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Villa C, Ferini-Strambi L, Combi R. The Synergistic Relationship between Alzheimer's Disease and Sleep Disorders: An Update. J Alzheimers Dis 2016; 46:571-80. [PMID: 25835421 DOI: 10.3233/jad-150138] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Sleep disorders are frequently reported in Alzheimer's disease (AD), with a significant impact on patients and caregivers and a major risk factor for early institutionalization. Although changes in sleep organization are a hallmark of the normal aging processes, sleep macro- and micro-architectural alterations are more evident in patients affected by AD. Degeneration of neural pathways regulating sleep-wake patterns and sleep architecture may contribute to sleep alterations. In return, several recent studies suggested that common sleep disorders may precede clinical symptoms of dementia and represent risk factors for cognitive decline, through impairment of sleep-dependent memory consolidation processes. Thus, a close relationship between sleep disorders and AD has been largely hypothesized. Here, sleep alterations in AD and its pre-dementia stage, mild cognitive impairment, and their complex interactions are reviewed.
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Affiliation(s)
- Chiara Villa
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Sleep Disorders Center, University Vita-Salute San Raffaele, Milan, Italy
| | - Romina Combi
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
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Allen NE, Moloney N, van Vliet V, Canning CG. The Rationale for Exercise in the Management of Pain in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:229-39. [PMID: 25649828 PMCID: PMC4923748 DOI: 10.3233/jpd-140508] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pain is a distressing non-motor symptom experienced by up to 85% of people with Parkinson’s disease (PD), yet it is often untreated. This pain is likely to be influenced by many factors, including the disease process, PD impairments as well as co-existing musculoskeletal and/or neuropathic pain conditions. Expert opinion recommends that exercise is included as one component of pain management programs; however, the effect of exercise on pain in this population is unclear. This review presents evidence describing the potential influence of exercise on the pain-related pathophysiological processes present in PD. Emerging evidence from both animal and human studies suggests that exercise might contribute to neuroplasticity and neuro-restoration by increasing brain neurotrophic factors, synaptic strength and angiogenesis, as well as stimulating neurogenesis and improving metabolism and the immune response. These changes may be beneficial in improving the central processing of pain. There is also evidence that exercise can activate both the dopaminergic and non-dopaminergic pain inhibitory pathways, suggesting that exercise may help to modulate the experience of pain in PD. Whilst clinical data on the effects of exercise for pain relief in people with PD are scarce, and are urgently needed, preliminary guidelines are presented for exercise prescription for the management of central neuropathic, peripheral neuropathic and musculoskeletal pain in PD.
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Affiliation(s)
- Natalie E Allen
- Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Naharci MI, Ozturk A, Yasar H, Cintosun U, Kocak N, Bozoglu E, Tasci I, Doruk H. Galantamine improves sleep quality in patients with dementia. Acta Neurol Belg 2015; 115:563-8. [PMID: 25777522 DOI: 10.1007/s13760-015-0453-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality.
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Affiliation(s)
- Mehmet Ilkin Naharci
- Division of Geriatrics, Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey.
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
| | - Ahmet Ozturk
- Division of Geriatrics, Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Halit Yasar
- Department of Neurology, Mevki Military Hospital, Ankara, Turkey
| | - Umit Cintosun
- Division of Geriatrics, Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Necmettin Kocak
- Department of Epidemiology, Gulhane School of Medicine, Ankara, Turkey
| | - Ergun Bozoglu
- Division of Geriatrics, Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Ilker Tasci
- Division of Geriatrics, Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Huseyin Doruk
- Division of Geriatrics, Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
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Chwiszczuk L, Breitve M, Hynninen M, Gjerstad MD, Aarsland D, Rongve A. Higher Frequency and Complexity of Sleep Disturbances in Dementia with Lewy Bodies as Compared to Alzheimer's Disease. NEURODEGENER DIS 2015; 16:152-60. [PMID: 26551998 DOI: 10.1159/000439252] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sleep disturbances (SDs) are common in patients with all forms of dementia. However, most studies focus on Alzheimer's disease (AD) and less is known about the prevalence and characteristics of SD in dementia with Lewy bodies (DLB). OBJECTIVE The aims of this cross-sectional study were: (1) to examine the frequency of SD in DLB versus AD; (2) to compare patients with and without SD with regard to relevant clinical variables, and (3) to investigate the associations between SD and medication use. METHODS Patients with a first-time diagnosis of probable or possible DLB or AD were selected from the Dementia Study of Western Norway and recruited from clinics for old age psychiatry from 2010 until the end of 2013. RESULTS In all, 123 (55.7%) subjects with dementia suffered from at least one SD. Insomnia was present in 77 (34.8%), and 34 (20.7%) patients had probable REM-sleep behaviour disorder (RBD). All SDs were also significantly more frequent in patients with DLB than in AD, and DLB patients also more often had several co-occurring SDs. The presence of any SD was associated with more neuropsychiatric symptoms, higher morbidity, more parkinsonian symptoms and excessive daytime sleepiness. Antiparkinsonian medication was used more often in RBD, restless leg syndrome (RLS) and periodic limb movements, and benzodiazepines were also common in RLS. CONCLUSIONS Sleep problems are more common in DLB patients compared to AD, and are associated with more clinical impairment. DLB patients frequently have several sleep problems occurring simultaneously, which suggests a need for screening and accurate assessment of sleep in DLB.
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Wilfling D, Junghans A, Marshall L, Eisemann N, Meyer G, Möhler R, Köpke S. Non-pharmacological interventions for sleep disturbances in people with dementia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Denise Wilfling
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany 23583
| | - Anne Junghans
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany 23583
| | - Lisa Marshall
- University of Lübeck; Institute of Experimental and Clinical Pharmacology and Toxicology; Ratzeburger Allee 160 Lübeck Germany 23538
| | - Nora Eisemann
- University of Lübeck; Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany 23583
| | - Gabriele Meyer
- Martin-Luther-University Halle-Wittenberg; Institute of Health and Nursing Sciences; Magdeburger Straße 8 Halle (Saale) Germany 06112
| | - Ralph Möhler
- Witten/Herdecke University; School of Nursing Science, Faculty of Health; Stockumer Straße 12 Witten Germany 58453
| | - Sascha Köpke
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany 23583
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Smith K, Attenburrow MJ. Sleep problems in Alzheimer's disease: does drug treatment help or harm? BJPSYCH ADVANCES 2015. [DOI: 10.1192/apt.21.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryDrug treatments are commonly used for sleep disturbance in Alzheimer's disease, although none have a specific licence for this indication. This month's Cochrane review assessed the available evidence of benefit or harm in the use of these medications. The review identified two studies of melatonin, which did not show significant improvement in sleep over placebo. One study of trazodone suggested a beneficial effect on sleep, but its small sample size limits the generalisability of the results. Larger studies are needed, with careful assessment of the evidence for possible improvements in sleep but also of important side-effects such as falls and increased confusion.
