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He X, Hao J, Song Y, Cao H, Chen Y, Yang H. Effectiveness of non-pharmacological interventions for sleep disturbances in people living with dementia: A systematic review and meta-analysis. Geriatr Nurs 2023; 51:76-83. [PMID: 36921396 DOI: 10.1016/j.gerinurse.2023.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
We summarize the evidence on non-pharmacological interventions for sleep disturbances in people living with dementia(PlwD). A literature search was performed using PubMed, Embase, Cochrane library, Web of Science, PsycINFO, CINAHL, and clinicaltrials.gov. Up to August 20, 2022. Six studies met our eligibility criteria. Light therapy, the therapeutic pet-type robotic seal(PRAO), and slow-stroke back massage(SSBM) are non-pharmacological interventions for sleep disturbances in PlwD.PARO increased night-time sleep duration (p < 0.05). The benefit of SSBM for sleep disturbances in PlwD is unclear (p > 0.05). Although there is a lack of evidence for the effect of light therapy on sleep disturbances in PlwD (p > 0.05), light therapy reduced sleep disturbance (SMD = -0.38; 95% CI:1.25, 0.48), increased sleep efficiency (MD = 3.77; 95% CI:-0.23, 7.78), and also reduced depression (MD = -2.49; 95% CI: -2.92, -2.06). More large-scale randomized controlled trials are needed and consider combining multiple non-pharmacological measures for sleep interventions in PlwD.
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Affiliation(s)
- Xingyue He
- Nursing College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiaqi Hao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China; Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Yejun Song
- Department of Nursing, The Third people's Hospital of Taiyuan, Taiyuan, Shanxi, China
| | - Huili Cao
- Nursing College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yangjie Chen
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hui Yang
- Nursing College of Shanxi Medical University, Taiyuan, Shanxi, China; Department of Nursing, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
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Koren T, Fisher E, Webster L, Livingston G, Rapaport P. Prevalence of sleep disturbances in people with dementia living in the community: A systematic review and meta-analysis. Ageing Res Rev 2023; 83:101782. [PMID: 36356799 DOI: 10.1016/j.arr.2022.101782] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to systematically review and meta-analyse the prevalence of sleep disturbances in people with dementia and examine demographic predictors and whether overall prevalence has changed over time. We searched Embase, MEDLINE and PsycINFO for studies reporting the prevalence of sleep disturbances in people with dementia living at home. We meta-analysed the data and calculated the pooled prevalence of sleep disturbances in people with dementia overall and in dementia subtypes. We used meta-regressions to investigate the effects of study characteristics, publication dates and participant demographics. Eleven studies fulfilled the inclusion criteria. The pooled prevalence of any symptoms of sleep disturbance was 26 % (95 % confidence intervals, CI: 23-30 %; n = 2719) and of clinically significant sleep disturbance 19 % (13-25 %; n = 2753). The pooled prevalence of sleep disturbance symptoms was significantly lower among people with Alzheimer's disease (24 %; 16-33 %, n = 310) than Lewy body dementia (49 %; 37-61 %, n = 65). Meta-regression analysis did not find that publication year, participant's age, sex and study quality predicted prevalence. Sleep disturbances are common among people with dementia living in the community, especially in Lewy body dementia. There was no change in prevalence according to publication dates, suggesting treatment has not improved over time.
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Affiliation(s)
- Tala Koren
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Emily Fisher
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London WC1H 0AP, UK.
| | - Lucy Webster
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Gill Livingston
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Penny Rapaport
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
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Roland JP, Bliwise DL. Impact of Pharmacotherapy on Insomnia in Patients with Alzheimer's Disease. Drugs Aging 2021; 38:951-966. [PMID: 34569029 PMCID: PMC8593056 DOI: 10.1007/s40266-021-00891-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 02/03/2023]
Abstract
Insomnia is a pervasive sleep disorder affecting numerous patients across diverse demographical populations and comorbid disease states. Contributing factors are often a complex interaction of biological, psychological, and social components, requiring a multifaceted approach in terms of both diagnosis and management. In the setting of Alzheimer’s disease, insomnia is an even more complicated issue, with a higher overall prevalence than in the general population, greater complexity of contributing etiologies, and differences in diagnosis (at times based on caregiver observation of sleep disruption rather than subjective complaints by the individual with the disorder), and requiring more discretion in terms of treatment, particularly in regard to adverse effect profile concerns. There also is growing evidence of the bidirectional nature of sleep disruption and Alzheimer’s disease, with insomnia potentially contributing to disease progression, making the condition even more paramount to address. The objective of this review was to provide the clinician with an overview of treatment strategies that may have value in the treatment of disturbed sleep in Alzheimer’s disease. Nonpharmacological approaches to treatment should be exhausted foremost; however, pharmacotherapy may be needed in certain clinical scenarios, which can be a challenge for clinicians given the paucity of evidence and guidelines for treatment in the subpopulation of Alzheimer’s disease. Agents such as sedating antidepressants, melatonin, and site-specific γ-aminobutyric acid agonists are often employed based on historical usage but are not necessarily supported by high-quality trials. Newer agents such as dual orexin receptor antagonists have demonstrated some promise but still need further evaluation.
