Leucocyte count reduction as a predictor for better clinical outcome in Hemorrhagic Stroke patients During Hospitalization In Sanglah Hospital Denpasar.
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/281276711
POOR QUALITY OF SLEEP CORRELATED WITH
ELDERLY COGNITIVE IMPAIRMENT
CONFERENCE PAPER · AUGUST 2015
READS
27
5 AUTHORS, INCLUDING:
Eka Widyadharma
Udayana University, Bali, Indonesia
18 PUBLICATIONS 0 CITATIONS
SEE PROFILE
All in-text references underlined in blue are linked to publications on ResearchGate,
letting you access and read them immediately.
Available from: Eka Widyadharma
Retrieved on: 22 February 2016
POOR QUALITY OF SLEEP CORRELATED WITH
ELDERLY COGNITIVE IMPAIRMENT
Yuliantry Indah Lestari*, Utami, DK Indrasari **, Budiarsa, IGN**, Eka Widyadharma**
Neurology Department, Faculty of Medicine, Udayana University/Sanglah General Hospital
Denpasar, Bali
ABSTRACT
BACKGROUND
Physiologically the increasing age will reduce levels of melatonin in the body. It often causes
problems in the elderly sleep quality. Impaired quality of sleep is much associated with impaired
cognitive function. Research on the relationship between sleep quality of elderly with cognitive
function has not been done in Indonesia.
PURPOSE
To determine poor sleep quality correlated with the cognitive impairment in the elderly.
METHOD
This is a cross sectional study that using sampling consecutive methode. The Pittsburgh
Sleep Quality Index (PSQI) have been done to assess the quality of sleep and cognitive
impairement assessed by Montreal Cognitive Assesment- Indonesia ( MoCA-INA). Descriptive
analysis and spearman’s test were performed with SPSS 16.0 for Windows
RESULTS
Samples were obtained as many as 52 people with the proportion of 34(65,4%) of woman.
The mean age of subject 67,77 ± 4,68 years old with level of education 20 (38,5%) subject
mostly in elementary school. The mean PSQI score of subject 11,50 ± 5,086 and mean
MoCA-INA score 23,06± 2,052. There is a weak correlation (r = -0,399) between poor sleep
quality and impaired cognitive function which significant with statistical analysis (p=0,003 ).
CONCLUSION
Poor sleep quality correlated with cognitive impairment in the elderly.
Keywords: cognitive function, elderly, sleep quality
=====================================================================
*Resident of Neurology Department, Faculty of Medicine, Udayana University/Sanglah General
Hospital,
Denpasar
**Lecturer of Neurology Department, Faculty of Medicine, Udayana University/Sanglah General
Hospital, Denpasar
INTRODUCTION
The world is currently experiencing
demographic revolution in which the
number of elderly is increasing. Elderly is
defined as the age of 60 or more as defined
by the World Health Organization that
consists of (1) elderly 60-74 years, (2) old
elderly 75-90 years, (3) very old elderly
above 90 years. Currently population age 60
years or more is a tenth of total population,
and by 2050 it is estimated to become a fifth
and in 2150 it is estimated to be a third.
More than half of them live in developing
countries. In Indonesia, in 1999, the
proportion of population aged 60-64 years is
2,9 %, the group age 65-69 years of 2,3%,
the group age 70-74 years 1,4%, and
population aged 75 years or more are 1,4%
1. According to the estimation from United
State Bureau of Census 1993, the population
of elderly in Indonesia is projected to
increase 414% during the years 1990-2023,
Presented at National Congress of Indonesian Neurological Association, MAKASSAR, Agustus, 7‐9th 2015
1
the number that is highest in the world. In
2020 the number of elderly in Indonesia will
rank the fourth after China, India and the
United States2.
In a community based-study, it was
found that the prevalence of mild to severe
cognitive impairment to be 17-34% of
elderly population3. More than 80% elderly
suffered from physical diseases that interfere
with their independence in carrying out daily
functions. A number of 30% patients who
have physical diseases have psychiatric
comorbidities, especially depression and
anxiety. Most elderly with physical diseases
and mental disorders have sleeping
disorders.
