1 Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, Canada.
2 Department of Neuroscience, Université de Montreal, Montreal, Canada.
3 PERFORM Centre, Concordia University, Montreal, Canada.
4 Department of Health, Kinesiology and Applied Physiology, Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, Canada.
5 Canadian Sleep and Circadian Network, Montreal, Canada.
6 Integrated Program in Neuroscience, McGill University, Montreal, Canada.
7 Research Institute of McGill University Health Center, Montreal, Canada.
8 Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montreal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montreal, Canada.
9 Department of Psychology, Université de Montréal, Montreal, Canada.
10 Department of Neurology and Neurosurgery, McGill University-Montreal General Hospital, Montreal, Canada.
11 Department of Mathematics and Statistics, Concordia University, Montreal, Canada.

Study objectives: To examine the longitudinal association between probable insomnia status and both subjective and objective memory decline in middle-aged and older adults.

Methods: 26 363 participants, =45 years, completed baseline and follow-up (3 years after baseline) self-reported evaluations of sleep and memory, and neuropsychological testing in the following cognitive domains: memory, executive functions, and psychomotor speed. Participants were categorized as having probable insomnia disorder (PID), insomnia symptoms only (ISO), or no insomnia symptoms (NIS), based on sleep questionnaires. Participants were further grouped based on their sleep change over time. Prospective odds of self-reported memory worsening were assessed using logistic regression, and associations between insomnia and cognitive performance were assessed via linear mixed-effects modeling, adjusted for demographic, lifestyle, and medical factors.

Results: An increased odds (OR 1.70; 95% CI 1.29-2.26) of self-reported memory worsening was observed for NIS participants at baseline who developed PID at follow-up compared to those who developed ISO or remained NIS. Additionally, participants whose sleep worsened from baseline to follow-up (i.e. transitioned from NIS to ISO, ISO to PID, or NIS to PID) displayed increased odds (OR 1.22; 95% CI 1.10-1.34) of subjective memory worsening at follow-up compared to those who remained insomnia-free or improved their sleep. There were no significant associations between the development of PID or worsening sleep and performance on neuropsychological tests.

Conclusions: These findings of an increased odds for subjective memory decline in middle-aged and older adults with insomnia disorder suggest insomnia may be an important target for early interventions addressing age-related cognitive decline.