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Affiliation(s)
- Joshua P Roland
- Department of Pulmonology, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, UCLA, 700 W. 7th Street, Suite S270-D, Los Angeles, CA, 90017, USA.
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Emory University, Atlanta, GA, USA
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Suh SW, Han JW, Han JH, Bae JB, Moon W, Kim HS, Oh DJ, Kwak KP, Kim BJ, Kim SG, Kim JL, Kim TH, Ryu SH, Moon SW, Park JH, Byun S, Seo J, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW. Sex differences in subjective age-associated changes in sleep: a prospective elderly cohort study. Aging (Albany NY) 2020; 12:21942-21958. [PMID: 33170149 PMCID: PMC7695390 DOI: 10.18632/aging.104016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/22/2020] [Indexed: 01/16/2023]
Abstract
Subjective age-associated changes in sleep (AACS) and sex differences in AACS have never been prospectively investigated in elderly populations. We compared the AACS every 2 years over a total of 6 years between 4,686 community-dwelling healthy men and women aged 60 years or older who participated in the Korean Longitudinal Study on Cognitive Aging and Dementia. Sleep parameters including sleep duration, latency, and efficiency, mid-sleep time, daytime dysfunction, and overall subjective sleep quality were measured using the Pittsburgh Sleep Quality Index at baseline and at each follow-up. The effects of time and sex on subjective sleep parameters were analyzed using linear mixed-effects models. During the 6 years of follow-up, we observed that overall, sleep latency increased, while daytime dysfunction and sleep quality worsened. Significant sex differences in AACS was found, with women showing shortened sleep duration, delayed mid-sleep time, and decreased sleep efficiency over 6 years. Sleep quality worsened in both groups but a more pronounced change was observed in women. Clinicians should be cautious in determining when to treat declared sleep disturbances in this population.
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Affiliation(s)
- Seung Wan Suh
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woori Moon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dae Jong Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jiyeong Seo
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Sciences, Seoul, Korea
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Conditions associated with REM sleep behaviour disorder: description of a hospital series. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abenza Abildúa MJ, Miralles Martinez A, Arpa Gutiérrez FJ, Lores Gutiérrez V, Algarra Lucas C, Jimeno Montero C, Sánchez García B, Mata Álvarez-Santullano M, Borrue Fernández C, Cordero Martín G, Gutiérrez Cueto G, Torrecillas Narváez MD, Thuissard Vasallo I, Gómez Aceña A. Conditions associated with REM sleep behaviour disorder: Description of a hospital series. Neurologia 2017; 34:159-164. [PMID: 28215911 DOI: 10.1016/j.nrl.2016.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION REM sleep behaviour disorder (RBD) is characterised by violent behaviours (screaming, kicking, vivid dreams) during REM sleep. It has a prevalence of 1% to 2% of the general population and is especially frequent in men and the population older than 60. In the last decade, RBD has been suggested to be a prodrome of neurodegenerative disease. We analysed associated neurological diseases and responses to drug treatment in 33 patients with RBD treated in the multidisciplinary sleep disorders unit at Hospital Infanta Sofía. PATIENTS AND METHODS We conducted an observational descriptive retrospective analysis of patients diagnosed with RBD and treated in our multidisciplinary sleep disorders unit between October 2012 and December 2015. We recorded age, sex, associated diseases, and treatments administered to these patients. RESULTS A total of 365 patients were attended at our unit, including 33 with RBD: 13 women (40%) and 20 men (60%). Mean age was 62.72 years. An associated disorder was identified in 48%, with the most common being mild cognitive impairment (69%). The percentage of patients with RBD and an associated disorder among patients older than 60 was 68%. Eighty-two percent of the patients required treatment. The most commonly used drug was clonazepam (76%), followed by melatonin (9%), gabapentin (6%), and trazodone (3%). DISCUSSION In our series, 48% of the patients had an associated disorder. The likelihood of detecting an associated disorder increases with patients' age. The vast majority of patients required drug treatment due to symptom severity; the most frequently administered drug was clonazepam (76%).