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Kwon KJ, Lee EJ, Kim MK, Jeon SJ, Choi YY, Shin CY, Han SH. The potential role of melatonin on sleep deprivation-induced cognitive impairments: implication of FMRP on cognitive function. Neuroscience 2015; 301:403-14. [PMID: 26047724 DOI: 10.1016/j.neuroscience.2015.05.079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/05/2015] [Accepted: 05/29/2015] [Indexed: 12/31/2022]
Abstract
While prolonged sleep deprivation (SD) could lead to profound negative health consequences, such as impairments in vital biological functions of immunity and cognition, melatonin possesses powerful ameliorating effects against those harmful insults. Melatonin has strong antioxidant and anti-inflammatory effects that help to restore body's immune and cognitive functions. In this study, we investigated the possible role of melatonin in reversing cognitive dysfunction induced by SD in rats. Our experimental results revealed that sleep-deprived animals exhibited spatial memory impairment in the Morris water maze tasks compared with the control groups. Furthermore, there was an increased glial activation most prominent in the hippocampal region of the SD group compared to the normal control (NC) group. Additionally, markers of oxidative stress such as 4-hydroxynonenal (4-HNE) and 7,8-dihydro-8-oxo-deoxyguanine (8-oxo-dG) were significantly increased, while fragile X-mental retardation protein (FMRP) expression was decreased in the SD group. Interestingly, melatonin treatment normalized these events to control levels following SD. Our data demonstrate that SD induces oxidative stress through glial activation and decreases FMRP expression in the neurons. Furthermore, our results suggest the efficacy of melatonin for the treatment of sleep-related neuronal dysfunction, which occurs in neurological disorders such as Alzheimer's disease and autism.
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Affiliation(s)
- K J Kwon
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea; Department of Neurology, Konkuk University Medical Center, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - E J Lee
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - M K Kim
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - S J Jeon
- Department of Oriental Pharmaceutical Science, College of Pharmacy, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Y Y Choi
- Department of Biomedical Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - C Y Shin
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - S-H Han
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea; Department of Neurology, Konkuk University Medical Center, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea.
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Pfeffer M, Wicht H, von Gall C, Korf HW. Owls and larks in mice. Front Neurol 2015; 6:101. [PMID: 26029157 PMCID: PMC4432671 DOI: 10.3389/fneur.2015.00101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/24/2015] [Indexed: 11/13/2022] Open
Abstract
Humans come in different chronotypes and, particularly, the late chronotype (the so-called owl) has been shown to be associated with several health risks. A number of studies show that laboratory mice also display various chronotypes. In mice as well as in humans, the chronotype shows correlations with the period length and rhythm stability. In addition, some mouse models for human diseases show alterations in their chronotypic behavior, which are comparable to those humans. Thus, analysis of the behavior of mice is a powerful tool to unravel the molecular and genetic background of the chronotype and the prevalence of risks and diseases that are associated with it. In this review, we summarize the correlation of chronotype with free-running period length and rhythm stability in inbred mouse strains, in mice with a compromised molecular clockwork, and in a mouse model for neurodegeneration.
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Affiliation(s)
- Martina Pfeffer
- Dr. Senckenbergische Anatomie II, Fachbereich Medizin der Goethe-Universität , Frankfurt am Main , Germany ; Dr. Senckenbergisches Chronomedizinisches Institut, Fachbereich Medizin der Goethe-Universität , Frankfurt am Main , Germany
| | - Helmut Wicht
- Dr. Senckenbergische Anatomie II, Fachbereich Medizin der Goethe-Universität , Frankfurt am Main , Germany ; Dr. Senckenbergisches Chronomedizinisches Institut, Fachbereich Medizin der Goethe-Universität , Frankfurt am Main , Germany
| | - Charlotte von Gall
- Institut für Anatomie II, Fachbereich Medizin, Heinrich Heine Universität , Düsseldorf , Germany
| | - Horst-Werner Korf
- Dr. Senckenbergische Anatomie II, Fachbereich Medizin der Goethe-Universität , Frankfurt am Main , Germany ; Dr. Senckenbergisches Chronomedizinisches Institut, Fachbereich Medizin der Goethe-Universität , Frankfurt am Main , Germany
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Sleep in Neurodegenerative Disorders. CURRENT SLEEP MEDICINE REPORTS 2015. [DOI: 10.1007/s40675-015-0016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim J, Sidransky E, Lopez G. Understanding and managing parkinsonism in patients with glucocerebrosidase mutations. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1034271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tardy M, Gonthier R, Barthelemy JC, Roche F, Crawford-Achour E. Subjective sleep and cognitive complaints in 65 year old subjects: a significant association. The PROOF cohort. J Nutr Health Aging 2015; 19:424-30. [PMID: 25809806 DOI: 10.1007/s12603-014-0547-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The prevalence of subjective sleep and cognitive complaints increases with age. The purpose of this study was to investigate the link between subjective cognitive and sleep complaints in a population aged 65. DESIGN AND SETTING analysis of a cohort of 1011 subjects aged 65 years old at time of inclusion. METHODS Older people underwent a cognitive tests battery and a nocturnal polygraphy recording. Subjective cognitive difficulties were scored on the McNair and Kahn Scale. Subjective sleep complaints were evaluated according to the St. Mary's Hospital Sleep Questionnaire and the Epworth Sleepiness Scale score. RESULTS In a 65 years old population, an association between subjective cognitive difficulties and poor sleep quality was observed. This remained significant after adjustment on gender, depression score, anxiety, educational level, medication intake, Apnea/Hypopnea index, Body Mass Index and Mini-Mental State Examination (OR = 2.1; p = 0.0002). Similar significant association was demonstrated between subjective cognitive difficulties and daytime sleepiness (OR = 2.6; p = 0.0007). CONCLUSION There was a significant association between subjective cognitive and sleep complaints, and daytime sleepiness in our population of older people.
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Affiliation(s)
- M Tardy
- Dr Emilie Crawford-Achour, Hôpital La Charité, Rue Pointe Cadet, 42055 Saint Etienne, Cedex, Mail : , Tel: 0033(0)477127098, Fax: 0033(0)477127083
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Sethi M, Joshi SS, Webb RL, Beckett TL, Donohue KD, Murphy MP, O'Hara BF, Duncan MJ. Increased fragmentation of sleep-wake cycles in the 5XFAD mouse model of Alzheimer's disease. Neuroscience 2015; 290:80-9. [PMID: 25637807 PMCID: PMC4361816 DOI: 10.1016/j.neuroscience.2015.01.035] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 01/19/2023]
Abstract
Sleep perturbations including fragmented sleep with frequent night-time awakenings and daytime naps are common in patients with Alzheimer's disease (AD), and these daily disruptions are a major factor for institutionalization. The objective of this study was to investigate if sleep-wake patterns are altered in 5XFAD mice, a well-characterized double transgenic mouse model of AD which exhibits an early onset of robust AD pathology and memory deficits. These mice have five distinct human mutations in two genes, the amyloid precursor protein (APP) and Presenilin1 (PS1) engineered into two transgenes driven by a neuron-specific promoter (Thy1), and thus develop severe amyloid deposition by 4 months of age. Age-matched (4-6.5 months old) male and female 5XFAD mice were monitored and compared to wild-type littermate controls for multiple sleep traits using a non-invasive, high throughput, automated piezoelectric system which detects breathing and gross body movements to characterize sleep and wake. Sleep-wake patterns were recorded continuously under baseline conditions (undisturbed) for 3 days and after sleep deprivation of 4h, which in mice produces a significant sleep debt and challenge to sleep homeostasis. Under baseline conditions, 5XFAD mice exhibited shorter bout lengths (14% lower values for males and 26% for females) as compared to controls (p<0.001). In females, the 5XFAD mice also showed 12% less total sleep than WT (p<0.01). Bout length reductions were greater during the night (the active phase for mice) than during the day, which does not model the human condition of disrupted sleep at night (the inactive period). However, the overall decrease in bout length suggests increased fragmentation and disruption in sleep consolidation that may be relevant to human sleep. The 5XFAD mice may serve as a useful model for testing therapeutic strategies to improve sleep consolidation in AD patients.
