Objectives/Aims Distressing dreams are associated with faster cognitive decline and increased dementia risk in people with Parkinson’s disease (PD). Whether distressing dreams might be associated with cognitive decline and dementia in people without PD is unknown. This study investigated the association between self-reported distressing dream frequency and the risk of cognitive decline and incident dementia in community- dwelling men and women without cognitive impairment or PD.

Methods Risk of cognitive decline was evaluated in 605 middle-aged adults (mean age = 50 years) from the Midlife in the United States study, who were cognitively normal at baseline, and were followed-up for a mean of 9 years. Cognitive decline was defined as having an annual rate of decline in global cognitive function (measured using five cognitive tests) ≥ 1 standard deviation faster than the mean decline rate from baseline to follow-up. Risk of incident all-cause dementia was evaluated in 2600 older adults (mean age = 83 years) pooled from the Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures, who were dementia-free at baseline, and were followed-up for up a mean of 4.5 years. Incident dementia was based on doctor- diagnosis. Frequency of distressing dreams was assessed in all cohorts at baseline (January 2002 – March 2012) using item 5h of the Pittsburgh Sleep Quality Index. The association between self-reported distressing dream frequency (‘never’, ‘less than weekly’, ‘weekly’) and later cognitive outcomes, was evaluated using multivariable logistic regression in the middle-aged and pooled older adult cohorts.

Results After adjustment for all covariates, a higher frequency of distressing dreams was linearly and statistically significantly associated with higher risk of cognitive decline amongst middle-aged adults (P for trend = 0.016), and higher risk of incident all-cause dementia amongst older adults (P for trend <0.001). Compared with middle-aged adults who reported having no distressing dreams at baseline, those who reported having weekly distressing dreams had a 4-fold risk of experiencing cognitive decline (odds ratio [OR] = 3.99; 95% CI: 1.07, 14.85). Amongst older adults, the difference in dementia risk was 2.2-fold (aOR = 2.21; 95% CI: 1.35, 3.62). In sex-stratified analyses, the associations between distressing dreams and both cognitive outcomes were only statistically significant amongst men.

Conclusions Distressing dreams predict cognitive decline and all-cause dementia in middle-aged and older adults without cognitive impairment or PD - especially amongst men. These findings may help to identify individuals at risk of dementia and could facilitate early prevention strategies.