Narcolepsy pp 223-229 | Cite as

Memory and Cognition in Narcolepsy

  • Christian Bellebaum
  • Irene Daum


Many patients suffering from the sleep disorder of narcolepsy complain about cognitive dysfunction, most concerning frequent memory and concentration problems. These self-reports have not been consistently corroborated by any standardized assessment of cognitive function. While some investigations did not find significant differences in memory function between narcoleptic patients and healthy control subjects, others yielded mild impairments, which did not match the severity of subjective complaints. For attention and executive control, cognitive domains for which empirical data are as yet sparse, dysfunction is more consistently observed. Narcolepsy patients are primarily impaired on attention tasks with higher demands on attentional resources or those which require concentration across an extended period of time, suggesting an increased need for allocating cognitive resources to maintain alertness, thereby compensating for increased levels of sleepiness. This compensatory mechanism leads to performance in the normal range on short or less demanding tasks. If the remaining resources are not sufficient for the task at hand, performance decrements are observed, frequently in the form of a speed-accuracy trade-off. This mechanism underlies the general pattern of cognitive dysfunction in narcolepsy. Findings of compensatory recruitment of brain areas in healthy sleep-deprived subjects also provide evidence for this view.


Narcolepsy Memory Attention Executive function Sleepiness Compensatory recruitment 