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Affiliation(s)
- M Sethi
- Department of Biology, University of Kentucky, Lexington, KY 40506, USA
| | - S S Joshi
- Department of Biology, University of Kentucky, Lexington, KY 40506, USA
| | - R L Webb
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY 40536, USA; Sanders-Brown Center on Aging and Alzheimer's Disease Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - T L Beckett
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY 40536, USA; Sanders-Brown Center on Aging and Alzheimer's Disease Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - K D Donohue
- Department of Electrical and Computer Engineering, University of Kentucky, KY 40506, USA
| | - M P Murphy
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY 40536, USA; Sanders-Brown Center on Aging and Alzheimer's Disease Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - B F O'Hara
- Department of Biology, University of Kentucky, Lexington, KY 40506, USA
| | - M J Duncan
- Department of Anatomy and Neurobiology, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
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de Oliveira FF, Bertolucci PHF, Chen ES, Smith MDAC. Assessment of sleep satisfaction in patients with dementia due to Alzheimer’s disease. J Clin Neurosci 2014; 21:2112-7. [DOI: 10.1016/j.jocn.2014.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 05/15/2014] [Indexed: 12/11/2022]
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Effects of social activation and physical mobilization on sleep in nursing home residents. Geriatr Nurs 2014; 35:455-61. [DOI: 10.1016/j.gerinurse.2014.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 11/23/2022]
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Laudon M, Frydman-Marom A. Therapeutic effects of melatonin receptor agonists on sleep and comorbid disorders. Int J Mol Sci 2014; 15:15924-50. [PMID: 25207602 PMCID: PMC4200764 DOI: 10.3390/ijms150915924] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/20/2014] [Accepted: 08/27/2014] [Indexed: 12/12/2022] Open
Abstract
Several melatonin receptors agonists (ramelteon, prolonged-release melatonin, agomelatine and tasimelteon) have recently become available for the treatment of insomnia, depression and circadian rhythms sleep-wake disorders. The efficacy and safety profiles of these compounds in the treatment of the indicated disorders are reviewed. Accumulating evidence indicates that sleep-wake disorders and co-existing medical conditions are mutually exacerbating. This understanding has now been incorporated into the new Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Therefore, when evaluating the risk/benefit ratio of sleep drugs, it is pertinent to also evaluate their effects on wake and comorbid condition. Beneficial effects of melatonin receptor agonists on comorbid neurological, psychiatric, cardiovascular and metabolic symptomatology beyond sleep regulation are also described. The review underlines the beneficial value of enhancing physiological sleep in comorbid conditions.
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Affiliation(s)
- Moshe Laudon
- Neurim Pharmaceuticals Ltd., 27 Habarzel St. Tel-Aviv 6971039, Israel.
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Ketata W, Feki W, Yangui I, Msaad S, Ayoub A. [Obstructive sleep apnea syndrome in the elderly]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:223-232. [PMID: 24894966 DOI: 10.1016/j.pneumo.2014.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 01/22/2014] [Accepted: 02/05/2014] [Indexed: 06/03/2023]
Abstract
Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a common disease in the general population. However, original works on the SAHS in the elderly are few and their results are discordant. Studies show an increased prevalence of OSAHS with age, and despite this high prevalence, it remains under-diagnosed due to lack of knowledge of geriatric features of this disease and the frequency of comorbidities that may worsen as a result of nocturnal breathing problems but can also mask the symptoms necessary for positive diagnosis. The functional symptoms are dominated by neurological signs such as daytime hypersomnia and cognitive impairment often reported by those around the patient. The treatment is based mainly on continuous positive airway pressure which tolerance in elderly patients suffering from sleep apnea is similar to that of younger patients. Mandibular implants can be discussed depending on the severity of the condition. Surgical treatment is not indicated because of the increased frequency of complications.
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Affiliation(s)
- W Ketata
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie.
| | - W Feki
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - I Yangui
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - S Msaad
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - A Ayoub
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
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Guarnieri B, Musicco M, Caffarra P, Adorni F, Appollonio I, Arnaldi D, Bartoli A, Bonanni E, Bonuccelli U, Caltagirone C, Cerroni G, Concari L, Cosentino FII, Fermi S, Ferri R, Gelosa G, Lombardi G, Mearelli S, Nobili F, Passero S, Perri R, Rocchi R, Sucapane P, Tognoni G, Zabberoni S, Sorbi S. Recommendations of the Sleep Study Group of the Italian Dementia Research Association (SINDem) on clinical assessment and management of sleep disorders in individuals with mild cognitive impairment and dementia: a clinical review. Neurol Sci 2014; 35:1329-48. [PMID: 25037740 DOI: 10.1007/s10072-014-1873-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/26/2014] [Indexed: 02/02/2023]
Abstract
Clinical assessment and management of sleep disturbances in patients with mild cognitive impairment and dementia has important clinical and social implications. Poor sleep results in an increased risk of morbidities and mortality in demented patients and is a source of stress for caregivers. Sleep disturbances show high prevalence in mild cognitive impairment and dementia patients and they are often associated one to another in the same patient. A careful clinical evaluation of sleep disorders should be performed routinely in the clinical setting of individuals with cognitive decline. The Sleep Study Group of the Italian Dementia Research Association (SINDem) reviewed evidence from original research articles, meta-analyses and systematic reviews published up to December 2013. The evidence was classified in quality levels (I, II, III) and strength of recommendations (A, B, C, D, E). Where there was a lack of evidence, but clear consensus, good practice points were provided. These recommendations may not be appropriate for all circumstances and should therefore be adopted only after a patient's individual characteristics have been carefully evaluated.
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Affiliation(s)
- B Guarnieri
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo, Pescara, Italy,
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Dauvilliers YA, Lehmann S, Jaussent I, Gabelle A. Hypocretin and brain β-amyloid peptide interactions in cognitive disorders and narcolepsy. Front Aging Neurosci 2014; 6:119. [PMID: 24966833 PMCID: PMC4052448 DOI: 10.3389/fnagi.2014.00119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/27/2014] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine relationships between cerebrospinal fluid (CSF) Alzheimer' disease (AD) biomarkers and hypocretin-1 levels in patients with cognitive abnormalities and hypocretin-deficient narcolepsy-cataplexy (NC), estimate diagnostic accuracy, and determine correlations with sleep disturbances. Background: Sleep disturbances are frequent in AD. Interactions between brain β-amyloid (Aβ) aggregation and a wake-related neurotransmitter hypocretin have been reported in a mouse model of AD. Methods: Ninety-one cognitive patients (37 AD, 16 mild cognitive impairment—MCI that converts to AD, 38 other dementias) and 15 elderly patients with NC were recruited. Patients were diagnosed blind to CSF results. CSF Aβ42, total tau, ptau181, and hypocretin-1 were measured. Sleep disturbances were assessed with questionnaires in 32 cognitive patients. Results: Lower CSF Aβ42 but higher tau and P-tau levels were found in AD and MCI compared to other dementias. CSF hypocretin-1 levels were higher in patients with MCI due to AD compared to other dementias, with a similar tendency for patients with advanced AD. CSF hypocretin-1 was significantly and independently associated with AD/MCI due to AD, with an OR of 2.70 after full adjustment, exceeding that for Aβ42. Aβ42 correlated positively with hypocretin-1 levels in advanced stage AD. No association was found between sleep disturbances and CSF biomarkers. No patients with NC achieved pathological cutoffs for Aβ42, with respectively one and four patients with NC above tau and P-tau cutoffs and no correlations between hypocretin-1 and other biomarkers. Conclusions: Our results suggest a pathophysiological relationship between Aβ42 and hypocretin-1 in the AD process, with higher CSF hypocretin-1 levels in early disease stages. Further longitudinal studies are needed to validate these biomarker interactions and to determine the cause-effect relationship and the role of wake/sleep behavior in amyloid plaque regulation.
