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Using exome sequencing, we analyzed 196 participants of the Cretan Aging Cohort (CAC; 95 with Alzheimer's disease [AD], 20 with mild cognitive impairment [MCI], and 81 cognitively normal controls). The APOE ε4 allele was more common in AD patients (23.2%) than in controls (7.4%; p0.01) and the PSEN2 p.Arg29His and p.Cys391Arg variants were found in 3 AD and 1 MCI patient, respectively. Also, we found the frontotemporal dementia (FTD)-associated TARDBP gene p.Ile383Val variant in 2 elderly patients diagnosed with AD and in 2 patients, non CAC members, with the amyotrophic lateral sclerosis/FTD phenotype. Furthermore, the p.Ser498Ala variant in the positively selected GLUD2 gene was less frequent in AD patients (2.11%) than in controls (16%; p0.01), suggesting a possible protective effect. While the same trend was found in another local replication cohort (n = 406) and in section of the ADNI cohort (n = 808), this finding did not reach statistical significance and therefore it should be considered preliminary. Our results attest to the value of genetic testing to study aged adults with AD phenotype.

To examine treatment response to cognitive behavior therapy for insomnia (CBT-I) in patients with chronic insomnia with and without underestimation of sleep duration.We studied 41 patients with chronic insomnia who had received 5-week CBT-I. Self-reported and objective sleep were assessed with sleep diary and actigraphy, respectively. Sleep perception was calculated as self-reported total sleep time/objective total sleep time. The underestimation of sleep duration group was defined based on sleep perception less than the median of the overall sample (85%). Insomnia Severity Index was used to assess the severity of insomnia.The total scores of Insomnia Severity Index decreased significantly after CBT-I in both groups with and without underestimation of sleep duration. Compared to pretreatment, self-reported sleep efficiency increased and total wake time decreased after CBT-I, while the magnitude of changes in sleep efficiency (The current preliminary study suggests that sleep perception moderates the self-reported CBT-I effects on chronic insomnia: the phenotype of underestimation of sleep duration is associated with a better response to CBT-I, especially in self-reported sleep parameters.Sun Q, Dai Y, Chen B, et al. The underestimation of sleep duration phenotype is associated with better treatment response to cognitive behavior therapy for insomnia in patients with chronic insomnia: a preliminary study.

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [https://rpubs.com/camhi/sysrev_table]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

BackgroundEvidence-based policymaking is needed so that health systems can address the gap in care for children and adolescents facing mental health challenges. We describe the development of an open-resource dataset providing a comprehensive assessment of the needs for child and adolescent mental health care in Greece.MethodsThis study is a part of the Child and Adolescent Mental Health Initiative (CAMHI), a program aiming to enhance mental health care capacity for children and adolescents across Greece. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 to examine the current state, needs, barriers, and opportunities according to multiple viewpoints. Participants consisted of children, adolescents (including underrepresented minorities), caregivers, schoolteachers, and health professionals. We surveyed geographically distributed samples to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Focus groups were conducted with informants to reach an in-depth understanding of those topics.ResultsWe surveyed 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals. Fourteen focus groups were conducted with the general and professional community. A repository with quantitative and qualitative findings informing multiple topics is now available for researchers, policymakers, and society [https://osf.io/crz6h/].DiscussionThis resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.FundingThe Stavros Niarchos Foundation.

Aims Post-operative atrial fibrillation is defined as an episode of atrial fibrillation that occurs 1–5 days after a surgical procedure in patients without a previous history of atrial fibrillation. Multiple factors such as demographics, cardiac surgical, endogenous, or mental health may relate to post-operative atrial fibrillation. The aim of this study was to identify multivariable high-risk factors for post-operative atrial fibrillation and to propose a risk-assessment tool. Methods and results A cross-sectional observational study was conducted in a University Hospital of Greece. Predictor variables examined demographic and clinical variables, anxiety, depression, health-related quality of life, frailty, perioperative mortality (European System for Cardiac Operative Risk Evaluation II), and 10-year survival/mortality risk (Charlson Comorbidity Index score). The outcome variable was post-operative atrial fibrillation. Multivariable analysis was assessed to identify predictors of post-operative atrial fibrillation. Ninety-one patients were included in our sample. Post-operative atrial fibrillation was diagnosed in 44 (48.4%). Factors associated with post-operative atrial fibrillation are the following: age group of 66–75 years [OR 5.78, 95% confidence interval (CI) 1.37–24.34], Charlson Comorbidity Index score (OR 1.42, 95% CI 1.07–1.89), and hours of mechanical ventilation (OR 1.03, 95% CI 1.00–1.06). The Charlson Comorbidity Index score was identified as an independent predictor of post-operative atrial fibrillation (exp: 1.412, 95% CI: 1.017–1.961). Conclusion Patients with post-operative atrial fibrillation had a higher Charlson Comorbidity Index score. The Charlson Comorbidity Index was identified as an independent clinical predictor of post-operative atrial fibrillation. The risk-assessment tool proposed includes age, Charlson Comorbidity Index score, and hours of mechanical ventilation. Future studies are needed to establish such an assessment.

