# Risk Factors for Poor Sleep Quality and Subjective Cognitive Decline in Older Adults Living in the United States During the COVID-19 Pandemic

## TL;DR

This study found that poor sleep, depression, and anxiety during the pandemic are linked to greater concerns about cognitive decline in older US adults.

## Contribution

The study identifies pandemic-specific associations between mental health, sleep, and cognitive concerns in older adults.

## Key findings

- Poorer sleep during the pandemic was linked to greater subjective cognitive decline (β = 0.16, p = 0.01).
- Depression and anxiety were strongly associated with greater cognitive decline (β = 0.46 and β = 0.29, respectively).
- Depression and anxiety also predicted worsened sleep during the pandemic (OR = 1.17 and OR = 1.15, respectively).

## Abstract

Background/Objectives: Poor sleep quality, depression, and anxiety are associated with subjective cognitive decline (SCD) and greater risk for developing cognitive impairment and Alzheimer’s disease. The COVID-19 pandemic negatively impacted sleep habits and psychological well-being in many individuals, yet their relationship to SCD in this context remains understudied. We examined sociodemographic characteristics, depression, anxiety, and sleep changes during the pandemic (i.e., increased problems/poorer quality) and SCD in older individuals living in the US. Methods: In total, 288 older adults (Mage = 67.4 [7.4]) completed an online survey including a sociodemographic questionnaire, the Center for Epidemiologic Studies Depression Scale (Revised) (CES-D-10; depression), General Anxiety Disorder-7 (GAD-7; anxiety), the Everyday Cognition scale (ECog; SCD), and a question about increased sleep problems/worsened sleep quality during the pandemic. Hierarchical and logistic regression analyses were used to assess relations among sociodemographic factors, depression, anxiety, changes in sleep quality, and SCD. Results: Self-reported pandemic-related impairments in sleep were associated with greater SCD (β = 0.16, p = 0.01). Depression (β = 0.46, p < 0.001) and anxiety (β = 0.29, p < 0.001) were also associated with greater SCD. Depression (OR = 1.17, p < 0.001) and anxiety (OR = 1.15, p = 0.017) predicted reported poorer sleep during the pandemic. Conclusions: Depression, anxiety, and poorer sleep quality during the COVID-19 pandemic were associated with greater SCD concerns. Greater depression and anxiety were also associated with the reported sleep problems/worsened sleep quality. Prevention and management of anxiety and depressive symptoms may help maintain sleep quality and reduce risk of cognitive decline.