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Affiliation(s)
- Yves A Dauvilliers
- Sleep Unit, National Reference Network for Orphan Diseases (Narcolepsy, Hypersomnia, Kleine-Levin Syndrome), Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier Montpellier, France ; INSERM, U1061, Montpellier 1 University Montpellier, France
| | - Sylvain Lehmann
- Biochimie-Protéomique Clinique - IRMB - CCBHM -Inserm U1040 CHU Montpellier Montpellier, France
| | | | - Audrey Gabelle
- Biochimie-Protéomique Clinique - IRMB - CCBHM -Inserm U1040 CHU Montpellier Montpellier, France ; Clinical Research Memory Center Languedoc-Roussillon, Gui de Chauliac Hospital, CHU Montpellier Montpellier, France
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Robinson I, Reddy AB. Molecular mechanisms of the circadian clockwork in mammals. FEBS Lett 2014; 588:2477-83. [PMID: 24911207 DOI: 10.1016/j.febslet.2014.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 01/14/2023]
Abstract
Circadian rhythms enable organisms to co-ordinate biological processes with the predictable 24 h cycle of day and night. Given that molecular clocks that coordinate such biological timing have evolved in almost all organisms, it is clear that being synchronous with the external environment confers competitive advantage. Conversely, it is apparent that being out of phase is detrimental, resulting in a number of clinical conditions, many of which are linked to metabolic dysfunction. The canonical clockwork involves a core set of genes that negatively regulate themselves through a so-called transcription translation feedback loop. However, recent studies describing evolutionarily conserved oscillations in redox reactions link circadian rhythms to metabolic processes, and in particular, redox pathways. In this review we describe the evidence for the interaction between transcriptional loops, redox and metabolism in mammals and suggest the clock may be potential target for the treatment of disease.
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Affiliation(s)
- I Robinson
- Department of Clinical Neurosciences, University of Cambridge Metabolic Research Laboratories, NIHR Biomedical Research Centre, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - A B Reddy
- Department of Clinical Neurosciences, University of Cambridge Metabolic Research Laboratories, NIHR Biomedical Research Centre, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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Innes KE, Selfe TK. Meditation as a therapeutic intervention for adults at risk for Alzheimer's disease - potential benefits and underlying mechanisms. Front Psychiatry 2014; 5:40. [PMID: 24795656 PMCID: PMC4005947 DOI: 10.3389/fpsyt.2014.00040] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/31/2014] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) is a chronic, progressive, brain disorder that affects at least 5.3 million Americans at an estimated cost of $148 billion, figures that are expected to rise steeply in coming years. Despite decades of research, there is still no cure for AD, and effective therapies for preventing or slowing progression of cognitive decline in at-risk populations remain elusive. Although the etiology of AD remains uncertain, chronic stress, sleep deficits, and mood disturbance, conditions common in those with cognitive impairment, have been prospectively linked to the development and progression of both chronic illness and memory loss and are significant predictors of AD. Therapies such as meditation that specifically target these risk factors may thus hold promise for slowing and possibly preventing cognitive decline in those at risk. In this study, we briefly review the existing evidence regarding the potential utility of meditation as a therapeutic intervention for those with and at risk for AD, discuss possible mechanisms underlying the observed benefits of meditation, and outline directions for future research.
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Affiliation(s)
- Kim E. Innes
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, Charlottesville, VA, USA
| | - Terry Kit Selfe
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, Charlottesville, VA, USA
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Abstract
BACKGROUND Sleep disturbances, including reduced nocturnal sleep time, sleep fragmentation, nocturnal wandering and daytime sleepiness are common clinical problems in dementia due to Alzheimer's disease (AD), and are associated with significant caregiver distress, increased healthcare costs and institutionalisation. Drug treatment is often sought to alleviate these problems, but there is significant uncertainty about the efficacy and adverse effects of the various hypnotic drugs in this vulnerable population. OBJECTIVES To assess the effects, including common adverse effects, of any drug treatment versus placebo for sleep disorders in people with Alzheimer's disease through identification and analysis of all relevant randomized controlled trials (RCTs). SEARCH METHODS We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 31 March 2013 using the terms: sleep, insomnia, circadian, hypersomnia, parasomnia, somnolence, "rest-activity", sundowning. SELECTION CRITERIA We included RCTs that compared a drug with placebo and that had the primary aim of improving sleep in people with Alzheimer's disease who had an identified sleep disturbance at baseline. Trials could also include non-pharmacological interventions as long as both drug and placebo groups had the same exposure to them. DATA COLLECTION AND ANALYSIS Two authors working independently extracted data on study design, risk of bias and results from the included study reports. Additional information was obtained from study authors where necessary. We used the mean difference as the measure of treatment effect and, where possible, synthesized results using a fixed-effect model. MAIN RESULTS We found RCTs eligible for inclusion for three drugs: melatonin (209 participants, three studies, but only two yielded data suitable for meta-analysis), trazodone (30 participants, one study) and ramelteon (74 participants, one study, no peer-reviewed publication, very limited information available).The melatonin and trazodone studies were of people with moderate-to-severe AD; the ramelteon study was of people with mild-to-moderate AD. In all studies participants had a variety of common sleep problems. All primary sleep outcomes were measured using actigraphy. In one study of melatonin, drug treatment was combined with morning bright light therapy. Only two studies made a systematic assessment of adverse effects. Overall, the published studies were at low risk of bias, although there were areas of incomplete reporting and some problems with participant attrition, related largely to poor tolerance of actigraphy and technical difficulties. The risk of bias in the ramelteon study was unclear due to incomplete reporting.We found no evidence that melatonin, either immediate- or slow-release, improved any major sleep outcome in patients with AD. We were able to synthesize data for two sleep outcomes: total nocturnal sleep time (MD 10.68 minutes, 95% CI -16.22 to 37.59, two studies), and the ratio of daytime sleep to night-time sleep (MD -0.13, 95% CI -0.29 to 0.03, two studies). Other outcomes were reported in single studies. We found no difference between intervention and control groups for sleep efficiency, time awake after sleep onset or number of night-time awakenings, nor in cognition or performance of activities of daily living (ADLs). No serious adverse effects of melatonin were reported in the included studies.Trazodone 50 mg administered at night for two weeks significantly improved total nocturnal sleep time (MD 42.46 minutes, 95% CI 0.9 to 84.0, one study) and sleep efficiency (MD 8.53, 95% CI 1.9 to 15.1, one study), but there was no clear evidence of any effect on the amount of time spent awake after sleep onset (MD -20.41, 95% CI -60.4 to 19.6, one study) or the number of nocturnal awakenings (MD -3.71, 95% CI -8.2 to 0.8, one study). No effect was seen on daytime sleep, nor on cognition or ADLs. No serious adverse effects were reported.Results from a phase 2 trial investigating ramelteon 8 mg administered at night were available in summary form in a sponsor's synopsis. Ramelteon had no effect on total nocturnal sleep time at one week (primary outcome) or eight weeks (end of treatment). The synopsis reported few significant differences from placebo for any sleep, behavioural or cognitive outcomes; none were likely to be of clinical significance. There were no serious adverse effects of ramelteon. AUTHORS' CONCLUSIONS We discovered a distinct lack of evidence to help guide drug treatment of sleep problems in AD. In particular, we found no RCTs of many drugs that are widely prescribed for sleep problems in AD, including the benzodiazepine and non-benzodiazepine hypnotics, although there is considerable uncertainty about the balance of benefits and risks associated with these common treatments. From the studies we identified for this review, we found no evidence that melatonin is beneficial to AD patients with moderate to severe dementia and sleep problems. There is some evidence to support the use of a low dose (50 mg) of trazodone, although a larger trial is needed to allow a more definitive conclusion to be reached on the balance of risks and benefits. There was no evidence of any effect of ramelteon on sleep in patients with mild to moderate dementia due to AD. This is an area with a high need for pragmatic trials, particularly of those drugs that are in common clinical use for sleep problems in AD. Systematic assessment of adverse effects is essential.
