Table 1.
Study characteristics and quality ratings
| Study reference | N (N sleep disturbances measured in) | Number of care homes | Dementia type | Dementia severity | Females (%) | Mean age | Measure of sleep disturbances | Study quality | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | Total | ||||||||
| Aasmul et al. 2014 [35, 96] | 352 (341) | 18 | Not specified | Advanced | 74.4 | 86.0 | NPI sleep item |
✓ | ✘ | ✓ | ✓ | 3 |
| Appelhof et al. 2019 [68] | 274 (227) | 13 | All young onset; AD 43.8%; VaD 10.6%; FTD 29.2%; mixed AD/VaD 5.1%; LBD/PPD 1.8%; alcohol-related dementia 2.2%; other 7.3% | GDS mild 15.7%; moderate 20.8%; severe 62.8% | 49.6 | 63.8 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Aupperle et al. 2004 [46] | 173 (134) | 29 | All AD | Moderate to severe | 81.5 | 82.6 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Balzotti et al. 2018 [67] | 30 (30) | 1 | 57% AD, 43% VaD | Mean MMSE score 7.6 | 83.3 | 85.7 | NPI sleep item | ✓ | ✘ | ✓ | ? | 3 |
| Bergh et al. 2011 [9] | 169 (169) | 7 | Not specified | CDR mild 20.71%; moderate 37.27%; severe 42.01% | 69.2 | 84.9 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Bergh et al. 2012 [21] | 620 (619) | 32 | Not specified | CDR mild 22%; moderate 29%; severe 50% | 71.0 | 84.7 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Bidzan et al. 2006 [71] | 31 (31) | 2 | All AD | Mean MMSE score 14.8 | Not specified | 79.2 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Bidzan et al. 2008 [72] | 58 (58) | 3 | All AD | MMSE score between 11 and 23 | Not specified | 77.0 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Bidzan et al. 2014 [41] | 48 (48) | 1 | All AD | Mean MMSE score 15.96 | Not specified | 70.0 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Bjork et al. 2018 [63] | 2827 (2827) | not specified | Not specified | Mild 37.7%; moderate 38.6%; severe 23.6% | 69.9 | 85.6 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Blytt et al. 2017 [24] | 1535 (1535) | 64 | Not specified | Mild 35%; moderate 29%; severe 36% | 75.7 | 85.3 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Blytt et al. 2018 [25] | 106 (106) | 47 | Not specified | Mean MMSE score 7.6 | 76.0 | 85.5 | Actigraphy | ✓ | ✘ | ✓ | ✓ | 3 |
| Boada et al. 2006 [52] | 79 (79) | 2 | All AD | Mild 26.6%; moderate 35.4%; moderately severe 19%; severe 19% | 73.4 | 83.7 | BEHAVE-AD diurnal rhythm disturbance item | ✓ | ✓ | ✓ | ? | 3 |
| Brodaty et al. 2001 [53] | 505 (505) | 11 | All AD | Not specified | 74.1 | 83.4 | BEHAVE-AD diurnal rhythm disturbance item | ✓ | ✓ | ✓ | ✓ | 4 |
| Brown et al. 2015 [62] | 22 (22) | 4 | Not specified | Not specified | 73.0 | 85.6 | Actigraphy | ✓ | ✘ | ✓ | ✘ | 2 |
| Castineiras et al. 2012 [32] | 212 (212) | 6 | AD 26.9%; VaD 18.9%; mixed 7.1%; DLB 0.9%; FTD 0.5%; unknown 45.8% | Mild 14.6%; moderate 16.5%; moderately severe 35.4%; severe 33.5% | 73.1 | 85.7 | NPI sleep item | ✓ | ✓ | ✓ | ? | 3 |
| Chen et al 2018 [65] | 112 (112) | 1 | Not specified | CDR mild 10.7%; moderate 39.3%; severe 50.0% | 63.4 | 81.2 | NPI sleep item | ✓ | ✘ | ✓ | ✘ | 2 |
| Cheng et al. 2009 [51] | 63 (63) | not specified | All AD | Mean MMSE 10.3 | 60.7 | 81.9 | BEHAVE-AD diurnal rhythm disturbance | ✓ | ✘ | ✓ | ? | 2 |
