Multicenter Study on Sleep and Circadian Alterations as Objective Markers of Mild Cognitive Impairment and Alzheimer's Disease Reveals Sex Differences

Biancamaria Guarnieri, Michelangelo Maestri, Federico Cucchiara, Annalisa Lo Gerfo, Alessandro Schirru, Dario Arnaldi, Pietro Mattioli, Flavio Nobili, Gemma Lombardi, Gianluigi Cerroni, Antonella Bartoli, Raffaele Manni, Elena Sinforiani, Michele Terzaghi, Maria Grazia Arena, Rosalia Silvestri, Chiara La Morgia, Maria Caterina Di Perri, Ferdinando Franzoni, Gloria TognoniMichelangelo Mancuso, Sandro Sorbi, Ubaldo Bonuccelli, Gabriele Siciliano, Ugo Faraguna, Enrica Bonanni

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Circadian and sleep disturbances are associated with increased risk of mild cognitive impairment (MCI) and Alzheimer's disease (AD). Wearable activity trackers could provide a new approach in diagnosis and prevention.

OBJECTIVE: To evaluate sleep and circadian rhythm parameters, through wearable activity trackers, in MCI and AD patients as compared to controls, focusing on sex dissimilarities.

METHODS: Based on minute level data from consumer wearable devices, we analyzed actigraphic sleep parameters by applying an electromedical type I registered algorithm, and the corresponding circadian variables in 158 subjects: 86 females and 72 males (42 AD, 28 MCI, and 88 controls). Moreover, we used a confusion-matrix chart method to assess accuracy, precision, sensitivity, and specificity of two decision-tree models based on actigraphic data in predicting disease or health status.

RESULTS: Wake after sleep onset (WASO) was higher (p < 0.001) and sleep efficiency (SE) lower (p = 0.003) in MCI, and Sleep Regularity Index (SRI) was lower in AD patients compared to controls (p = 0.004). SE was lower in male AD compared to female AD (p = 0.038) and SRI lower in male AD compared to male controls (p = 0.008), male MCI (p = 0.047), but also female AD subjects (p = 0.046). Mesor was significantly lower in males in the overall population. Age reduced the dissimilarities for WASO and SE but demonstrated sex differences for amplitude (p = 0.009) in the overall population, controls (p = 0.005), and AD subjects (p = 0.034). The confusion-matrices showed good predictive power of actigraphic data.

CONCLUSION: Actigraphic data could help identify disease or health status. Sex (possibly gender) differences could impact on neurodegeneration and disease trajectory with potential clinical applications.

Original languageEnglish
Pages (from-to)1707-1719
Number of pages13
JournalJournal of Alzheimer's disease : JAD
Issue number4
Publication statusPublished - 2020


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