Accepted for/Published in: JMIR Aging
Date Submitted: Jul 10, 2025
Open Peer Review Period: Jul 28, 2025 - Sep 22, 2025
Date Accepted: Feb 26, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Dynamic relationship between sleep patterns and behavioral and psychological symptoms of dementia: Evidence from a panel vector autoregression model
ABSTRACT
Background:
A higher prevalence of behavioral and psychological symptoms of dementia is associated with a greater caregiver burden and increased mortality in people with dementia. Considering the possibility of a reciprocal relationship between sleep disturbances and these symptoms, time series analyses are necessary to explore these bidirectional dynamics.
Objective:
This study aimed to investigate the bidirectional relationship between sleep disturbances and behavioral and psychological symptoms of dementia in older adults.
Methods:
Daily interactions between sleep patterns and behavioral and psychological symptoms of dementia were analyzed over a 14-day period using a panel vector autoregressive model. Data were collected from June 2018 to June 2020 in community and institutional settings. A total of 154 older adults with dementia wore wrist actigraphy devices continuously for two weeks for sleep data, and caregivers recorded behavioral and psychological symptoms of dementia in a daily symptom diary.
Results:
Using a panel vector autoregressive model, we analyzed data from 154 older adults living with dementia and their caregivers and found that the previous day’s number of awakenings significantly increased the following day’s irritability (p=0.032) and appetite or eating disorders (p=0.038). Conversely, some of the previous day’s behavioral and psychological symptoms of dementia had significant effects on the following day’s sleep patterns: delusions increased total sleep time (p<0.001), wake after sleep onset (p=0.013), and number of awakenings (p=0.006), and irritability resulted in an incrThis study demonstrates that the relationship between the behavioral and psychological symptoms of dementia and sleep patterns is dynamic and forms a vicious cycle. Consequently, early intervention to alleviate symptoms is imperative, and strategies to enhance sleep quality and address sleep disturbances should be prioritized.ease in the number of awakenings (p=0.007). Notably, irritability had bidirectional causality with the number of awakenings.
Conclusions:
This study demonstrates that the relationship between the behavioral and psychological symptoms of dementia and sleep patterns is dynamic and forms a vicious cycle. Consequently, early intervention to alleviate symptoms is imperative, and strategies to enhance sleep quality and address sleep disturbances should be prioritized. Clinical Trial: N/A
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Copyright
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