Abstract Details

Title The Nature and Magnitude of Cognitive Impairment in Narcolepsy and Idiopathic Hypersomnia: A Meta-analysis

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) S18 - Behavioral Neurology and Neuropsychiatry (3:42 PM-3:54 PM)

Poster/Presentation
Number 002

Background

Narcolepsy type 1 (NT1), narcolepsy type 2 (NT2) and Idiopathic hypersomnia (IH) are rare central disorders of hypersomnolence with high disease burden, including cognitive complaints. Neuropsychological models provide a strong brain-behavior framework for identification of the nature and magnitude of cognitive impairment and integration into etiological models of NT1, NT2, and IH.

Objective

To quantify the nature and magnitude of cognitive impairment in narcolepsy and idiopathic hypersomnia (IH).

Design/Methods Following PRISMA guidelines, we performed a meta-analysis (MA) of neuropsychological studies of NT1, NT2 and IH conducted between 2000 and 2022. Each cognitive test comparing patient and control groups was classified by the neuropsychological domain it assessed. For each test, the difference between patient and control groups was expressed as a standardized mean difference (Cohen’s d). The MA estimated Cohen’s ds for cognitive domains pooled according to clinical disease group.

Results 87 studies were identified and screened for inclusion; 39 satisfied inclusion criteria, yielding 35 comparisons (k): NT1: k=25; NT2: k=5; IH: k=5. Data were sufficient to compute pooled performance estimates for attention, executive function, and memory domains. The MA indicated impaired performance for all domains. For attention, a large magnitude impairment was found for NT1 (d=-0.90) and IH (d=-0.97), and moderate magnitude impairment for NT2 (d=-0.60). Moderate magnitudes of impairment were identified in executive function for NT1 (d=-0.30) and NT2 (d=-0.38), and in memory for NT1 (d=-0.33).

Conclusions The MA confirmed that cognitive impairments are present in NT1, NT2, and IH with impairment in the attention domain largest in each group. Moderate impairment was also found in executive function and memory. These results provide a quantitative confirmation of reports of cognitive difficulties made by patients and clinicians and provide a basis for the future design of studies to determine whether cognitive impairments can be ameliorated by treatments for narcolepsy and IH.

Authors/Disclosures
Brian Harel, PhD PRESENTER	Brian Harel has received personal compensation for serving as an employee of Takeda. An immediate family member of Brian Harel has received personal compensation for serving as an employee of Astra Zeneca. Brian Harel has stock in Takeda, Merck, Day One Biopharmaceuticals. An immediate family member of Brian Harel has stock in Eli Lilly, Pfizer, Astra Zeneca. Brian Harel has stock in Cogstate.
Paul Maruff, PhD (Cogstate)	Dr. Maruff has received personal compensation for serving as an employee of Cogstate .
Robert Latzman (Takeda)	No disclosure on file
James Gattuso (The University of Melbourne)	No disclosure on file
Giuseppe Plazzi, MD (University di Bologna)	The institution of Dr. Plazzi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TAKEDA. The institution of Dr. Plazzi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BIOPROJET. The institution of Dr. Plazzi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for JAZZ. The institution of Dr. Plazzi has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for OREXIA. The institution of Dr. Plazzi has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for OREXIA/CENTESSA.
Thomas E. Scammell, MD	Dr. Scammell has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Takeda. Dr. Scammell has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for UpToDate. The institution of Dr. Scammell has received research support from Takeda.