Nightmares in the elderly: Associations with self-reported executive functions

Abstract

Study objectives

To describe nightmare phenomenology among community dwelling elderly and to test the hypothesis that reduction in cognitive control is associated with nightmare-related phenomenology including nightmare frequency and severity, greater emotional reactivity, imagery immersion, and dream enactment behaviors (DEBs).

Methods

Study 1: Survey with multiple regression and ANOVAs on N = 56 people with frequent nightmares plus N = 62 age- and gender-matched controls to quantify the strength of the association between cognitive control variables and nightmare phenomenology. Study 2: Computational simulation of nightmare phenomenology in relation to cognitive control to simulate the empirical findings and to assess the underlying causal theory through computationally supported causal inference.

Results

Study 1: Regressions demonstrated a strong association between reduction in cognitive control and more extreme nightmare phenomenology, including severity, frequency, daytime effects, and DEBs. Study 2: The computational simulation of nightmare phenomenology in relation to cognitive control is validated relative to regressions from study 1 and offers computational support for the causal theory explaining the associations in study 1.

Conclusions

In aging people, decline in executive cognitive functions, cognitive control, and inhibitory processes reduce cognitive control over emotions, thus contributing to unusual nightmare activity, including more extreme nightmare phenomenology such as more severe nightmares, greater emotional reactivity, deeper imagery immersion, and DEBs.