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Affiliation(s)
- Jenny McCleery
- Oxford Health NHS Foundation Trust, Elms Centre, Oxford Road, Banbury, Oxfordshire, UK, OX16 9AL
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Midorikawa T, Komatsu T, Mitani T, Togo F. [Effects of bright light exposure on the behavioral and psychological symptoms of dementia and the burden on caregivers in institutionalized elderly with cognitive decline]. Nihon Ronen Igakkai Zasshi 2014; 51:184-190. [PMID: 24858123 DOI: 10.3143/geriatrics.51.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The purpose of this study was to examine the effects of bright light exposure on behavioral and psychological symptoms of dementia (BPSD), including sleep disturbances and the burden on caregivers in institutionalized elderly with cognitive decline. METHODS The subjects included eight people with cognitive decline (mean [SD] age, 79.9 [9.1] years) living in geriatric healthcare facilities for the elderly. BPSD and the burden on caregivers were measured over three weeks using the CMAI (Cohen-Mansfield Agitation Inventory), NPI-NH (Neuropsychiatric Inventory-Nursing Home Version) and J-ZBI (Modified Japanese Version of the Zarit Caregiver Burden Interview) at the end of each week. During the second week, the subjects received either 12,000 K (white) or 2,400 K (orange) of light corresponding to approximately 2,000 lux from a light-emitting diode (LED) device, measured before the eyes in the gaze direction, from 9 : 00 to 9 : 30 during occupational tasks, such as origami and coloring. Differences in the variables obtained at the different weeks were assessed using ANOVA with multiple comparisons. RESULTS The scores for the severity of BPSD, including sleep disturbances and the burden on caregivers, on the NPI-NH significantly (P<0.05) improved following the treatment with white light exposure, while the scores for the MMSE and J-ZBI did not change over the three-week study period. CONCLUSIONS These results suggest that exposure to white bright light during occupational tasks in the morning may have a benefit in improving BPSD, including sleep disturbances and the burden on caregivers.
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Affiliation(s)
- Toru Midorikawa
- Health Care Facility at Medical Corporation of Doaikai, Hospital of Watanabe
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Kuck J, Pantke M, Flick U, Garms-Homolová V. Ein- und Durchschlafstörungen bei Heimbewohnern, eingeschätzt durch Pflegende, und die Verordnungspraxis von Psychopharmaka. SOMNOLOGIE 2013. [DOI: 10.1007/s11818-013-0639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Allen AM, Coon DW, Uriri-Glover J, Grando V. Factors Associated With Sleep Disturbance Among Older Adults in Inpatient Rehabilitation Facilities. Rehabil Nurs 2013; 38:221-30. [DOI: 10.1002/rnj.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 11/11/2022]
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Vyazovskiy VV, Harris KD. Sleep and the single neuron: the role of global slow oscillations in individual cell rest. Nat Rev Neurosci 2013; 14:443-51. [PMID: 23635871 PMCID: PMC3972489 DOI: 10.1038/nrn3494] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sleep is universal in animals, but its specific functions remain elusive. We propose that sleep's primary function is to allow individual neurons to perform prophylactic cellular maintenance. Just as muscle cells must rest after strenuous exercise to prevent long-term damage, brain cells must rest after intense synaptic activity. We suggest that periods of reduced synaptic input ('off periods' or 'down states') are necessary for such maintenance. This in turn requires a state of globally synchronized neuronal activity, reduced sensory input and behavioural immobility - the well-known manifestations of sleep.
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Affiliation(s)
- Vladyslav V. Vyazovskiy
- University of Surrey, Faculty of Health and Medical Sciences, Department of Biochemistry and Physiology, Guildford, GU2 7XH, UK
| | - Kenneth D. Harris
- University College London (UCL) Institute of Neurology, UCL Department of Neuroscience, Physiology, and Pharmacology, London, WC1E 6DE, UK
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Nascimento CMC, Ayan C, Cancela JM, Gobbi LTB, Gobbi S, Stella F. Effect of a multimodal exercise program on sleep disturbances and instrumental activities of daily living performance on Parkinson's and Alzheimer's disease patients. Geriatr Gerontol Int 2013; 14:259-66. [DOI: 10.1111/ggi.12082] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Carla Manuela Crispim Nascimento
- Laboratory of Aging and Physical Activity (LAFE); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
- HealthyFyt Group, Faculty of Sports Science; University of Vigo; Vigo Spain
| | - Carlos Ayan
- HealthyFyt Group, Faculty of Sports Science; University of Vigo; Vigo Spain
| | - Jose Maria Cancela
- HealthyFyt Group, Faculty of Sports Science; University of Vigo; Vigo Spain
| | - Lilian Teresa Bucken Gobbi
- Posture and Gait Studies Lab (LEPLO); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
| | - Sebastião Gobbi
- Laboratory of Aging and Physical Activity (LAFE); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
| | - Florindo Stella
- Laboratory of Aging and Physical Activity (LAFE); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
- Laboratory of Neuroscience (LIM-27); Department and Institute of Psychiatry; Faculty of Medicine; University of São Paulo; São Paulo Brazil
- Clinical Geriatric Psychiatry; Faculty of Medical Sciences; State University of Campinas; São Paulo Brazil
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Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease -- a randomized study. Parkinsonism Relat Disord 2013; 19:670-5. [PMID: 23561946 DOI: 10.1016/j.parkreldis.2013.03.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/24/2013] [Accepted: 03/11/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although a variety of pharmacologic and non-pharmacologic treatments are effective for insomnia in the general population, insomnia in Parkinson's disease differs in important ways and may need different treatments. No studies have conclusively demonstrated effective insomnia treatments in Parkinson's disease. METHODS We conducted a three-arm six-week randomized pilot study assessing non-pharmacologic treatment (cognitive behavioural therapy with bright light therapy) or doxepin (10 mg daily), compared to an inactive placebo in Parkinson's patients with insomnia. Sleep outcomes included insomnia scales, clinical global impression, sleep diaries and actigraphy. Secondary outcomes included motor severity, fatigue, depression and quality of life. RESULTS 18 patients were randomized, 6 to each group. Compared to placebo, doxepin improved the Insomnia Severity Index (-9 ± 5.4 vs. -2 ± 3.9, p = 0.03), the SCOPA-night score (-5.2 ± 1.5 vs. -2.3 ± 2.8, p = 0.049), the Pittsburgh Sleep Quality Index-sleep disturbances subscale (-0.5 ± 0.5 vs 0.2 ± 0.4, p = 0.02), and both patient and examiner-rated clinical global impression of change (1.7 ± 0.8 vs. 0.5 ± 0.8, p = 0.03 and 1.4 ± 0.5 vs. 0.3 ± 0.5, p = 0.003). On secondary outcomes doxepin reduced the fatigue severity scale (p = 0.02) and improved scores on the Montreal Cognitive Assessment (p = 0.007). Non-pharmacological treatment reduced the Insomnia Severity Index (-7.8 ± 3.8 vs. -2.0 ± 3.9, p = 0.03), and the examiner-reported clinical global impression of change (p = 0.006), but was associated with decline in Parkinson Disease Questionnaire-39. There were no changes in other primary and secondary outcomes, including actigraphy outcomes. Adverse events were comparable in all groups. CONCLUSION Doxepin and non-pharmacologic treatment substantially improved insomnia in Parkinson's disease. These potential benefits must be replicated in a full confirmatory randomized controlled trial.
