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Sleep Onset/Maintenance Difficulties and Cognitive Function in Nondemented Older Adults: The Role of Cognitive Reserve

  • Molly E. Zimmerman (a1), Marcelo E. Bigal (a1) (a2), Mindy J. Katz (a1), Adam M. Brickman (a3) and Richard B. Lipton (a1)...


This study examined the relationship between cognitive function and sleep onset/maintenance difficulties (SO/MD) in nondemented older adults. We hypothesized that SO/MD negatively impacts cognition and that older adults with lower education would be especially vulnerable to its effects. The sample comprised 549 older adults from the Einstein Aging Study (EAS), a community-based cohort. Participants completed neuropsychological assessment and a sleep questionnaire. Univariate ANCOVAs were performed with cognitive performance as a dependent variable, SO/MD (present or absent) and education (lower: ⩽12 years; higher: >12 years) as between-subjects factors, and age, ethnicity, gender, depression, and cardiovascular comorbidies as covariates. Participants were an average age of 79.7 ± 5.0 years (range = 71–97 years). Fifty-seven percent (n = 314) of the sample met criteria for SO/MD. Among participants with SO/MD, those with lower education performed more poorly on a test of category fluency than participants with higher education (means: 35.2 vs. 41.0; p < .001); among older adults without SO/MD, educational attainment had no measurable effect on cognition (SO/MD × education interaction (F(1,536) = 14.5; p = .00)). Consistent with the cognitive reserve hypothesis, older adults with lower education appear selectively vulnerable to the negative effects of sleep onset/maintenance difficulties on tests of verbal fluency. (JINS, 2012, 18, 461–470)


Corresponding author

Correspondence and reprint requests to: Molly E. Zimmerman, Albert Einstein College of Medicine, Department of Neurology, 1165 Morris Park Avenue, Room 338, Bronx, NY 10461. E-mail:


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