{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:22:30Z","timestamp":1793730150568,"version":"4.6.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:00Z","timestamp":1613692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010766","name":"Schweizerischen Neurologischen Gesellschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010766","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>\n                    Growing evidence implicates a distinct role of disturbed slow-wave sleep in neurodegenerative diseases. Reduced non-rapid eye movement (NREM) sleep slow-wave activity (SWA), a marker of slow-wave sleep intensity, has been linked with age-related cognitive impairment and Alzheimer disease pathology. However, it remains debated if SWA is associated with cognition in Parkinson disease (PD). Here, we investigated the relationship of regional SWA with cognitive performance in PD. In the present study, 140 non-demented PD patients underwent polysomnography and were administered the Montr\u00e9al Cognitive Assessment (MoCA) to screen for cognitive impairment. We performed spectral analysis of frontal, central, and occipital sleep electroencephalography (EEG) derivations to measure SWA, and spectral power in other frequency bands, which we compared to cognition using linear mixed models. We found that worse MoCA performance was associated with reduced 1\u20134 Hz SWA in a region-dependent manner (\n                    <jats:italic>F<\/jats:italic>\n                    <jats:sub>2, 687<\/jats:sub>\n                    =11.67,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001). This effect was driven by reduced regional SWA in the lower delta frequencies, with a strong association of worse MoCA performance with reduced 1\u20132 Hz SWA (\n                    <jats:italic>F<\/jats:italic>\n                    <jats:sub>2, 687<\/jats:sub>\n                    =18.0,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001). The association of MoCA with 1\u20132 Hz SWA (and 1\u20134 Hz SWA) followed an antero-posterior gradient, with strongest, weaker, and absent associations over frontal (rho = 0.33,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001), central (rho = 0.28,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001), and occipital derivations, respectively. Our study shows that cognitive impairment in PD is associated with reduced NREM sleep SWA, predominantly in lower delta frequencies (1\u20132 Hz) and over frontal regions. This finding suggests a potential role of reduced frontal slow-wave sleep intensity in cognitive impairment in PD.\n                  <\/jats:p>","DOI":"10.3389\/fneur.2021.618101","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T17:39:17Z","timestamp":1613842757000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":57,"title":["Reduced Regional NREM Sleep Slow-Wave Activity Is Associated With Cognitive Impairment in Parkinson Disease"],"prefix":"10.3389","volume":"12","author":[{"given":"Simon J.","family":"Schreiner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas L.","family":"Imbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp O.","family":"Valko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina","family":"Maric","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rina","family":"Maqkaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Werth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian R.","family":"Baumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heide","family":"Baumann-Vogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1038\/nrneurol.2017.27","article-title":"Cognitive decline in Parkinson disease","volume":"13","author":"Aarsland","year":"2017","journal-title":"Nat Rev Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1126\/science.1180962","article-title":"Amyloid-beta dynamics are regulated by orexin and the sleep-wake cycle","volume":"326","author":"Kang","year":"2009","journal-title":"Science."},{"key":"B3","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1126\/science.1241224","article-title":"Sleep drives metabolite clearance from the adult brain","volume":"342","author":"Xie","year":"2013","journal-title":"Science."},{"key":"B4","doi-asserted-by":"publisher","first-page":"eaav2546","DOI":"10.1126\/science.aav2546","article-title":"The sleep-wake cycle regulates brain interstitial fluid tau in mice and CSF tau in humans","volume":"363","author":"Holth","year":"2019","journal-title":"Science."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2104","DOI":"10.1093\/brain\/awx148","article-title":"Slow wave sleep disruption increases cerebrospinal fluid amyloid-\u03b2 levels","volume":"140","author":"Ju","year":"2017","journal-title":"Brain."