Background Evidence suggests that the outbreak of the coronavirus disease 2019 (COVID-19) and the prevention/control measures for COVID-19 may cause insomnia during the acute phase of COVID-19 pandemic in China. However, it is unclear whether insomnia sustains during the later phases of the pandemic. Methods We searched PubMed/Medline, EMBASE, PsycINFO and China National Knowledge Infrastructure from the 27th December 2019 to the 2nd February 2021. As early stage studies on COVID-19 pandemic in China were defined as those conducted prior to April 1st, 2020, while late stage studies were those conducted after April 1st, 2020. Results A total of 98 studies with 193,889 participants were included. The pooled prevalence of insomnia symptoms among all populations was 39.1% (95% CI 36.2–42.0%); the pooled prevalence of insomnia symptoms during the early and late stages of COVID-19 in China were 37.0% (95% CI 34.1–39.9%) and 41.8% (95% CI 33.6–50.0%), respectively. Importantly, there was no significant difference regarding the prevalence of insomnia symptoms between the early and late stages of COVID-19. Meta-regression showed that healthcare workers, COVID-19 patients, patients with chronic medical conditions and patients with mental disorders had a higher prevalence of insomnia symptoms compared to the general population. This association remained significant in healthcare workers and patients with chronic medical conditions after adjusting for age, gender, areas of high or low prevalence of COVID-19 cases, anxiety and depression. Conclusions Over one third of our sample present insomnia symptoms during the early stage of COVID-19 pandemic in China. Interestingly, prevalence of insomnia symptoms sustains high during the late stage of the pandemic despite the control of the disease and the amelioration of its adverse effects. Our findings suggest that insomnia symptoms related to COVID-19 appear to persist of over time.

Early maladaptive schemas (EMS), illness representations, and coping are associated with clinical outcomes of patients with major depressive disorder (MDD). However, the pathways that link these factors are largely unknown. The present prospective study aimed at investigating the possible mediating role of illness representations and coping in the associations among schema domains, symptom severity, and suicide risk in MDD. Participants were 135 patients diagnosed with MDD, aged 48.13 ± 14.12 (84.4% females). The Young Schema Questionnaire-Short Form 3 was used to measure schema domains at baseline. Illness representations and coping were measured at approximately five months later (mean = 5.04 ± 1.16 months) with the Illness Perception Questionnaire-Mental Health and the Brief COPE Inventory, respectively. MDD outcomes were measured about 10 months after the baseline assessment (mean = 9.44 ± 2.36 months) with the Beck Depression Inventory and the Risk Assessment Suicidality Scale. SPSS AMOS 27 was used to conduct path analysis. Serial mediation Structural Equation Modelling, controlling for age, education, marital status, working status, MDD duration, pharmacotherapy, and psychotherapy, revealed that Impaired Autonomy and Performance was positively linked to suicide risk. Negative MDD impact representations and symptom severity serially mediated the aforementioned association. Finally, problem-focused coping was negatively related to symptom severity and suicide risk. This study’s main limitation was modest sample size. Representations regarding the impact and severity of MDD mediate the effects of Impaired Autonomy and Performance on future suicide risk in MDD. Healing Impaired Autonomy and Performance domain of EMS, restructuring patients’ representations of high MDD impact, and enhancing problem-focused coping could significantly reduce symptom severity and suicide risk in Schema Therapy with MDD individuals.

Introduction We have previously shown that although sleep duration is similar between cognitively non-impaired (CNI) elders and patients with Mild Cognitive Impairment (MCI), long sleep duration is associated with disease severity in patients with multi-domain MCI and Dementia. Our aim was to examine the associations between sleep duration and cognitive status in subjects with CNI and MCI followed 8 years later. Methods A sub-sample of 110 participants (77.3% females) were recruited from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years). Participants with an initial diagnosis of CNI (n=57) and MCI (n=53) (mean age at baseline=72.7 years [SD=6.8]) were followed-up 8 years later (mean age at follow up=80.5 years [SD=6.7]). All participants underwent neuropsychiatric/neuropsychological evaluation (baseline & follow-up) and a 7-day 24h actigraphy (follow-up). Sleep duration measured as night Total Sleep Time (TST) at follow-up was compared between the diagnostic groups using ANCOVA controlling for age, gender, depression symptom severity, psychotropic medication. Long sleep duration was defined by values >75% percentile of the total sample distribution on each sleep index. Results At follow up 62.7% of participants have deteriorated cognitively with 29 being diagnosed with CNI, 49 with MCI and 32 with dementia. Patients with dementia had significantly longer night TST (mean=493, SD=106 min) than persons with MCI (mean=453, SD=68 min, p=0.05) who in turn had longer night TST than CNI participants (mean=409, SD=58 min, p=0.02). Also, long night sleep duration was significantly more prevalent among dementia patients and MCI compared to CNI individuals [67.7% vs. 36.7% vs. 10.3%, respectively; all p< 0.02)]. Conclusion Our study confirms and expands previous findings that objective long sleep duration is a marker of worse cognitive status in elderly with MCI or Dementia and that this association is even stronger in old-old individuals. Support (if any) National Strategic Reference Framework (NSRF)-Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397