  1. 1.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders. Diagnostic and coding manual, 2nd Edition. Westchester: American Academy of Sleep Medicine.Google Scholar
  2. 2.
    Yoss, R.E., Daly, D.D. (1957) Criteria for the diagnosis of the narcoleptic syndrome. Proc Staff Meet Mayo Clin 32, 320–328.PubMedGoogle Scholar
  3. 3.
    Thannickal, T.C., Moore, R.Y., Nienhuis, R., Ramanathan, L., Gulyani, S., Aldrich, M., Cornford, M., Siegel, J.M. (2000) Reduced number of hypocretin neurons in human narcolepsy. Neuron 27, 469–474.CrossRefPubMedGoogle Scholar
  4. 4.
    Peyron, C., Tighe, D.K., van den Pol, A.N., de Lecea, L., Heller, H.C., Sutcliffe, J.G., Kilduff, T.S. (1998) Neurons containing hypocretin (orexin) project to multiple neuronal systems. J Neurosci 18, 9996–10015.Google Scholar
  5. 5.
    Kish, S.J., Mamelak, M., Slimovitch, C., Dixon, L.M., Lewis, A., Shannak, K., DiStefano, L., Chang, L.J., Hornykiewicz, O. (1992) Brain neurotransmitter changes in human narcolepsy. Neurology 42, 229–234.PubMedGoogle Scholar
  6. 6.
    Aldrich, M.S., Prokopowicz, G., Ockert, K., Hollingsworth, Z., Penney, J.B., Albin, R.L. (1994) Neurochemical studies of human narcolepsy: alpha-adrenergic receptor autoradiography of human narcoleptic brain and brainstem. Sleep 17, 598–608.PubMedGoogle Scholar
  7. 7.
    Naumann, A., Daum, I. (2003) Narcolepsy: pathophysiology and neuropsychological changes. Behav Neurol 14, 89–98.PubMedGoogle Scholar
  8. 8.
    Ganado, W. (1958) The narcolepsy syndrome. Neurology 8, 487–496.PubMedGoogle Scholar
  9. 9.
    Broughton, R., Ghanem, Q., Hishikawa, Y., Sugita, Y., Nevsimalova, S., Roth, B. (1983) Life effects of narcolepsy: relationships to geographic origin (North American, Asian or European) and to other patient and illness variables. Can J Neurol Sci 10, 100–104.Google Scholar
  10. 10.
    Broughton, R., Ghanem, Q., Hishikawa, Y., Sugita, Y., Nevsimalova, S., Roth, B. (1981) Life effects of narcolepsy in 180 patients from North America, Asia and Europe compared to matched controls. Can J Neurol Sci 8, 299–304.PubMedGoogle Scholar
  11. 11.
    Rogers, A.E., Rosenberg, R.S. (1990) Tests of memory in narcoleptics. Sleep 13, 42–52.PubMedGoogle Scholar
  12. 12.
    Aguirre, M., Broughton, R., Stuss, D. (1985) Does memory impairment exist in narcolepsy-cataplexy? J Clin Exp Neuropsychol 7, 14–24.CrossRefPubMedGoogle Scholar
  13. 13.
    Riedel, B.W., Lichstein, K.L. (2000) Insomnia and daytime functioning. Sleep Med Rev 4, 277–298.CrossRefPubMedGoogle Scholar
  14. 14.
    Marshall, L., Born, J. (2007) The contribution of sleep to hippocampus-dependent memory consolidation. Trends Cogn Sci 11, 442–450.CrossRefPubMedGoogle Scholar
  15. 15.
    Naumann, A., Bellebaum, C., Daum, I. (2006) Cognitive deficits in narcolepsy. J Sleep Res 15, 329–338.CrossRefPubMedGoogle Scholar
  16. 16.
    Levander, S., Sachs, C. (1985) Vigilance performance and autonomic function in narcolepsy: effects of central stimulants. Psychophysiology 22, 24–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Rieger, M., Mayer, G., Gauggel, S. (2003) Attention deficits in patients with narcolepsy. Sleep 26, 36–43.PubMedGoogle Scholar
  18. 18.
    Rasch, B., Born, J. (2007) Maintaining memories by reactivation. Curr Opin Neurobiol 17, 698–703.CrossRefPubMedGoogle Scholar
  19. 19.
    Nishino, S. (2007) Clinical and neurobiological aspects of narcolepsy. Sleep Med 8, 373–399.CrossRefPubMedGoogle Scholar
  20. 20.
    Dement, W., Rechtschaffen, A., Gulevich, G. (1966) The nature of the narcoleptic sleep attack. Neurology 16, 18–33.PubMedGoogle Scholar
  21. 21.
    Posner, M.I., Petersen, S.E. (1990) The attention system of the human brain. Annu Rev Neurosci 13, 25–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Pollak, C.P., Wagner, D.R., Moline, M.L., Monk, T.H. (1992) Cognitive and motor performance of narcoleptic and normal subjects living in temporal isolation. Sleep 15, 202–211.PubMedGoogle Scholar
  23. 23.
    Schulz, H., Wilde-Frenz, J. (1995) Symposium: cognitive processes and sleep disturbances: the disturbance of cognitive processes in narcolepsy. J Sleep Res 4, 10–14.CrossRefPubMedGoogle Scholar
  24. 24.
    George, C.F., Boudreau, A.C., Smiley, A. (1996) Comparison of simulated driving performance in narcolepsy and sleep apnea patients. Sleep 19, 711–717.PubMedGoogle Scholar
  25. 25.
    Findley, L.J., Suratt, P.M., Dinges, D.F. (1999) Time-on-task decrements in “steer clear” performance of patients with sleep apnea and narcolepsy. Sleep 22, 804–809.Google Scholar
  26. 26.
    Valley, V., Broughton, R. (1981) Daytime performance deficits and physiological vigilance in untreated patients with narcolepsy-cataplexy compared to controls. Rev Electroencephalogr Neurophysiol Clin 11, 133–139.CrossRefPubMedGoogle Scholar
  27. 27.