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsy025","article-title":"Sleep deprivation and cerebrospinal fluid biomarkers for Alzheimer's disease","author":"Olsson","year":"2018","journal-title":"Sleep."},{"key":"B7","doi-asserted-by":"publisher","first-page":"eaav5447","DOI":"10.1126\/sciadv.aav5447","article-title":"Increased glymphatic influx is correlated with high EEG delta power and low heart rate in mice under anesthesia","volume":"5","author":"Hablitz","year":"2019","journal-title":"Sci Adv."},{"key":"B8","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1017\/S135561771200001X","article-title":"Concurrent impairments in sleep and memory in amnestic mild cognitive impairment","volume":"18","author":"Westerberg","year":"2012","journal-title":"J Int Neuropsychol Soc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1038\/nn.4035","article-title":"beta-amyloid disrupts human NREM slow waves and related hippocampus-dependent memory consolidation","volume":"18","author":"Mander","year":"2015","journal-title":"Nat Neurosci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"eaau6550","DOI":"10.1126\/scitranslmed.aau6550","article-title":"Reduced non-rapid eye movement sleep is associated with tau pathology in early Alzheimer's disease","volume":"11","author":"Lucey","year":"2019","journal-title":"Sci Transl Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"4291","DOI":"10.1016\/j.cub.2020.08.017","article-title":"Sleep Disturbance Forecasts \u03b2-Amyloid Accumulation across Subsequent Years","volume":"30","author":"Winer","year":"2020","journal-title":"Curr Biol."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsaa160","article-title":"NREM sleep EEG oscillations in idiopathic REM sleep behavior disorder: a study of sleep spindles and slow oscillations","author":"Sunwoo","year":"2020","journal-title":"Sleep."},{"key":"B13","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1002\/mds.10242","article-title":"Microstructure of the non-rapid eye movement sleep electroencephalogram in patients with newly diagnosed Parkinson's disease: effects of dopaminergic treatment","volume":"17","author":"Brunner","year":"2002","journal-title":"Mov Disord."},{"key":"B14","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.sleep.2005.03.011","article-title":"Progressive sleep 'destructuring' in Parkinson's disease. A polysomnographic study in 46 patients","volume":"6","author":"Diederich","year":"2005","journal-title":"Sleep Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1002\/ana.25360","article-title":"Levodopa-induced dyskinesia in Parkinson disease: sleep matters","volume":"84","author":"Amato","year":"2018","journal-title":"Ann Neurol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1002\/ana.25459","article-title":"Slow-wave sleep and motor progression in Parkinson disease","volume":"85","author":"Schreiner","year":"2019","journal-title":"Ann Neurol."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aww018","article-title":"Electroencephalographic prodromal markers of dementia across conscious states in Parkinson's disease","author":"Latreille","year":"2016","journal-title":"Brain."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3233\/JPD-202215","article-title":"Slow wave sleep and EEG delta spectral power are associated with cognitive function in Parkinson's disease","author":"Wood","year":"2020","journal-title":"J Parkinsons Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1073\/pnas.0807933106","article-title":"Source modeling sleep slow waves","volume":"106","author":"Murphy","year":"2009","journal-title":"Proc Natl Acad Sci USA."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.5665\/sleep.6240","article-title":"Reduced slow-wave sleep is associated with high cerebrospinal fluid Abeta42 levels in cognitively normal elderly","volume":"39","author":"Varga","year":"2016","journal-title":"Sleep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1002\/mds.25650","article-title":"Body side and predominant motor features at the onset of Parkinson's disease are linked to motor and nonmotor progression","volume":"29","author":"Baumann","year":"2014","journal-title":"Mov Disord."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1002\/mds.23429","article-title":"Systematic review of levodopa dose equivalency reporting in Parkinson's disease","volume":"25","author":"Tomlinson","year":"2010","journal-title":"Mov Disord."},{"key":"B23","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1212\/WNL.0b013e3181fc29c9","article-title":"The MoCA: well-suited screen for cognitive impairment in Parkinson disease","volume":"75","author":"Dalrymple-Alford","year":"2010","journal-title":"Neurology."