Sleep and its stages is correlated to
the process of consolidation of declarative
and procedural memories5. REM (Rapid Eye
Movement) sleep is beneficial for restoring
the ability of learning, consolidation of
memory, restoration of adrenergic system
and restoration od reticular system to make
ready for arousal6. Zimmerman et al,2006
stated that memory impairment is a
cognitive impairment that is commonly
found in patients with Obstructive Sleep
Apnea (OSA)7.
The existence of cognitive impairment
might interfere in conducting the Activities
of Daily Living-ADL, and this might
decrease the quality of life of elderly which
implies interference in independence in
carrying out the activity of daily living. The
lost of social function and the function of
independence in elderly will lead to
problems with family members. The
research concerning sleep quality which are
specifically correlated to cognitive function
disturbances in elderly is rarely found in
Indonesia. This is the reason why this
community based research was conducted.
The community chosen was an elderly
integrated care post (posyandu) in Banjar
Batanancak and Banjar Kedaton, Tonja
Village. These two locations were chosen
because these two elderly posyandu is active
at carrying out activities for its members.
AIM
This research aimed at determining
the correlation between impaired sleep
quality and the occurrence of declined
cognitive function in elderly in Banjar
Batanancak and Kedaton, Tonja village,
Denpasar.
METHODS
This research is an analytic
observational research with cross sectional
design with elderly in Banjar Batanancak
and Kedaton Desa Tonja Denpasar. Samples
were
obtained
using
non
random
consecutive sampling. Inclusion criteris is
age of ≥ 60 years, cooperative and provided
consent to participate in this research.
Elderly who were unable to do the activities
of daily living independently and
experiencing severe mental disorder
(schizophrenia) were excluded. All elderly
who came to Banjar Batanancak and
Kedaton Desa Tonja Denpasar were noted
for demographic characteristics. The sex of
the research subjects were distinguished as
male and female based on the interview with
nominal measurement scale. The educational
level was defined as the educational stage
that was able to be completed, and was
categorized as no school, elementary school,
junior highschool, senior highschool, and
higher education. The data were obtained
from the interview. Sleep quality and
cognitive function was determined by
instruments.
The sleep quality was measured
subjectively using The Pittsburgh Sleep
Quality Index (PSQI) with examination of 7
components of latency, duration, quality,
efficiency of sleep habit, sleep disorder, the
use of sleeping pill, and disturbance of
bodily function in day time 8. The PSQI
questionnaire consists of 9 item of questions
with each questions scored 0-3. To assess
sleep efficiency in components number 4
based on summation and division of values
obtained from scores of questions item
number 1, 3, 4. The calculation was by
summing the duration of sleep (in hours)
divided by the duration of being on the bed
and multiply it by 100%. If the result is
>85% it would be scored 0, 75-84% woild
Presented at National Congress of Indonesian Neurological Association, MAKASSAR, Agustus, 7‐9th 2015
2
be scored 1, 65-74% is scored 2, and 5. Higher PSQI showed poorer sleep
quality.
Cognitive function was subjectively
measured using Indonesian version of
Montreal Cognitive Assesment (MoCa-Ina).
This test is used to determine the presence of
Mild Cognitive impairment (MCI). MoCA
consists of 30 questions that can be
completed in 10 minutes and assess some
domains of cognitive functions. The
research from Nasreddine dkk in 2005 to
validate to detect the ones with mild
cognitive impairment and early Alzheimer’s
disease
using
Mini
Mental
State
Examination (MMSE) and Montreal
Cognitive Assesment (MoCA). From those
research, the cut off point of 26 was
obtained to detect MCI using MoCA has
sensitivity of 90% and specificity of 87%
with subjects 94 people. So for MoCa, when
subjects obtained value of ≥26 it was
considered
normal10,11.
Husein
dkk,
produced the instrument MoCa in
Indonesian language (MoCA-INA) that has
been validated in concordance to rules of
validation, transcultural, and reliable, with
total Kappa score between 2 doctors (inter
rater) was 0,820. While in each domain:
visuospatial/executive 0,817; naming 0,985
and attention 0,969. While for language
domain 0,990; abstraction 0,957; memory
0,984 and 1,00. This instrument is able to be
used in screening of cognitive function in
Indonesian patients.12 Impaired cognitive
function was determined if MoCA-INA
score was 0,05 no significant correlation
was found between the two variables. The
strength of the correlation (r) was
determined if the value of r 0,0-
POOR QUALITY OF SLEEP CORRELATED WITH
ELDERLY COGNITIVE IMPAIRMENT
CONFERENCE PAPER · AUGUST 2015
READS
27
5 AUTHORS, INCLUDING:
Eka Widyadharma
Udayana University, Bali, Indonesia
18 PUBLICATIONS 0 CITATIONS
SEE PROFILE
All in-text references underlined in blue are linked to publications on ResearchGate,
letting you access and read them immediately.
