Nocturnal sleep enhances working memory training in Parkinson's disease but not Lewy body dementia

Abstract

Working memory is essential to higher order cognition (e.g. fluid intelligence) and to performance of daily activities. Though working memory capacity was traditionally thought to be inflexible, recent studies report that working memory capacity can be trained and that offline processes occurring during sleep may facilitate improvements in working memory performance. We utilized a 48-h in-laboratory protocol consisting of repeated digit span forward (short-term attention measure) and digit span backward (working memory measure) tests and overnight polysomnography to investigate the specific sleep-dependent processes that may facilitate working memory performance improvements in the synucleinopathies. We found that digit span backward performance improved following a nocturnal sleep interval in patients with Parkinson's disease on dopaminergic medication, but not in those not taking dopaminergic medication and not in patients with dementia with Lewy bodies. Furthermore, the improvements in patients with Parkinson's disease on dopaminergic medication were positively correlated with the amount of slow-wave sleep that patients obtained between training sessions and negatively correlated with severity of nocturnal oxygen desaturation. The translational implication is that working memory capacity is potentially modifiable in patients with Parkinson's disease but that sleep disturbances may first need to be corrected.

Figure 1

Example of the 48-h protocol focusing on the polysomnographic and digit span assessments. The timing of assessments was tailored to each patient depending on their typical bed and wake times.

Figure 2

Change in digit span forward and backward performance (Mean Day 2-Mean Day 1) across groups. Error bars reflect standard errors.

Figure 3

Scatterplots illustrating the relationship between mean digit span backward improvement (difference score used for illustrative purposes) and sleep parameters. (A) Night 2 slow-wave sleep (SWS) per cent; (B) severity of Night 2 night time oxygen desaturation in patients with Parkinson's disease on dopaminergic medication. P-values are uncorrected. The correlation is significant after Hochberg correction for Night 2 slow-wave sleep but not for Night 2 oxygen desaturation.