Lacey Atkins, UQ : "An investigation of risk factors for Alzheimer's disease in obstructive sleep apnoea patients"
PhD Exit Seminar by:
Lacey Atkins, Queensland Brain Institute, University of Queensland
Title: An investigation of risk factors for Alzheimer's disease in obstructive sleep apnoea patients
Abstract:
Recent research has uncovered obstructive sleep apnoea (OSA) as a risk factor for the development of Alzheimer’s disease (AD). However, the specific features of OSA that underpin the increased likelihood of patients developing AD remain unclear. We tested the hypothesis that sleep-disordered hypoxia leads to neurodegeneration and subsequent cognitive impairment. Firstly, we determined the prevalence of preclinical AD in recently diagnosed and untreated OSA patients, and explored the relationship of hypoxia to neurodegeneration and/or cognitive impairment.
We found that 40% of recently diagnosed and untreated OSA patients have cognitive impairment, with 14% of these having cognitive scores suggestive of dementia. We further found that cognitive performance was predicted by the extent and duration of hypoxia, but not sleep fragmentation or duration.
We then measured the extent of neurodegeneration of the basal forebrain (BF) and hippocampus (two cardinal features of AD) using structural magnetic resonance imaging (MRI) data from OSA patients who had been followed longitudinally for 4 years. We found that OSA patients who developed AD had smaller BF volumes prior to developing AD than OSA patients who remained cognitively stable. Reduced BF volume also predicted future hippocampal degeneration.
OSA patients are at significant risk of developing AD, and although they receive treatment for their OSA, many are non-compliant, and there is no standard clinical pathway by which these patients can access care for their cognitive impairment. The current treatment for dementia is choline esterase inhibitors, which are designed to combat the loss of cholinergic neurons within the basal forebrain. As we have found that degeneration of this brain region in OSA patients predicts development of AD, our work provides the first evidence for indicating the possible use of AD drugs in OSA patients as an adjunct prophylactic treatment to reduce risk of dementia.
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