| Cunha et al. 1985 [55] | 227 (227) | 10 | Not specified | Severe 77.5%; mild 22.5% | 84.7 | 75.6 | CGBRS sleep problem item | ✓ | ✘ | ✓ | ✓ | 3 |
| Dechamps et al. 2008 [26] | 109 (109) | 4 | Not specified | MMSE ≥24 9%, MMSE between 10 and 23 61.5% MMSE<10 29.5% | 76.1 | 83.0 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Dichter et al. 2015 [48] | 154 (154) | 9 | Not specified | FAST stages 2-6 63.6%; stage 7 36.4% | 83.1 | 83.1 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Ferreira et al. 2016 [50] | 97 (97) | 3 | Not specified | Mean MMSE score 22 | 90.0 | 81.0 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Fetveit et al. 2002 [61, 97] | 29 (25) | 1 | Majority AD, number not specified | Mean MMSE score 13.4 | not specified | 85.4 | Actigraphy | ✓ | ✓ | ✓ | ✓ | 4 |
| Gustafsson et al. 2016 [56] | 3482 (3482) | not specified | Not specified | Mean GCS score 11.8 in 2007; 12.4 in 2013 | 69.4 | 84.8 | MDDAS interrupted night sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Hsieh et al. 2009 [37] | 103 (103) | 10 | AD 50.5%; VaD 49.5% | Mean CDR score 1.38 AD; 1.33 VD | 47.6 | 72.2 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Koopmans et al. 2009 [23] | 39 (39) | 2 | 70% AD; 10% VaD; 20% not specified | Advanced | 90.0 | 83.0 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Krolak‐Salmon et al. 2016 [28] | 211 (211) | not specified | All AD | Not specified | 61.1 | 84.0 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Kume et al. 2016 [59] | 17 (17) | 4 | AD 58.8%; VaD 41.2% | Mean CDR score 1.4 | 58.8 | 82.2 | Actigraphy | ✓ | ✘ | ✓ | ? | 2 |
| Lam et al. 2006 [73] | 125 (125) | 3 | AD 43.2%; VaD 24.8%; not specified 32.0% | Not specified | 58.4 | 82.0 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Lee et al. 2015 [38] | 529 (529) | 20 | Not specified | Not specified | 77.5 | 81.2 | NPI sleep item | ✓ | ? | ✓ | ? | 2 |
| Lichtwarck et al. 2018 [34] | 229 (229) | 33 | Not specified | Mild 4.4%; moderate 25.8; severe 69.5% | 60.3 | 83.2 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Lövheim et al. 2009 [57] | 1826 (1826) | not specified | Not specified | Mean GCS score 11.5 | 68.9 | 82.8 | MDDAS interrupted night sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Malara et al. 2016 [43] | 201 (201) | 10 | VaD 61.9%; AD 29.3% | Mild 11.1%; moderate 27.1%; severe 61.9% |
66.3 | 83.9 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Melander et al. 2018 [66] | 14 (14) | 5 | VaD 50%, AD 14.3%, FTD 14.3%, mixed 14.3%, LBD 7.1% | All GDS score 6 | 78.6 | 81.5 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Mulders et al. 2016 [22] | 230 (225) | 8 | All young onset; AD 32.0%; VaD 12.9%; FTD 16.0%; AlcD 17.8%; Other 21.3% | GDS score 2-4 17.3%; score 5 24.4%; score 6 30.2%; score 7 28.0% | 46.7 | 60.1 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Ozaki et al. 2017 [40] | 312 (200) | 10 | AD 35.9%; VaD 19.6%; other 9.9%; not specified 34.6% | Mild 28.8%; moderate 54.8%; severe 16.3% | 82.4 | 87.6 | NPI sleep item | ✓ | ✓ | ✓ | ✘ | 3 |
| Palm et al. 2018 [64] | 1132 (1132) | 140 | Not specified | DSS mean score 9.5 | 79.2 | 83.4 | NPI sleep item | ✓ | ✓ | ✓ | ✘ | 3 |
