, S. J., Oh, S. H., Lee, K. H., Han, G., Hong, J. W., Kwak, K. P., Kim, B. J., Kim, S. G., Kim, J. L., Kim, T. H., Ryu, S. H., Moon, S. W., Park, J. H., Seo, J., Youn, J. C.,…Kim, K. W. (2018). Sleep and cognitive decline: A prospective nondemented elderly cohort study. Annals of Neurology, 83(3), 472-482. https://doi.org/10.1002/ana.25166
44. Vestergaard, S., Nayfield, S. G., Patel, K. V., Eldadah, B., Cesari, M., Ferrucci, L., Ceresini, G., & Guralnik, J. M. (2009). Fatigue in a representative population of older persons and its association with functional impairment, functional limitation, and disability. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 64(1), 76-82. https://doi.org/10.1093/gerona/gln017
45. Warsame, F., Chu, N. M., Hong, J., Mathur, A., Crews, D. C., Bayliss, G., Segev, D. L., & McAdams-DeMarco, M. A. (2023). Sleep duration and cognitive function among older adults with chronic kidney disease: results from the National Health and Nutrition Examination Survey (2011–2014). Nephrology Dialysis Transplantation, 38(7), 1636-1644. https://doi.org/10.1093/ndt/gfac325