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Bright light therapy in Parkinson's disease: an overview of the background and evidence. PARKINSONS DISEASE 2012; 2012:767105. [PMID: 23320250 PMCID: PMC3540893 DOI: 10.1155/2012/767105] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/16/2012] [Accepted: 11/21/2012] [Indexed: 11/20/2022]
Abstract
Sleep disorders are common in Parkinson's disease (PD) and seem to be strongly associated with depression. It has been suggested that sleep disorders as well as depression are caused by a disturbed circadian rhythm. Indeed, PD patients are prone to misalignment of their circadian rhythm due to various factors, and many patients with PD display a phase advance of their circadian rhythm. Current treatment options for sleep disorders and depression in patients with PD are limited and can have serious side effects; alternative treatments are therefore badly needed. Bright light therapy (BLT) restores circadian rhythmicity effectively in mood- and sleep-disturbed patients without PD. The few studies that focused on the efficacy of BLT in patients with PD demonstrated a positive effect of BLT not only on sleep and mood but also on motor function. More research on the neurobiology and efficacy of BLT in PD is warranted.
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Abstract
Pain is a common symptom in Parkinson's disease (PD) and accounts for substantial morbidity in up to 80 % of patients. Despite contributing to disease-related discomfort and disability, pain in PD frequently goes underacknowledged and undertreated in clinical practice. Although the exact underlying neurophysiology is unclear, there is increasing understanding of the role of the basal ganglia in somatosensory processing, as well as involvement of additional brainstem structures and non-dopaminergic pathways; appreciation of these mechanisms has implications for treatment strategies. Categorizing painful symptoms based on their clinical description into musculoskeletal, dystonic, radicular-peripheral neuropathic and central pain categories provides a useful framework for management. Importantly, these symptoms should be evaluated in relation to motor symptoms and dopaminergic therapy. A multi-disciplinary approach is recommended as follows: physical therapy, liaison with pain management and consultations to rheumatological, orthopaedic and neurosurgical services should be considered.
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Affiliation(s)
- Munazza Sophie
- Department of Neurology, Columbia University, New York, NY, USA
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83
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Kelly JM, Bianchi MT. Mammalian sleep genetics. Neurogenetics 2012; 13:287-326. [DOI: 10.1007/s10048-012-0341-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
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Rothman SM, Mattson MP. Sleep disturbances in Alzheimer's and Parkinson's diseases. Neuromolecular Med 2012; 14:194-204. [PMID: 22552887 PMCID: PMC4544709 DOI: 10.1007/s12017-012-8181-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/10/2012] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative disorders and exact a burden on our society greater than cardiovascular disease and cancer combined. While cognitive and motor symptoms are used to define AD and PD, respectively, patients with both disorders exhibit sleep disturbances including insomnia, hypersomnia and excessive daytime napping. The molecular basis of perturbed sleep in AD and PD may involve damage to hypothalamic and brainstem nuclei that control sleep-wake cycles. Perturbations in neurotransmitter and hormone signaling (e.g., serotonin, norepinephrine and melatonin) and the neurotrophic factor BDNF likely contribute to the disease process. Abnormal accumulations of neurotoxic forms of amyloid β-peptide, tau and α-synuclein occur in brain regions involved in the regulation of sleep in AD and PD patients, and are sufficient to cause sleep disturbances in animal models of these neurodegenerative disorders. Disturbed regulation of sleep often occurs early in the course of AD and PD, and may contribute to the cognitive and motor symptoms. Treatments that target signaling pathways that control sleep have been shown to retard the disease process in animal models of AD and PD, suggesting a potential for such interventions in humans at risk for or in the early stages of these disorders.
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Affiliation(s)
- Sarah M Rothman
- Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA.
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Jung JY, Roh M, Ko KK, Jang HS, Lee SR, Ha JH, Jang IS, Lee HW, Lee MG. Effects of single treatment of anti-dementia drugs on sleep-wake patterns in rats. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2012; 16:231-6. [PMID: 22915987 PMCID: PMC3419757 DOI: 10.4196/kjpp.2012.16.4.231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/24/2012] [Accepted: 06/12/2012] [Indexed: 11/21/2022]
Abstract
We studied the effects of acetylcholinesterase inhibitors, donepezil and galantamine, and an N-methyl-D-aspartate (NMDA) receptor blocker, memantine, on sleep-wake architecture in rats. Screw electrodes were chronically implanted into the frontal and parietal cortex for the electroencephalography (EEG). EEG was recorded with a bio-potential amplifier for 8 h from 09:30 to 17:30. Vibration was recorded to monitor animal activity with a vibration measuring device. Sleep-wake states such as wake (W), slow-wave sleep (S) and paradoxical or rapid eye movement sleep (P), were scored every 10 sec by an experimenter. We measured mean episode duration and number of episode to determine which factor sleep disturbance was attributed to. Donepezil and memantine showed a significant increase in total W duration and decreases in total S and P duration and delta activity. Memantine showed increases in sleep latency and motor activity. Changes of S and P duration in memantine were attributed from changes of mean episode duration. Galantamine had little effect on sleep architecture. From these results, it is showed that galantamine may be an anti-dementia drug that does not cause sleep disturbances and memantine may be a drug that causes severe sleep disturbance.
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Affiliation(s)
- Ji-Young Jung
- Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu 700-422, Korea
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Association of sleep quality and dementia among long-lived Chinese older adults. AGE 2012; 35:1423-32. [PMID: 22669593 DOI: 10.1007/s11357-012-9432-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 05/15/2012] [Indexed: 02/05/2023]
Abstract
In this study, we examined the existence of relationship between sleep quality and dementia in subjects aged 90 years and above. The sample included 216 men and 444 women. Dementia and sleep quality were measured with 30-item mini-mental state examination (MMSE) and the Pittsburgh sleep quality index, respectively. Subjects with dementia had higher sleep quality score (7.83 ± 2.15 vs. 5.22 ± 2.49; P < 0.0001), longer sleep latency (50.97 ± 21.33 vs. 37.61 ± 12.53; P < 0.0001), and a lower sleep efficiency percentage (73.95 ± 8.783 vs. 81.32 ± 10.21; P < 0.0001) and more likely to report poor sleep quality (25.42 vs.17.13 %; P = 0.035). Subjects with poor sleep quality had significantly lower MMSE scores (P = 0.007) and higher prevalence of dementia (P = 0.042). Multiple logistic regressions were performed by adjusting clinical factors that are thought to be associated with dementia or sleep quality. We found that poor sleep quality was a risk factor for dementia (unadjusted odds ratio (OR) 1.719, 95 % confidence interval (CI) 1.138-2.597; adjusted OR 1.759, 95 % CI 1.012-3.057). There was no significant difference in MMSE scores (11.25 ± 3.40, 16.26 ± 5.14, and 15.43 ± 5.51; P = 0.105) among participants with daily average sleep durations of <5, 5-9, and >9 h, respectively. Among Chinese nonagenarians and centenarians, dementia was correlated with poor sleep quality, longer sleep latency, and lower sleep efficiency percentage.