Low back pain is one of the most common reasons for seeking medical help in primary health care, as one of the most common conditions that cause chronic pain. There are several studies associating low back pain with depression, because of the general passive attitude of depressed people and the general psychological factors of depressed people which are involved in chronic low back pain and low back pain. Although studies have shown an association between low back pain and depression, little is known about the role of socio-demographic factors that may also play a role in this association. In particular, in Crete, with its particular socio-economic and environmental (climatic) characteristics, there is no relevant research on the relationship between back pain and depression. The aim of this study is to identify the association between low back pain and depression in patients of a large Greek region, the Region of Crete, in order to contribute to the entire Greek literature, but also to the overall effort to find solutions for patients back pain, who also have problems with depression. In order to achieve the purpose of this study, a quantitative survey was conducted. According to the results of the present study, it is concluded that the pain is more intense and affects more these patients suffering from low back pain, in contrast to the patients of the control group. In addition, severe and chronic low back pain affects both the depression and anxiety of these patients, who have more sleep problems than the control group, where there is no correlation.

Although research has generally shown a negative association between depression and adherence to the Mediterranean diet (MeDi), the literature related to older adults is controversial, perhaps partially due to the fact that cognitive status has not been considered. The aim of the current work was to investigate the association between MeDi and incident depression in a representative cohort of people, taking into account their cognitive status in multiple ways. The sample was drawn from the HELIAD study, a longitudinal study including a follow-up of 3 years after the baseline assessment. In total, 879 participants without depression at baseline were included (55.4% women, mean age ± Standard Deviation: 73.3 ± 5.0 years). Depression was determined as a score in the Geriatric depression scale ≥6 and/or antidepressant medication and/or clinical diagnosis of depression. Cox proportional hazard models adjusted for age, sex and education were employed. In the basic model, adherence to the MeDi was negatively associated with depression. In the most conservative model, excluding participants with dementia and Mild Cognitive Impairment, and after controlling for the baseline Cognitive Status, each unit (range 0–55) increase in MeDi was associated with a 6.2% decrease in the risk for depression (p < 0.001). These findings indicate that MeDi is negatively associated with depression longitudinally in older adults, above and beyond cognitive status.

BackgroundEvidence-based information is essential to delivering effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a comprehensive analysis of scientific evidence on child and adolescent mental health in Greece.MethodsThis systematic review encompasses three research topics related to the mental health of children and adolescents in Greece: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality was ascertained using validated tools. This review was registered in protocols.io [68583].OutcomesWe included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics were compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource on-line [https://camhi.gr/en/systematic-review-tables/].InterpretationScientific evidence on child and adolescent mental health in Greece has been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policy making in Greece and may encourage similar assessments in other countries.FundingThe Stavros Niarchos Foundation.

Objective To examine the relationship between insomnia symptoms and metabolic syndrome in patients with severe psychiatric disorders. Methods We conducted a cross-sectional study including 272 inpatients (mean age: 34.06 ± 11.52 years, 67.3% males) with severe psychiatric disorders consecutively admitted in Shantou University Mental Health Center Inpatient Department. All patients underwent a psychiatric evaluation. Insomnia symptoms were assessed by the Pittsburgh Sleep Quality Index (PSQI) and defined present if PSQI>7. The diagnosis of metabolic syndrome was defined using the new International Diabetes Federation definition based on clinical and laboratory evaluation. Results Among the 272 patients, 94 (34.6%) presented insomnia symptoms. Overall, patients with insomnia symptoms had significantly higher percentage of metabolic syndrome (23.4% vs. 12.4%, p = 0.019) and hypertriglyceridemia (30.9% vs. 19.1%, p = 0.029), and marginally significantly higher levels of fasting insulin (58.75 ± 37.22 pmol/L vs. 51.72 ± 34.09 pmol/L, p = 0.050), homeostasis model assessment of insulin resistance (1.83 ± 1.31 vs. 1.62 ± 1.25, p = 0.055) and percentage of insulin resistance (55.3% vs. 44.4%, p = 0.086) compared to those without insomnia symptoms. Multiple logistic regressions showed that patients with insomnia symptoms had significantly higher odds for metabolic syndrome [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.25–7.14], central obesity (OR = 3.02, 95% CI = 1.18–7.76), hypertriglyceridemia (OR = 2.46, 95% CI = 1.28–4.76) and marginally significantly higher odds for insulin resistance (OR = 1.68, 95% CI = 0.93–3.02) after controlling for potential confounders. Conclusions Within severely mentally ill patients, insomnia symptoms are associated with metabolic syndrome and insulin resistance. It appears that insomnia symptoms are independent clinical indicators of underlying metabolic syndrome in patients with severe psychiatric disorders.