Available from: Eka Widyadharma
Retrieved on: 22 February 2016
POOR QUALITY OF SLEEP CORRELATED WITH
ELDERLY COGNITIVE IMPAIRMENT
Yuliantry Indah Lestari*, Utami, DK Indrasari **, Budiarsa, IGN**, Eka Widyadharma**
Neurology Department, Faculty of Medicine, Udayana University/Sanglah General Hospital
Denpasar, Bali
ABSTRACT
BACKGROUND
Physiologically the increasing age will reduce levels of melatonin in the body. It often causes
problems in the elderly sleep quality. Impaired quality of sleep is much associated with impaired
cognitive function. Research on the relationship between sleep quality of elderly with cognitive
function has not been done in Indonesia.
PURPOSE
To determine poor sleep quality correlated with the cognitive impairment in the elderly.
METHOD
This is a cross sectional study that using sampling consecutive methode. The Pittsburgh
Sleep Quality Index (PSQI) have been done to assess the quality of sleep and cognitive
impairement assessed by Montreal Cognitive Assesment- Indonesia ( MoCA-INA). Descriptive
analysis and spearman’s test were performed with SPSS 16.0 for Windows
RESULTS
Samples were obtained as many as 52 people with the proportion of 34(65,4%) of woman.
The mean age of subject 67,77 ± 4,68 years old with level of education 20 (38,5%) subject
mostly in elementary school. The mean PSQI score of subject 11,50 ± 5,086 and mean
MoCA-INA score 23,06± 2,052. There is a weak correlation (r = -0,399) between poor sleep
quality and impaired cognitive function which significant with statistical analysis (p=0,003 ).
CONCLUSION
Poor sleep quality correlated with cognitive impairment in the elderly.
Keywords: cognitive function, elderly, sleep quality
=====================================================================
*Resident of Neurology Department, Faculty of Medicine, Udayana University/Sanglah General
Hospital,
Denpasar
**Lecturer of Neurology Department, Faculty of Medicine, Udayana University/Sanglah General
Hospital, Denpasar
INTRODUCTION
The world is currently experiencing
demographic revolution in which the
number of elderly is increasing. Elderly is
defined as the age of 60 or more as defined
by the World Health Organization that
consists of (1) elderly 60-74 years, (2) old
elderly 75-90 years, (3) very old elderly
above 90 years. Currently population age 60
years or more is a tenth of total population,
and by 2050 it is estimated to become a fifth
and in 2150 it is estimated to be a third.
More than half of them live in developing
countries. In Indonesia, in 1999, the
proportion of population aged 60-64 years is
2,9 %, the group age 65-69 years of 2,3%,
the group age 70-74 years 1,4%, and
population aged 75 years or more are 1,4%
1. According to the estimation from United
State Bureau of Census 1993, the population
of elderly in Indonesia is projected to
increase 414% during the years 1990-2023,
Presented at National Congress of Indonesian Neurological Association, MAKASSAR, Agustus, 7‐9th 2015
1
the number that is highest in the world. In
2020 the number of elderly in Indonesia will
rank the fourth after China, India and the
United States2.
In a community based-study, it was
found that the prevalence of mild to severe
cognitive impairment to be 17-34% of
elderly population3. More than 80% elderly
suffered from physical diseases that interfere
with their independence in carrying out daily
functions. A number of 30% patients who
have physical diseases have psychiatric
comorbidities, especially depression and
anxiety. Most elderly with physical diseases
and mental disorders have sleeping
disorders.