},{"key":"B25","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1136\/jnnp.55.3.181","article-title":"Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases","volume":"55","author":"Hughes","year":"1992","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1002\/mds.21507","article-title":"Clinical diagnostic criteria for dementia associated with Parkinson's disease","volume":"22","author":"Emre","year":"2007","journal-title":"Mov Disord."},{"key":"B27","article-title":"The AASM Scoring Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.2","author":"Berry","year":"2015"},{"key":"B28","article-title":"International Classification of Sleep Disorders","author":"Medicine","year":"2014"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsx033","article-title":"The impact of subthalamic deep brain stimulation on sleep-wake behavior: a prospective electrophysiological study in 50 Parkinson patients","author":"Baumann-Vogel","year":"2017","journal-title":"Sleep."},{"key":"B30","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1111\/nan.12024","article-title":"Disturbed sleep in Parkinson's disease: anatomical and pathological correlates","volume":"39","author":"Kalaitzakis","year":"2013","journal-title":"Neuropathol Appl Neurobiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.smrv.2016.02.002","article-title":"Candidate mechanisms underlying the association between sleep-wake disruptions and Alzheimer's disease","volume":"31","author":"Cedernaes","year":"2017","journal-title":"Sleep Med Rev."},{"key":"B32","doi-asserted-by":"publisher","first-page":"603","DOI":"10.3233\/JPD-191627","article-title":"Sleep disturbance as potential risk and progression factor for Parkinson's disease","volume":"9","author":"Bohnen","year":"2019","journal-title":"J Parkinsons Dis."},{"key":"B33","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1017\/S1355617711001482","article-title":"The impact of sleep quality on cognitive functioning in Parkinson's disease","volume":"18","author":"Stavitsky","year":"2012","journal-title":"J Int Neuropsychol Soc."},{"key":"B34","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/0891988713509135","article-title":"The relationships between poor sleep efficiency and mild cognitive impairment in Parkinson disease","volume":"27","author":"Gunn","year":"2014","journal-title":"J Geriatr Psychiatry Neurol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.parkreldis.2016.03.006","article-title":"Longitudinal changes in cognition in early Parkinson's disease patients with REM sleep behavior disorder","volume":"27","author":"Chahine","year":"2016","journal-title":"Parkinsonism Relat Disord."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1212\/WNL.0000000000003738","article-title":"Reduced cognitive function in patients with Parkinson disease and obstructive sleep apnea","volume":"88","author":"Mery","year":"2017","journal-title":"Neurology."},{"key":"B37","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1111\/pcn.12819","article-title":"Global cognitive performance is associated with sleep efficiency measured by polysomnography in patients with Parkinson's disease","volume":"73","author":"Sobreira","year":"2019","journal-title":"Psychiatry Clin Neurosci."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/j.neurobiolaging.2014.09.009","article-title":"Sleep spindles in Parkinson's disease may predict the development of dementia","volume":"36","author":"Latreille","year":"2015","journal-title":"Neurobiol Aging."},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2020.06.020","article-title":"Polysomnographic predictors of sleep, motor and cognitive dysfunction progression in Parkinson's disease: a longitudinal study","author":"Bugalho","year":"2020","journal-title":"Sleep Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1097\/00001756-199612200-00025","article-title":"Brain topography of the human sleep EEG: antero-posterior shifts of spectral power","volume":"8","author":"Werth","year":"1996","journal-title":"Neuroreport."},{"key":"B41","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1159\/000341998","article-title":"Cognitive impairment in Parkinson's disease: the dual syndrome hypothesis","volume":"11","author":"Kehagia","year":"2013","journal-title":"Neurodegener Dis."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awm111","article-title":"Evolution of cognitive dysfunction in an incident Parkinson's disease cohort","author":"Williams-Gray","year":"2007","journal-title":"Brain."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.618101\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T17:39:20Z","timestamp":1613842760000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.618101\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,19]]},"references-count":42,"alternative-id":["10.3389\/fneur.2021.618101"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2021.618101","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,19]]},"article-number":"618101"}}