Introduction Previous cross-sectional studies have shown that insomnia symptoms and objective short sleep are associated with disease severity in patients with Mild Cognitive Impairment (MCI) and Dementia. Our aim was to examine the longitudinal associations between sleep quality/quantity with cognitive progression in non-demented community-dwelling elderly. Methods A sub-sample of 105 participants (77.5% females) from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years; baseline) were followed up 8 years later (follow-up). All participants underwent neuropsychiatric/neuropsychological evaluation on both phases. At baseline, subjective sleep complaints and objective sleep variables based on 3-day 24 hour actigraphy were assessed. The impact of baseline objective sleep characteristics and/or insomnia (as defined by at least two subjective sleep complaints) on cognitive progression was assessed with univariate and multivariate models controlling for confounders. Results At baseline 50 participants were diagnosed as CNI and 55 as MCI; at follow-up 60 participants (57.1%) displayed clinically significant cognitive deterioration while the remaining showed relatively stable cognitive status. The frequency of persons reporting insomnia symptoms at baseline was higher among those who displayed cognitive deterioration (31.7%) than those in the cognitively stable group (13.3%, p=0.037). Logistic regression analysis showed that participants with insomnia symptoms at baseline, were significantly more likely to deteriorate cognitively at follow-up (p=0.05, OR=2.90). Also, among objective sleep variables added to the model, it was poor sleep efficiency that was associated with cognitive deterioration (p=0.035, OR=3.48). Conclusion More than half of the participants displayed significant cognitive deterioration over 8 years and this decline was predicted by insomnia symptoms and objective poor sleep efficiency at baseline. Improving both quality and quantity of sleep may significantly delay the deterioration of cognitive function in non-demented community-dwelling elderly. Support (if any) National Strategic Reference Framework (NSRF) - Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397

Background: Apolipoprotein E gene (APOE) ɛ4 allele increases the risk for Alzheimer’s disease (AD). Furthermore, among patients with cognitive impairment, longer sleep duration is associated with worse cognitive performance. To date, literature examining the associations between APOE ɛ4 allele and objective sleep duration is limited. Objective: Our aim was to assess the association between APOE ɛ4 and objective sleep duration, among patients with mild cognitive impairment (MCI) and AD. A sub-sample of 89 patients with AD (n = 49) and MCI (n = 40) were recruited from a large, population-based cohort of 3,140 elders (>60 years) residing on Crete, Greece. Methods: All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, 3-day 24 h actigraphy and APOE ɛ4 allele genotyping. Comparisons of sleep duration variables between APOE ɛ4 allele carriers and non-carriers were assessed using ANCOVA, controlling for confounders. Results: The sample included 18 APOE ɛ4 carriers and 71 non-carriers, aged 78.6±6.6 and 78.2±6.5 years, respectively. Comparisons between the APOE ɛ4 carriers and non-carriers revealed no significant differences in terms of demographic and clinical variables. In terms of objective sleep duration across the two groups, APOE ɛ4 carriers compared to non-carriers had significantly longer nighttime Total Sleep Time (nTST) (7.7±1.4 versus 7.2±1.3 h, respectively, p = 0.011), as well as 24 h TST (8.5±1.6 versus 7.8±1.5 h, respectively, p = 0.012). Conclusion: Among patients with MCI and AD, APOE ɛ4 carriers have longer objective nighttime and 24 h sleep duration compared to non-carriers. These findings further support that objective long sleep duration is a genetically-driven pre-clinical marker associated with worse prognosis in elderly with cognitive impairment.

Road traffic collisions are a major issue for public health. Depression is characterized by mental, emotional and executive dysfunction, which may have an impact on driving behaviour. Patients with depression (N = 39) and healthy controls (N = 30) were asked to complete questionnaires and to drive on a driving simulator in different scenarios. Driving simulator data included speed, safety distance from the preceding vehicle and lateral position. Demographic and medical information, insomnia (Athens Insomnia Scale, AIS), sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Fatigue Severity Scale, FSS), symptoms of sleep apnoea (StopBang Questionnaire) and driving (Driver Stress Inventory, DSI and Driver Behaviour Questionnaire, DBQ) were assessed. Gender and age influenced almost all variables. The group of patients with depression did not differ from controls regarding driving behaviour as assessed through questionnaires; on the driving simulator, patients kept a longer safety distance. Subjective fatigue was positively associated with aggression, dislike of driving, hazard monitoring and violations as assessed by questionnaires. ESS and AIS scores were positively associated with keeping a longer safety distance and with Lateral Position Standard Deviation (LPSD), denoting lower ability to keep a stable position. It seems that, although certain symptoms of depression (insomnia, fatigue and somnolence) may affect driving performance, patients drive more carefully eliminating, thus, their impact.

There is growing evidence that high basal cortisol levels and systemic inflammation independently contribute to cognitive decline among older people without dementia. The present cross-sectional study examined (a) the potential synergistic effect of cortisol levels and systemic inflammation on executive function and (b) whether this effect is more prominent among older people with mild cognitive impairment (MCI). A sub-sample of 99 patients with MCI and 84 older people without cognitive impairment (CNI) (aged 73.8 ± 7.0 years) were recruited from a large population-based cohort in Crete, Greece, and underwent comprehensive neuropsychiatric and neuropsychological evaluation and a single morning measurement of cortisol and IL-6 plasma levels. Using moderated regression models, we found that the relation between cortisol and executive function in the total sample was moderated by IL-6 levels (b = −0.994, p = 0.044) and diagnostic group separately (b = −0.632, p < 0.001). Moreover, the interaction between cortisol and IL-6 levels was significant only among persons with MCI (b = −0.562, p < 0.001). The synergistic effect of stress hormones and systemic inflammation on cognitive status appears to be stronger among older people who already display signs of cognitive decline. Targeting hypercortisolemia and inflammation may be a promising strategy toward improving the course of cognitive decline.