| Prado-Jean et al. 2010 [27] | 319 (319) | 17 | Not specified | Mild 24.4%; moderate 50.2%; severe 25.4% | 76.5 | 85.6 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Reuther et al. 2016 [47] | 840 (840) | 40 | Not specified | FAST scale mild 3.8%; moderate 63.5%; severe 32.7% | 76.0 | 85.0 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Ricci et al. 2009 [33] | 173 (157) | 1 | AD 44.5%; VaD 30.6%; mixed 17.3%; ns 10.8%; DLB 1.7%; PDD 1.2%; PPA 1.2% | Not specified | 74.9 | 79.9 | NPI sleep item | ✓ | ? | ✓ | ? | 2 |
| Ruths et al. 2008 [44] | 55 (55) | 13 | Not specified | Not specified | 78.2 | 84.1 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Schüssler et al. 2015 [58] | 178 (178) | 175 | AD 52%; VaD 15.8%; other 19.2%; ns 13% | Mean MMSE 16.5 | 83.1 | 83.5 | CDS Day-/night pattern item | ✓ | ✘ | ✓ | ✓ | 3 |
| Seidl et al. 2007 [36] | 128 (128) | not specified | AD 77.3%; VaD or mixed 17.2%; Other 5.5% | GDS score ≤3 26%; score 4 14%; score 5 19%; score 6 30%; score 7 11% | 81.4 | 84.8 | NPI sleep item | ✓ | ? | ✓ | ? | 2 |
| Selbaek et al. 2014 [29] | 931 (931) | 26 | Not specified | CDR 1 25%, 2 33%, 3 42% | 74.0 | 84.5 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Song et al. 2015 [49] | 423 (423) | 6 | Not specified | Mild 9.1%; moderate 21.7%; severe 69.2% | 82.0 | 83.3 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Suzuki et al. 2017 [70] | 226 (226) | not specified | AD 47.0%; VaD 14.0%; LBD 1.0%; FTD 1.5%; mixed 15.5%; other 7.5%; not specified 13.5% | Mean MMSE score 9.53 | 76.6 | 85.1 | NPI sleep item | ? | ✓ | ✓ | ✘ | 2 |
| Tan et al. 2015 [54] | 169 (169) | 6 | Not specified | Not specified | 77.5 | 87.5 | ESS | ✓ | ✘ | ✓ | ✓ | 3 |
| Thodberg et al. 2016 [60] | 100 (70) | 4 | Not specified | Not specified | 69.0 | 85.5 | Actigraphy | ✓ | ? | ✓ | ? | 2 |
| Tournier et al. 2017 [39] | 13 (11) | 1 | Not specified | 36% moderate; 64% severe | 90.9 | 82.9 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Wetzels et al. 2010 [10] | 290 (117) | 9 | AD 35.0%; VaD 11.1%; mixed AD/VaD 1.7%; other 52.1 | GDS score 4 11.1; score 5 26.5; score 6 33.3; score 7 29.1% | 71.7 | 81.7 | NPI sleep item | ✓ | ✘ | ✓ | ? | 2 |
| Wilfling et al. 2019 [69] | 1187 (1187) | 38 | Not specified | Not specified | 74.0 | 83.0 | SDI | ✓ | ✓ | ✓ | ✓ | 4 |
| Wu et al. 2009 [42] | 93 (93) | 7 | Not specified | GDS score 4 2.2%; Score 5 12.9%; score 6 55.9%; score 7 29.0% | 76.3 | 88.6 | NPI sleep item | ✓ | ✘ | ✓ | ✘ | 2 |
| Zuidema et al. 2006 [31] | 59 (59) | 2 | Not specified | Not specified | 83.0 | 82.0 | NPI sleep item | ✓ | ✘ | ✓ | ✓ | 3 |
| Zuidema et al. 2007 [30, 98] | 1437 (1437) | 27 | Not specified | Mild 4%; moderate 20%; moderately severe 51%; severe 26% | 81.0 | 83.0 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
| Zwijsen et al. 2014 [45] | 432 (432) | 17 | AD 47.7%; VaD 19.0%; mixed AD/VaD 15.5%; DLB 3.7%; FTD 2.5%; other 8.6% | GDS score ≤3 1%; score 4 4%; score 5 21%; score 6 62%; score 7 12% | 69.9 | 83.3 | NPI sleep item | ✓ | ✓ | ✓ | ✓ | 4 |
AD, Alzheimer’s Disease; CGBRS, Crichton Geriatric Behavioural Rating Scale; DSS, Dementia Screening Scale; ESS, Epworth Sleepiness Scale; FAST, Functional Assessment Staging Test; FTD, Frontotemporal dementia; GCS, Gottfries Cognitive Scale; GDS, Global Deterioration Scale; LBD, Lewy Body dementia; MMSE, Mini Mental State Examination; NPI, Neuropsychiatric Inventory; PDD, Parkinson’s disease dementia; PPA, Primary progressive aphasia; SDI, Sleep Disorder Inventory; VaD, Vascular dementia.