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Association Between Sleep Quality and Cognitive Impairment Among Chinese Nonagenarians/Centenarians. J Clin Neurophysiol 2012; 29:250-5. [DOI: 10.1097/wnp.0b013e3182570f2e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Guarnieri B, Adorni F, Musicco M, Appollonio I, Bonanni E, Caffarra P, Caltagirone C, Cerroni G, Concari L, Cosentino F, Ferrara S, Fermi S, Ferri R, Gelosa G, Lombardi G, Mazzei D, Mearelli S, Morrone E, Murri L, Nobili F, Passero S, Perri R, Rocchi R, Sucapane P, Tognoni G, Zabberoni S, Sorbi S. Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients. Dement Geriatr Cogn Disord 2012; 33:50-8. [PMID: 22415141 PMCID: PMC3696366 DOI: 10.1159/000335363] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Sleep disturbances are common in the elderly and in persons with cognitive decline. The aim of this study was to describe frequency and characteristics of insomnia, excessive daytime sleepiness, sleep-disordered breathing, REM behavior disorder and restless legs syndrome in a large cohort of persons with mild cognitive impairment or dementia. METHODS 431 consecutive patients were enrolled in 10 Italian neurological centers: 204 had Alzheimer's disease, 138 mild cognitive impairment, 43 vascular dementia, 25 frontotemporal dementia and 21 Lewy body dementia or Parkinson's disease dementia. Sleep disorders were investigated with a battery of standardized questions and questionnaires. RESULTS Over 60% of persons had one or more sleep disturbances almost invariably associated one to another without any evident and specific pattern of co-occurrence. Persons with Alzheimer's disease and those with mild cognitive impairment had the same frequency of any sleep disorder. Sleep-disordered breathing was more frequent in vascular dementia. REM behavior disorder was more represented in Lewy body or Parkinson's disease dementia. CONCLUSION A careful clinical evaluation of sleep disorders should be performed routinely in the clinical setting of persons with cognitive decline. Instrumental supports should be used only in selected patients.
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Affiliation(s)
- B. Guarnieri
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo, Bicocca University, Milan,*Dr. Biancamaria Guarnieri, Center of Sleep Medicine, Villa Serena Hospital, Viale L. Petruzzi 42, IT–65013 Città S. Angelo (Italy), Tel. +39 08 5959 0237, E-Mail
| | - F. Adorni
- Italian National Research Center (ITB-CNR), Bicocca University, Milan
| | - M. Musicco
- Italian National Research Center (ITB-CNR), Bicocca University, Milan
| | - I. Appollonio
- Neuroscience Department, S. Gerardo Hospital Monza, Bicocca University, Milan
| | - E. Bonanni
- Neuroscience Department, University of Pisa, Pisa
| | - P. Caffarra
- Neuroscience Department, University of Parma, Parma
| | - C. Caltagirone
- Tor Vergata University, S. Lucia Foundation, IRCCS, Rome
| | - G. Cerroni
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo, Bicocca University, Milan
| | - L. Concari
- Neuroscience Department, University of Parma, Parma
| | | | - S. Ferrara
- Department of Neurology, Villa Serena Hospital, Città S. Angelo, Italy
| | - S. Fermi
- Neuroscience Department, S. Gerardo Hospital Monza, Bicocca University, Milan
| | - R. Ferri
- Department of Neurology, Oasi Institute IRCCS, Troina
| | - G. Gelosa
- Neuroscience Department, S. Gerardo Hospital Monza, Bicocca University, Milan
| | - G. Lombardi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence
| | - D. Mazzei
- Clinical Neurophysiology, Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa
| | - S. Mearelli
- Department of Neurology, University of L’Aquila, L’Aquila
| | - E. Morrone
- Sleep Physiopathology, S. Martino Hospital, Genoa
| | - L. Murri
- Neuroscience Department, University of Pisa, Pisa
| | - F.M. Nobili
- Clinical Neurophysiology, Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa
| | - S. Passero
- Neuroscience Department, University of Siena, Siena
| | - R. Perri
- S. Lucia Foundation, IRCCS, Rome
| | - R. Rocchi
- Neuroscience Department, University of Siena, Siena
| | - P. Sucapane
- Department of Neurology, University of L’Aquila, L’Aquila
| | - G. Tognoni
- Neuroscience Department, University of Pisa, Pisa
| | | | - S. Sorbi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence
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Diederich NJ, McIntyre DJ. Sleep disorders in Parkinson's disease: Many causes, few therapeutic options. J Neurol Sci 2012; 314:12-9. [DOI: 10.1016/j.jns.2011.10.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 09/20/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
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90
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Pfeffer M, Plenzig S, Gispert S, Wada K, Korf HW, Von Gall C. Disturbed sleep/wake rhythms and neuronal cell loss in lateral hypothalamus and retina of mice with a spontaneous deletion in the ubiquitin carboxyl-terminal hydrolase L1 gene. Neurobiol Aging 2012; 33:393-403. [DOI: 10.1016/j.neurobiolaging.2010.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 02/18/2010] [Accepted: 02/22/2010] [Indexed: 12/22/2022]
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91
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Insomnia in central neurologic diseases – Occurrence and management. Sleep Med Rev 2011; 15:369-78. [DOI: 10.1016/j.smrv.2011.01.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/21/2022]
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92
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Pharmacotherapies for sleep disturbances in Alzheimer's disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
BACKGROUND The increasing prevalence of dementia will precipitate a significant burden in terms of the costs of caring for people with dementia over the next 30 years; sleep disturbances in dementia are an important factor contributing to this burden. METHODS We reviewed sleep disturbances in people with dementia and their carers and describe the various diagnostic, assessment and treatment strategies available to physicians in the management of this clinically significant problem. RESULTS Sleep disturbances in people with dementia and their carers (i) are highly prevalent; (ii) impact significantly on quality of life of both people with dementia and their carers; (iii) increase the rate of cognitive decline; and (iv) accelerate the breakdown of community-based care. The training of physicians in the assessment and treatment of sleep disturbances in dementia and caregiving is scant despite a wide range of assessment strategies and treatment approaches, which comprise both pharmacological (including hypnotic/sedative medications) and non-pharmacological approaches (including: environmental; psychobehavioral; exercise and activity; and multi-component interventions). Specific diagnostic criteria for sleep disturbances in people with dementia and their carers remain lacking despite established criteria for general insomnia. Further to this, proposed changes to diagnostic criteria for DSM-V do not include a specific focus for the diagnosis and management of sleep disturbances in people with dementia or their carers. CONCLUSIONS This review suggests that the improved training of physicians to meet the needs of these vulnerable groups of older people is a priority, especially in the context of a rapidly increasing demand for accurate, early diagnosis and efficient management of sleep disturbance in these groups.