Identifying modifiable factors that may predict long-term cognitive decline in the elderly with adequate daily functionality is critical. Such factors may include poor sleep quality and quantity, sleep-related breathing disorders, inflammatory cytokines and stress hormones, as well as mental health problems. This work reports the methodology and descriptive characteristics of a long-term, multidisciplinary study on modifiable risk factors for cognitive status progression, focusing on the 7-year follow-up. Participants were recruited from a large community-dwelling cohort residing in Crete, Greece (CAC; Cretan Aging Cohort). Baseline assessments were conducted in 2013–2014 (Phase I and II, circa 6-month time interval) and follow-up in 2020–2022 (Phase III). In total, 151 individuals completed the Phase III evaluation. Of those, 71 were cognitively non-impaired (CNI group) in Phase II and 80 had been diagnosed with mild cognitive impairment (MCI). In addition to sociodemographic, lifestyle, medical, neuropsychological, and neuropsychiatric data, objective sleep was assessed based on actigraphy (Phase II and III) and home polysomnography (Phase III), while inflammation markers and stress hormones were measured in both phases. Despite the homogeneity of the sample in most sociodemographic indices, MCI persons were significantly older (mean age = 75.03 years, SD = 6.34) and genetically predisposed for cognitive deterioration (APOE ε4 allele carriership). Also, at follow-up, we detected a significant increase in self-reported anxiety symptoms along with a substantial rise in psychotropic medication use and incidence of major medical morbidities. The longitudinal design of the CAC study may provide significant data on possible modifiable factors in the course of cognitive progression in the community-dwelling elderly.

Inflammation in elderly is associated with physical and cognitive morbidity and mortality. We aimed to explore the association of modifiable lifestyle parameters with inflammation among non-demented, community-dwelling elderly. A sub-sample of 117 patients with mild cognitive impairment (MCI, n = 63) and cognitively non-impaired controls (CNI, n = 54) were recruited from a large, population-based cohort in Crete, Greece, of 3140 elders (>60 years old). All participants underwent assessment of medical history/physical examination, extensive neuropsychiatric/neuropsychological evaluation, diet, three-day 24-h actigraphy, subjective sleep, physical activity, and measurement of IL-6 and TNFα plasma levels. Associations between inflammatory markers and diet, objective sleep duration, subjective sleep quality, and lack of physical activity were assessed using multivariate models. Regression analyses in the total group revealed significant associations between TNF-α and low vegetable consumption (p = 0.003), and marginally with objective long nighttime sleep duration (p = 0.04). In addition, IL-6 was associated with low vegetable consumption (p = 0.001) and lack of physical activity (p = 0.001). Poor diet and lack of physical activity appear to be modifiable risk factors of inflammation, whereas long sleep appears to be a marker of increased inflammatory response in elderly. Our findings may have clinical implications given the association of inflammatory response with morbidity, including cognitive decline, and mortality in elderly.

Family therapy for schizophrenia has been demonstrated to be effective and is recommended by international clinical guidelines. Reviews of family therapy research conclude that interventions may prevent relapse of the disease, when symptoms are already reduced under psychotropic medication, by reducing family factors associated with relapse. The purpose of this study was to examine the effectiveness of Brief Solution Focused therapy (BSFT) in patients with schizophrenia focusing on the impact of change in family characteristics such as cohesion, conflict, organization and control on patients' psychopathology measured with BPRS. Thirty patients diagnosed with schizophrenia were randomly assigned to the control or intervention group. The intervention group received treatment according to the BSFT model, whereas the control group received the standard care for schizophrenia. The BSFT is a future-oriented psychotherapy model which encourages clients to focus on ''change-talking'' instead of ''problem-talking'' and on instances where a successful solution has been achieved. The intervention was consisted of 5 sessions delivered in 3 months. Main outcomes were patient-rated family characteristics measured by the Family Environment Scale (FES), and psychiatrist-rated symptom severity measured with the Brief Psychiatric Rating Scale (BPRS). The two groups did not differ in terms of age, sex, number of relapses, previous hospital admissions, and BPRS score at baseline. At the end of treatment compared to baseline there was a reduction of the BPRS score in the intervention group (p0.001) whereas no statistically significant changes were noticed in the control group after 3 months. Also, following treatment, patients in the intervention group displayed reduced scores on the Conflict FES scale (p=0.001) accompanied by increased scores on the Cohesion (p=0.004), Expressiveness (p=0.004), and Active Recreational subscales (p=0.001) according to patient's perspective. These preliminary findings suggest that BSFT in patients with schizophrenia, appears to be effective in altering the global properties of the whole family system, specifically cohesion, conflict, organization and control which, in turn, have an impact on reducing patient psychopathology.