Sleep and its stages is correlated to
the process of consolidation of declarative
and procedural memories5. REM (Rapid Eye
Movement) sleep is beneficial for restoring
the ability of learning, consolidation of
memory, restoration of adrenergic system
and restoration od reticular system to make
ready for arousal6. Zimmerman et al,2006
stated that memory impairment is a
cognitive impairment that is commonly
found in patients with Obstructive Sleep
Apnea (OSA)7.
The existence of cognitive impairment
might interfere in conducting the Activities
of Daily Living-ADL, and this might
decrease the quality of life of elderly which
implies interference in independence in
carrying out the activity of daily living. The
lost of social function and the function of
independence in elderly will lead to
problems with family members. The
research concerning sleep quality which are
specifically correlated to cognitive function
disturbances in elderly is rarely found in
Indonesia. This is the reason why this
community based research was conducted.
The community chosen was an elderly
integrated care post (posyandu) in Banjar
Batanancak and Banjar Kedaton, Tonja
Village. These two locations were chosen
because these two elderly posyandu is active
at carrying out activities for its members.
AIM
This research aimed at determining
the correlation between impaired sleep
quality and the occurrence of declined
cognitive function in elderly in Banjar
Batanancak and Kedaton, Tonja village,
Denpasar.
METHODS
This research is an analytic
observational research with cross sectional
design with elderly in Banjar Batanancak
and Kedaton Desa Tonja Denpasar. Samples
were
obtained
using
non
random
consecutive sampling. Inclusion criteris is
age of ≥ 60 years, cooperative and provided
consent to participate in this research.
Elderly who were unable to do the activities
of daily living independently and
experiencing severe mental disorder
(schizophrenia) were excluded. All elderly
who came to Banjar Batanancak and
Kedaton Desa Tonja Denpasar were noted
for demographic characteristics. The sex of
the research subjects were distinguished as
male and female based on the interview with
nominal measurement scale. The educational
level was defined as the educational stage
that was able to be completed, and was
categorized as no school, elementary school,
junior highschool, senior highschool, and
higher education. The data were obtained
from the interview. Sleep quality and
cognitive function was determined by
instruments.
The sleep quality was measured
subjectively using The Pittsburgh Sleep
Quality Index (PSQI) with examination of 7
components of latency, duration, quality,
efficiency of sleep habit, sleep disorder, the
use of sleeping pill, and disturbance of
bodily function in day time 8. The PSQI
questionnaire consists of 9 item of questions
with each questions scored 0-3. To assess
sleep efficiency in components number 4
based on summation and division of values
obtained from scores of questions item
number 1, 3, 4. The calculation was by
summing the duration of sleep (in hours)
divided by the duration of being on the bed
and multiply it by 100%. If the result is
>85% it would be scored 0, 75-84% woild
Presented at National Congress of Indonesian Neurological Association, MAKASSAR, Agustus, 7‐9th 2015
2
be scored 1, 65-74% is scored 2, and 5. Higher PSQI showed poorer sleep
quality.
Cognitive function was subjectively
measured using Indonesian version of
Montreal Cognitive Assesment (MoCa-Ina).
This test is used to determine the presence of
Mild Cognitive impairment (MCI). MoCA
consists of 30 questions that can be
completed in 10 minutes and assess some
domains of cognitive functions. The
research from Nasreddine dkk in 2005 to
validate to detect the ones with mild
cognitive impairment and early Alzheimer’s
disease
using
Mini
Mental
State
Examination (MMSE) and Montreal
Cognitive Assesment (MoCA). From those
research, the cut off point of 26 was
obtained to detect MCI using MoCA has
sensitivity of 90% and specificity of 87%
with subjects 94 people. So for MoCa, when
subjects obtained value of ≥26 it was
considered
normal10,11.
Husein
dkk,
produced the instrument MoCa in
Indonesian language (MoCA-INA) that has
been validated in concordance to rules of
validation, transcultural, and reliable, with
total Kappa score between 2 doctors (inter
rater) was 0,820. While in each domain:
visuospatial/executive 0,817; naming 0,985
and attention 0,969. While for language
domain 0,990; abstraction 0,957; memory
0,984 and 1,00. This instrument is able to be
used in screening of cognitive function in
Indonesian patients.12 Impaired cognitive
function was determined if MoCA-INA
score was 0,05 no significant correlation
was found between the two variables. The
strength of the correlation (r) was
determined if the value of r 0,0-