    Fulda, S., Schulz, H. (2001) Cognitive dysfunction in sleep disorders. Sleep Med Rev 5, 423–445.CrossRefPubMedGoogle Scholar
  28. 28.
    Hood, B., Bruck, D. (1996) Sleepiness and performance in narcolepsy. J Sleep Res 5, 128–134.CrossRefPubMedGoogle Scholar
  29. 29.
    Norman, D.A., Shallice, T. (1986) Attention to action: willed and automatic control of behavior. In: Dadidson, R.J., Schwartz, G.E., Shapiro, D. (Eds.) Consciousness and self regulation, Vol. 4. Plenum, New York, pp. 1–18.Google Scholar
  30. 30.
    Logan, G. (1985) Executive control of thought. Acta Psychol 60, 193–210.CrossRefGoogle Scholar
  31. 31.
    Henry, G.K., Hart, R.P., Kwentus, J.A., Sicola, M.J. (1988) Effects of protriptyline on vigilance and information processing in narcolepsy. Psychopharmacology (Berl) 95, 109–112.Google Scholar
  32. 32.
    Hood, B., Bruck, D. (2002) A comparison of sleep deprivation and narcolepsy in terms of complex cognitive performance and subjective sleepiness. Sleep Med 3, 259–266.CrossRefPubMedGoogle Scholar
  33. 33.
    Dement, W.C., Carskadon, M.A., Richardson, G. (1978) Excessive daytime sleepiness in the seep apnea syndrome. In: Guilleminault, C., Dement, W.C. (Eds.) Alan Liss, New York, pp. 23–46.Google Scholar
  34. 34.
    Roth, T., Hartse, K.M., Zorick, F., Conway, W. (1980) Multiple naps and the evaluation of daytime sleepiness in patients with upper airway sleep apnea. Sleep 3, 425–439.PubMedGoogle Scholar
  35. 35.
    Chakravorty, S.S., Rye, D.B. (2003) Narcolepsy in the older adult: epidemiology, diagnosis and management. Drugs Aging 20, 361–376.Google Scholar
  36. 36.
    Drummond, S.P., Meloy, M.J., Yanagi, M.A., Orff, H.J., Brown, G.G. (2005) Compensatory recruitment after sleep deprivation and the relationship with performance. Psychiatry Res 140, 211–223.CrossRefPubMedGoogle Scholar
  37. 37.
    Drummond, S.P., Brown, G.G. (2001) The effects of total sleep deprivation on cerebral responses to cognitive performance. Neuropsychopharmacology 25, S68–S73.CrossRefPubMedGoogle Scholar
  38. 38.
    Drummond, S.P., Bischoff-Grethe, A., Dinges, D.F., Ayalon, L., Mednick, S.C., Meloy, M.J. (2005) The neural basis of the psychomotor vigilance task. Sleep 28, 1059–1068.PubMedGoogle Scholar
  39. 39.
    Chee, M.W., Tan, J.C., Zheng, H., Parimal, S., Weissman, D.H., Zagorodnov, V., Dinges, D.F. (2008) Lapsing during sleep deprivation is associated with distributed changes in brain activation. J Neurosci 28, 5519–5528.CrossRefPubMedGoogle Scholar
  40. 40.
    Drummond, S.P., Gillin, J.C., Brown, G.G. (2001) Increased cerebral response during a divided attention task following sleep deprivation. J Sleep Res 10, 85–92.CrossRefPubMedGoogle Scholar
  41. 41.
    Drummond, S.P., Brown, G.G., Gillin, J.C., Stricker, J.L., Wong, E.C., Buxton, R.B. (2000) Altered brain response to verbal learning following sleep deprivation. Nature 403, 655–657.CrossRefPubMedGoogle Scholar
  42. 42.
    Drummond, S.P., Brown, G.G., Salamat, J.S., Gillin, J.C. (2004) Increasing task difficulty facilitates the cerebral compensatory response to total sleep deprivation. Sleep 27, 445–451.PubMedGoogle Scholar
  43. 43.
    Brenneis, C., Brandauer, E., Frauscher, B., Schocke, M., Trieb, T., Poewe, W., Hogl, B. (2005) Voxel-based morphometry in narcolepsy. Sleep Med 6, 531–536.CrossRefPubMedGoogle Scholar
  44. 44.
    Kaufmann, C., Schuld, A., Pollmacher, T., Auer, D.P. (2002) Reduced cortical gray matter in narcolepsy: preliminary findings with voxel-based morphometry. Neurology 58, 1852–1855.PubMedGoogle Scholar
  45. 45.
    Overeem, S., Steens, S.C., Good, C.D., Ferrari, M.D., Mignot, E., Frackowiak, R.S., van Buchem, M.A., Lammers, G.J. (2003) Voxel-based morphometry in hypocretin-deficient narcolepsy. Sleep 26, 44–46.PubMedGoogle Scholar
  46. 46.
    Dang-Vu, T.T., Desseilles, M., Petit, D., Mazza, S., Montplaisir, J., Maquet, P. (2007) Neuroimaging in sleep medicine. Sleep Med 8, 349–372.CrossRefPubMedGoogle Scholar
  47. 47.
    Schwartz, S., Ponz, A., Poryazova, R., Werth, E., Boesiger, P., Khatami, R., Bassetti, C.L. (2008) Abnormal activity in hypothalamus and amygdala during humour processing in human narcolepsy with cataplexy. Brain 131, 514–522.CrossRefPubMedGoogle Scholar
  48. 48.
    Reiss, A.L., Hoeft, F., Tenforde, A.S., Chen, W., Mobbs, D., Mignot, E.J. (2008) Anomalous hypothalamic responses to humor in cataplexy. PLoS ONE 3, e2225.CrossRefPubMedGoogle Scholar
  49. 49.
    Naumann, A., Bierbrauer, J., Przuntek, H., Daum, I. (2001) Attentive and preattentive processing in narcolepsy as revealed by event-related potentials (ERPs). Neuroreport 12, 2807–2811.Google Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Neuropsychology, Institute of Cognitive NeuroscienceRuhr-University of BochumBochumGermany

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