Although insomnia is by far the most common sleep disorder, our understanding of its neurobiology is limited. Insomnia, particularly when associated with objective sleep disturbance, has been associated with activation of the hypothalamic-pituitary-adrenal axis. The objective of this experimental study was to compare the response of the hypothalamic-pituitary-adrenal axis to ovine corticotropin-releasing hormone, a stress test, in men with insomnia versus controls. Circulating adrenocorticotropic hormone and cortisol levels were assayed before (-30 min, -15 min), at (0 min) and after (+5 min, +15 min, +30 min, +60 min, +90 min, +120 min) exogenous ovine corticotropin-releasing hormone administration in 23 men (11 insomnia, 12 controls), who underwent four consecutive nights of in-lab polysomnography. Men with insomnia compared with controls demonstrated markedly and significantly shorter total sleep time (368.4 ± 8.99 min versus 411.61 ± 8.61 min; p

Introduction Mild-to-moderate obstructive sleep apnea (OSA) affects 15-40% of the adult general population and is associated with incident hypertension, particularly in young and middle-aged adults. We examined whether visceral adiposity, a key predictor of OSA, and excessive daytime sleepiness (EDS), a cardinal symptom of OSA, are associated with hypertension in middle-aged and older adult patients with mild-to-moderate OSA. Methods A clinical sample of 148 adults (53.79±12.45y, 36.5% female) with mild-to-moderate OSA (5≤AHI Results VAI (OR=1.64, 95%CI=1.23-2.20, p=0.001) and EDS (OR=2.73, 95%CI=1.04-7.17, p=0.042), but not AHI (OR=1.05, 95%CI=0.98-1.13, p=0.165), were associated with significantly increased odds of hypertension in adults aged Conclusion These data indicate that the combination of visceral adiposity and subjective sleepiness improves markedly the ability for clinicians to detect cases of mild-to-moderate OSA with increased cardiovascular risk, an association that is strongest in young and middle-aged adults. These findings also further support that OSA in older subjects is a distinctly different phenotype than in young and middle-aged adults. Support (If Any)

Introduction Sleep disturbances have been linked with cognitive decline and previous cross-sectional have shown that long sleep duration is a marker of disease severity in patients Mild Cognitive Impairment (MCI) and Dementia.Our aim was to examine the longitudinal associations between sleep quantity and quality indices and cognitive progression in non-demented community-dwelling elderly. Methods A sub-sample of 62 participants (72.6% females) were recruited from a large population-based cohort in the island of Crete, Greece of 3,140 older adults (>60yrs). Participants were followed-up 8 years later (phase III). All participants underwent neuropsychiatric/neuropsychological evaluation (phases II & III) and a 3-day 24h actigraphy (phase II).Participants were diagnosed as CNI(N=38) and MCI(N=24) during phase II, and CNI (N=22), MCI (N=27) and Dementia (N=13) during phase III. On follow-up, 28 participants progressed to a cognitively declined diagnosis compared to phase II (deteriorated group), while 34 did not (non-deteriorated group). Objective sleep variables at phase II were compared between the deteriotated/non-deteriorated groups using ANCOVA controlling for confounders. Also, differences in neuropsychological testing scores (phase II- phase III) were calculated and associations of differences with sleep variables were examined using partial correlation models controlling for confounders. Results The deteriorated group compared to non-deteriorated had significantly longer night total sleep time (TST) (442±72.6min vs. 407±53.6min, p=0.033), 24h-TST (484±8.9min vs. 434±66.4min, p=0.008), night time in bed (TMB) (537±78.7min vs. 497±62.7min, p=0.03), and 24h-TMB (603±85min vs. 539±85min, p=0.005). Episodic memory worsening was moderately correlated with night TST (r=.316), night and 24h-TMB (r=.526, and r= .442 respectively), wake time after sleep onset (r=.351), and average duration of night awakenings (r=.405). Immediate episodic memory recall decline was positively correlated with night TMB (r=.338). Conclusion Preliminary results from the Cretan aging cohort indicate that almost half of the participants deteriorated cognitively in 8 years and this decline was predicted by objective sleep duration at baseline. Long sleep at baseline may predict deterioration of clinical cognitive status in non-demented elderly at follow-up. It appears that prolonged objective sleep duration and time in bed are novel and clinically useful prognostic factors of cognitive deterioration in elderly with or without cognitive deficits. Support (If Any) National Strategic Reference Framework (NSRF) - Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397

Background Prior studies have shown that young people “not in education, employment or training” (“NEET”) are at higher risk for psychopathology and substance abuse. Similar studies are lacking in Southern European populations. We aimed to examine the associations of anxiety and depressive symptoms, and substance use with NEET status in a large, randomized population-based sample in Greece. Methods A telephone structured questionnaire was conducted in a representative sample of 2771 young Greeks aged 15–24 years. Anxiety and depressive symptoms were assessed with GAD-7 and PHQ-9 scales, respectively. Substances use and several sociodemographic parameters were also examined. Results In our sample 16.4% were NEETs. In multivariate analyses, NEETs compared to non-NEETs were older, with lower family income, without insurance and more likely to be married and smoke. Furthermore, NEET status was associated with a higher GAD-7 score among older NEETs and long-term NEETs (NEETs unemployed for more than a year). Moreover, being NEET among older participants was associated with severe symptoms of anxiety and moderate/severe symptoms of depression. Limitations This was a telephone survey and a clinical evaluation of the patients was not performed. Furthermore, the structured interview was not designed to detect the level of substance use or the reasons for being NEET. Conclusions NEET status is frequent among young Greeks. Older, and long-term NEETs appear to be at higher risk for presenting anxiety/depression symptoms. Whether NEET status is associated with adverse outcomes later in life requires longitudinal studies.