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94
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Kyung Lee E, Douglass AB. Sleep in psychiatric disorders: where are we now? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:403-12. [PMID: 20704767 DOI: 10.1177/070674371005500703] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the precise function of sleep is unknown, decades of research strongly implicate that sleep has a vital role in central nervous system (CNS) restoration, memory consolidation, and affect regulation. Slow-wave sleep (SWS) and rapid eye movement (REM) sleep have been of significant interest to psychiatrists; SWS because of its putative role in CNS energy recuperation and cognitive function, and REM sleep because of its suggested involvement in memory, mood regulation, and possible emotional adaptation. With the advent of the polysomnogram, researchers are now beginning to understand some of the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. The same neurochemistry that controls the sleep-wake cycle has also been implicated in the pathophysiology of numerous psychiatric disorders. Thus it is no surprise that several psychiatric disorders have prominent sleep symptoms. This review will summarize normal sleep architecture, and then examine sleep abnormalities and comorbid sleep disorders seen in schizophrenia, as well as anxiety, cognitive, and substance abuse disorders.
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Affiliation(s)
- Elliott Kyung Lee
- Faculty of Medicine, University of Ottawa, Department of Psychiatry and Psychology, Ottawa, Ontario, Canada.
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95
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Rongve A, Boeve BF, Aarsland D. Frequency and correlates of caregiver-reported sleep disturbances in a sample of persons with early dementia. J Am Geriatr Soc 2010; 58:480-6. [PMID: 20398116 DOI: 10.1111/j.1532-5415.2010.02733.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify sleep disturbances in participants with subtypes of dementia and explore clinical correlates. DESIGN Cross-sectional. SETTING Outpatient clinics in western Norway and the Mayo Clinic Study of Aging, Olmsted County, Minnesota. PARTICIPANTS One hundred fifty-one community-dwelling western Norway residents referred for geriatric medicine, geriatric psychiatry or neurology evaluation and 420 participants without dementia from the Mayo Clinic Study of Aging. MEASUREMENTS Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The Mayo Sleep Questionnaire, an interview to detect sleep disturbances, was administered to diagnose probable rapid eye movement (REM) sleep behavior disorder, probable periodic leg movements during sleep, probable restless legs syndrome, probable sleepwalking, probable sleep-related leg cramps, probable obstructive sleep apnea, and excessive daytime sleepiness. Insomnia was assessed using the Neuropsychiatric Inventory, an interview to detect neuropsychiatric symptoms in dementia. RESULTS Seventy-one percent of the participants with dementia and 55.7% of control participants had sleep disturbances (P=.001). Most frequently reported in the mild dementia participants were insomnia (29.9%), probable sleep-related leg cramps (24.1%), excessive daytime sleepiness (22.6%), probable restless legs syndrome (20.7%), and probable REM sleep behavior disorder (18.5%). There were more sleep-related problems reported in participants with Lewy body dementias (LBD) (dementia with Lewy bodies and Parkinson's disease dementia) than in those with Alzheimer's disease (P=.008). Having any sleep disorder correlated with depression (P=.03) and anxiety (P=.02). CONCLUSION Sleep problems are common in dementia, particularly in subjects with LBD, and are associated with psychiatric symptoms. Further research is needed to understand these associations and identify treatment strategies.
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Affiliation(s)
- Arvid Rongve
- Research Department, Psychiatric Clinic, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway.
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Fox MT, Sidani S, Brooks D. Differences in Sleep Complaints in Adults With Varying Levels of Bed Days Residing in Extended Care Facilities for Chronic Disease Management. Clin Nurs Res 2010; 19:181-202. [DOI: 10.1177/1054773810365957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This cohort study examined differences in perceived insomnia and daytime sleepiness in 67 adults residing in extended care facilities for chronic disease management who had varying levels of bed days. One bed day was defined as spending 24 hours in bed. Planned pairwise comparisons, using Bonferroni adjustment, were made between participants who spent 0 ( n = 21), 2 to 4 ( n = 23), and 5 to 7 ( n = 23) days in bed during 1 week of monitoring. Participants who spent 5 to 7 days in bed had significantly greater insomnia than those who spent 2 to 4 days in bed. No group differences were found in daytime sleepiness. Based on the findings, nurses may assess subjective insomnia and explore sleep hygiene strategies, such as increasing time out of bed with patients who have high levels of 5 to 7 bed days.
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Affiliation(s)
| | | | - Dina Brooks
- University of Toronto, Toronto, Ontario, Canada
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98
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David R, Zeitzer J, Friedman L, Noda A, O'Hara R, Robert P, Yesavage JA. Non-pharmacologic management of sleep disturbance in Alzheimer's disease. J Nutr Health Aging 2010; 14:203-6. [PMID: 20191254 DOI: 10.1007/s12603-010-0050-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sleep and wake in Alzheimer's disease (AD) are often fragmented as manifested by bouts of wakefulness at night and napping during the day. Management of sleep disturbances in AD is important because of their negative impact on both patients and caregivers. Pharmacological treatments, mainly sedative-hypnotics and antipsychotics, are often used but can be associated with significant adverse effects. Non-pharmacological treatments represent a beneficial alternative approach to the management of sleep disturbances in AD since they are associated with fewer adverse effects and their efficacy can be sustained after treatment has been completed. The aim of this article is to review non-pharmacological treatments, such as sleep hygiene, sleep restriction therapy (SRT), cognitive behavioral therapy (CBT), light therapy, and continuous positive airway pressure (CPAP), for the management of sleep/wake disturbances in AD.
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Affiliation(s)
- R David
- Department of Veterans Affairs Health Care System, Palo Alto, California 94304, USA
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99
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Abstract
PURPOSE OF REVIEW Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery. RECENT FINDINGS Demented patients often receive prescribed medication that can interact with various anaesthetic drugs and cause serious side effects. The anaesthesiologist should consider this when choosing the drugs used during surgery and when relieving postoperative pain. Generally, hypnotics, opioids, and inhalational anaesthetics should be administered in lower doses and carefully titrated because of altered pharmacokinetics and pharmacodynamics leading to a great variability, as documented in elderly patients. Neuromuscular blocking agents, and especially rocuronium, display an increased variability in the duration of action, but the new drug sugammadex may reverse the neuromuscular block in a few minutes. Postoperative cognitive decline is more frequent in elderly patients with preexisting cognitive impairment and several preventive measurements can be provided. SUMMARY Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications.
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Bianchi SL, Caltagarone BM, Laferla FM, Eckenhoff RG, Kelz MB. Inhaled anesthetic potency in aged Alzheimer mice. Anesth Analg 2009; 110:427-30. [PMID: 19820240 DOI: 10.1213/ane.0b013e3181b5a292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The number of elderly patients with frank or incipient Alzheimer's disease (AD) requiring surgery is growing as the population ages. General anesthesia may exacerbate symptoms of and the pathology underlying AD, so minimizing anesthetic exposure may be important. This requires knowledge of whether the continuing AD pathogenesis alters anesthetic potency. METHODS We determined the induction potency and emergence time for isoflurane, halothane, and sevoflurane using the minimum alveolar anesthetic concentration for loss of righting reflex as an end point in 12- to 14-mo-old triple transgenic Alzheimer (3xTgAD) mice and wild type C57BL6 controls. 3xTgAD mice model AD by harboring three distinct mutations: the APP(Swe), Tau, and PS1 human transgenes, each of which has been associated with familial forms of human AD. RESULTS The 3xTgAD mice exhibited mild resistance (from 8% to 30%) to volatile anesthetics but displayed indistinguishable emergence patterns from all three inhaled anesthetics. CONCLUSIONS These results show that the genetic vulnerabilities and neuropathology associated with AD produce a small but significant decrease in sensitivity to the hypnotic actions of three inhaled anesthetics. Emergence times were not altered.
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Affiliation(s)
- Shannon L Bianchi
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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