Elevated basal cortisol levels in elderly may indicate dysregulation of the internal stress-related system, as well as dysfunction and structural alterations in brain structures necessary for cognition, such as hippocampus and prefrontal cortex. Because of the close relation of executive functions and episodic memory processing, in this study we explored whether the association of elevated cortisol levels on episodic memory could be partly attributed to cortisol effects on executive functions. In this cross-sectional study we analyzed data from a sample of 236 community-dwelling older adults from the Cretan Aging Cohort aged 75.56 ± 7.21 years [53 with dementia due to probable Alzheimer's disease, 99 with Mild Cognitive Impairment (MCI) and 84 cognitively non-impaired participants (NI)]. Morning serum cortisol levels were higher in the probable AD as compared to the NI group (p = .031). Mediated regression models in the total sample supported the hypothesis that the negative association of basal cortisol levels with delayed memory was fully mediated by the relation of basal cortisol levels with executive functions and immediate memory (adjusted for age and self-reported depression symptoms). Moderated mediation regression models revealed that the direct effect of cortisol on executive function and the effect of executive function on delayed memory performance were statistically significant among participants diagnosed with MCI, while the immediate memory effect on delayed memory was more pronounced in AD patients, as compared to the NI group. The current findings corroborate neuroimaging research highlighting cortisol effects on executive functions and immediate memory and further suggest that dysregulation of systems involved in these functions may account for the purported detrimental long-term effects of high cortisol levels on delayed memory.

Introduction Several studies have shown that the association of obstructive sleep apnea (OSA) with clinical outcomes, such as hypertension, weakens in older adults. An apnea hypopnea index (AHI) ≥5 is recommended as the cut-off for initiating treatment without any consideration of possible age differences. We aimed to examine at which cut-off point of AHI, OSA is associated with cardiovascular and/or cerebrovascular diseases (CBVD) in middle-aged adults and in older adults. Methods We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority), who underwent a 1-night sleep laboratory evaluation, clinical history and physical examination. Hypertension was defined as a diastolic blood pressure ≥90 mmHg or a systolic blood pressure ≥140 mmHg or the use of anti-hypertensive medication. CBVD was defined based on a self-report of a physician diagnosis of heart disease and/or stroke. Logistic regression models examined the odds of having hypertension or CBVD in a step-wise manner starting from an AHI ≥5 up to AHI ≥30 by increments of 5 events, while simultaneously adjusting for sex, race and BMI and stratifying by age. Results The odds of hypertension were significantly increased in adults aged Conclusion These data suggest that AHI cut-offs warranting treatment of OSA should be adjusted based on age and prevalent clinical disorders, consistent with the concept of personalized medicine. These findings are also consistent with the notion that OSA in older adults is a distinctly different phenotype than in young and middle-aged adults. Support (If Any)

Introduction Visceral adiposity is a key predictor of both metabolic syndrome and obstructive sleep apnea (OSA). Both metabolic syndrome and OSA are associated with cardiometabolic disorders, however, the association of OSA with these disorders weakens in older adults. We compared the relative strength of the association between visceral adiposity vs. OSA with hypertension and diabetes and whether this association is stronger in middle-aged vs. older adults. Methods A clinical sample of 148 adults (53.79±12.45y, 36,5% female) with mild-to-moderate OSA (5≤AHI Results VAI was associated with greater odds of having hypertension (OR=1.57, 95%CI=1.20-2.06, P=0.001) and diabetes (OR=1.27, 95%CI=1.02-1.57, p=0.031) compared to AHI (OR=1.05, 95%CI=0.98-1.13, p=0.185; and OR=1.07, 95% CI=1.00-1.14, p=0.690, respectively) in adults aged Conclusion These data indicate that visceral adiposity, but not AHI, is associated with cardiometabolic disorders in patients with mild-to-moderate OSA, an association that is stronger in middle-aged adults. Visceral obesity should be a priority in preventive/therapeutic interventions in young and middle-aged patients with OSA. These findings also further support that OSA in older adults is a distinctly different phenotype. Support (If Any)

STUDY OBJECTIVES: The insomnia with objective short sleep duration phenotype is associated with increased risk for adverse health outcomes, physiological hyperarousal, and a blunted response to cognitive behavioral therapy for insomnia (CBT-I). Whether insomnia with objective short sleep duration responds better to pharmacological treatment compared to CBT-I has not been examined. METHODS: Participants included 15 patients with chronic insomnia (86.7% female), aged 45.3 ± 8.1 years. Eight patients were randomized to CBT-I and 7 to trazodone. Patients were examined with 2 weeks of actigraphy, salivary cortisol, and the insomnia severity index at 3 time points (pretreatment, 3-month posttreatment, and 6-month follow-up). Mixed between-within-subjects analysis of variance and univariate analysis of covariance were conducted to assess the impact of trazodone and CBT-I on patients’ total sleep time, salivary cortisol, and insomnia severity index scores across the 3 time points. RESULTS: Trazodone, but not CBT-I, significantly lengthened total sleep time (when measured with actigraphy) both at posttreatment (51.01 minutes vs –11.73 minutes; P = .051; Cohen’s d = 1.383) and at follow-up (50.35 minutes vs –7.56 minutes; P = .012; Cohen’s d = 1.725), respectively. In addition, trazodone, but not CBT-I, showed a clinically meaningful decrease in salivary cortisol from pretreatment to posttreatment (–36.07% vs –11.70%; Cohen’s d = 0.793) and from pretreatment to follow-up (–21.37% vs –5.79%; Cohen’s d = 0.284), respectively. Finally, there were no differences on insomnia severity index scores between the trazodone and the CBT-I groups. CONCLUSIONS: The current preliminary, open-label, randomized trial suggests that trazodone, but not CBT-I, significantly improves objective sleep duration and reduces hypothalamic-pituitary-adrenal axis activation, suggesting a differential treatment response in the insomnia with objective short sleep duration phenotype. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Study of Trazodone & Cognitive Behavioral Therapy to Treat Insomnia; URL: https://clinicaltrials.gov/ct2/show/NCT01348542; Identifier: NCT01348542. CITATION: Vgontzas AN, Puzino K, Fernandez-Mendoza J, Krishnamurthy VB, Basta M, Bixler EO. Effects of trazodone versus cognitive behavioral therapy in the insomnia with short sleep duration phenotype: a preliminary study. J Clin Sleep Med. 2020;16(12):2009–2019.

Background Patients with dementia report excessive daytime sleep/sleepiness, which is associated with worse cognitive performance. Inflammatory markers may be elevated in patients with dementia and have been proposed as mediators of sleep/sleepiness. Objective To examine the association of objective daytime napping with cognitive performance and peripheral markers of inflammation in patients with dementia as compared to not cognitively impaired (NCI) controls. Methods A sub-sample of 46 patients with mild-to-moderate dementia and 85 NCI controls, were recruited from a large, population-based cohort of 3,140 elders (≥60 years) in Crete, Greece. All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, 3-day 24 h actigraphy and a single morning measure of IL-6 and TNFα plasma levels. Comparisons of sleep parameters and inflammation markers between diagnostic groups, and between nappers and non-nappers within each diagnostic group, were conducted using ANCOVA controlling for demographics/related clinical factors. Associations between inflammatory markers, sleep variables, and neuropsychological performance were assessed within each group using partial correlation analysis controlling for confounders. Results Patients with dementia slept 15 minutes longer during the day than NCI. Within dementia patients, nappers had significantly worse performance on autobiographic memory (p = 0.002), working memory (p = 0.007), episodic memory (p = 0.010), and assessment of daily function (p = 0.012) than non-nappers. Finally, IL-6 levels were significantly associated with nap duration within dementia patients who napped (r = 0.500, p = 0.01). Conclusions Daytime napping in patients with dementia is associated with worse cognitive performance and increased IL-6 levels. In dementia, objective daytime napping, may be a marker of the severity of the disease.

Population aging, characteristic of modern Western societies, is associated with various forms of cognitive decline. Insomnia/insomnia-type symptoms have been reported as modifiable risk factors for cognitive decline. The objective of this study was to examine, in a comprehensive way (a) the prevalence and the risk factors associated with insomnia-type symptoms and (b) the association of insomnia-type symptoms with cognitive impairment in a large, homogeneous, community-dwelling population in the island of Crete, Greece. Our sample consisted of 3066 community-dwelling elders aged 60–100 years participating in the Cretan Aging Cohort. All participants were interviewed with a structured questionnaire assessing demographics, physical and mental health, sleep, lifestyle habits and cognitive function using the Mini Mental State Examination (MMSE). Furthermore, insomnia-type symptom prevalence was estimated in the presence of one or more sleep complaints. Linear and logistic regression analyses examined (a) the association between insomnia-type symptoms and demographics, physical/mental health and lifestyle and (b) the association between cognition and insomnia-type symptoms. Prevalence of one or more insomnia-type symptoms was 64.6%. Multivariate analyses showed that female gender, widowhood, benzodiazepine use and physical ailments were significantly associated with insomnia-type symptoms. Multivariate models also showed that insomnia-type symptoms were associated with increased odds of cognitive impairment (p

Excessive daytime sleepiness (EDS) is a key symptom of obstructive sleep apnea (OSA). The Psychomotor Vigilance Task (PVT) has been suggested as an objective easy-to-use, inexpensive alternative to the Multiple Sleep Latency Test (MSLT) to measure EDS. In patients with OSA, physiological sleepiness, but not subjective EDS (Epworth Sleepiness Scale [ESS]), has been associated with increased levels of the sleep- inducing proinflammatory cytokine interleukin-6 (IL-6). The goal of this study was to assess the association of PVT with objectively measured sleepiness (MSLT) and subjectively measured sleepiness (ESS) and IL-6 levels in patients with OSA.We studied 58 untreated patients with OSA who underwent an 8-hour in-laboratory polysomnography for 4 consecutive nights. MSLT, PVT, and 24-hour serial profiles of IL-6 were assessed on the fourth day. PVT variables included number of lapses, mean reciprocal of the fastest 10% and slowest 10% reaction times, and median of 1/reaction time. ESS was assessed on day 1 of the study.Higher ESS scores were significantly associated with greater number of lapses (β = .34,Our findings suggest that PVT is associated with subjectively assessed daytime sleepiness, but not with physiological sleepiness nor IL-6 levels in patients with OSA. It appears that ESS and PVT may be useful in predicting risks associated with impaired performance, such as traffic accidents, in patients with OSA.