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Affiliation(s)
- M J Abenza Abildúa
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - A Miralles Martinez
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - F J Arpa Gutiérrez
- Servicio de Neurología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - V Lores Gutiérrez
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
| | - C Algarra Lucas
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - C Jimeno Montero
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - B Sánchez García
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
| | - M Mata Álvarez-Santullano
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - C Borrue Fernández
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - G Cordero Martín
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - G Gutiérrez Cueto
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
| | - M D Torrecillas Narváez
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - I Thuissard Vasallo
- Servicio de Estadística, Universidad Europea de Madrid, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - A Gómez Aceña
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
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7
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Brønnick K, Breitve MH, Rongve A, Aarsland D. Neurocognitive Deficits Distinguishing Mild Dementia with Lewy Bodies from Mild Alzheimer’s Disease are Associated with Parkinsonism. J Alzheimers Dis 2016; 53:1277-85. [DOI: 10.3233/jad-160294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kolbørn Brønnick
- Institute of Health, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Monica H. Breitve
- Department of Research and Innovation, Helse-Fonna HF, Haugesund Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Arvid Rongve
- Department of Research and Innovation, Helse-Fonna HF, Haugesund Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Old age psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
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8
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Shiga Y, Kanaya Y, Kono R, Takeshima S, Shimoe Y, Kuriyama M. [Dementia with Lewy bodies presenting marked tongue protrusion and bite due to lingual dystonia: A case report]. Rinsho Shinkeigaku 2016; 56:418-423. [PMID: 27212676 DOI: 10.5692/clinicalneurol.cn-000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report the patient of a 53-year-old woman who developed subacute-onset marked tonge protrusion and bite. She was diagnosed as dementia with Lewy bodies (DLB) from the clinical features including progressive cognitive decline, visual hallucinations, parkinsonism, and severe insomnia and depression, and the radiological finding of low dopamine transported uptake in basal ganglia by Dat SCAN and low blood circulation in occipital lobe of cerebrum. The patient received 600 mg doses of levodopa for over a year, followed by rotigotine and ropinirole with a rapid increase of dosage. It is believed that these treatments stimulated and sensitized dopamine D1 receptors, thereby inducing lingual dystonia. Furthermore, the patient demonstrated dyspnea and attacks of apnea caused by the closure of bilateral vocal cords due to laryngeal dyskinesia. After initiation of the neuroleptic, olanzapine, for a short duration, the high dose of levodopa overlapped with neuroleptic sensitivity, suggesting DOPA-induced dystonia and dyskinesia. This interaction can sometimes lead to lethal adverse events, and must be considered very important when treating patients with DLB.
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Affiliation(s)
- Yuji Shiga
- Department of Neurology, Brain Attack Center Ota Memorial Hospital
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10
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Parkinson's disease and sleep/wake disturbances. PARKINSONS DISEASE 2012; 2012:205471. [PMID: 23326757 PMCID: PMC3544335 DOI: 10.1155/2012/205471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/20/2012] [Indexed: 01/12/2023]
Abstract
Parkinson's disease (PD) has traditionally been characterized by its cardinal motor symptoms of bradykinesia, rigidity, resting tremor, and postural instability. However, PD is increasingly being recognized as a multidimensional disease associated with myriad nonmotor symptoms including autonomic dysfunction, mood disorders, cognitive impairment, pain, gastrointestinal disturbance, impaired olfaction, psychosis, and sleep disorders. Sleep disturbances, which include sleep fragmentation, daytime somnolence, sleep-disordered breathing, restless legs syndrome (RLS), nightmares, and rapid eye movement (REM) sleep behavior disorder (RBD), are estimated to occur in 60% to 98% of patients with PD. For years nonmotor symptoms received little attention from clinicians and researchers, but now these symptoms are known to be significant predictors of morbidity in determining quality of life, costs of disease, and rates of institutionalization. A discussion of the clinical aspects, pathophysiology, evaluation techniques, and treatment options for the sleep disorders that are encountered with PD is presented.
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11
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The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda. Int Psychogeriatr 2012; 24:1046-57. [PMID: 22172121 DOI: 10.1017/s1041610211002365] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are common and are core symptoms of the condition. They cause considerable distress to the person with dementia and their carers and predict early institutionalization and death. Historically, these symptoms have been managed with anxiolytic and antipsychotic medication. Although potentially effective, such medication has been used too widely and is associated with serious adverse side-effects and increased mortality. Consequently, there is a need to evaluate non-pharmacological therapies for behavioral and psychological symptoms in this population. One such therapy is physical activity, which has widespread health benefits. The aim of this review is to summarize the current findings of the efficacy of physical activity on BPSD. METHOD Published articles were identified using electronic and manual searches. Rather than systematically aggregating data, this review adopted a rapid critical interpretive approach to synthesize the literature. RESULTS Exercise appears to be beneficial in reducing some BPSD, especially depressed mood, agitation, and wandering, and may also improve night-time sleep. Evidence of the efficacy of exercise on improving other symptoms such as anxiety, apathy, and repetitive behaviors is currently weak or lacking. CONCLUSION The beneficial effect of exercise type, its duration, and frequency is unclear although some studies suggest that walking for at least 30 minutes, several times a week, may enhance outcome. The methodological shortcomings of current work in this area are substantial. The research and clinical implications of current findings are discussed.
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Probable dementia associated with Lewy body pathology as a cause of prolonged acute confusional state in a 79-year-old patient. Aging Clin Exp Res 2012; 24:200-2. [PMID: 22842839 DOI: 10.1007/bf03325166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Differentiation of "dementia with Lewy body pathology" (DLB) and delirium may be problematic in some cases, due to some of their common clinical characteristics such as fluctuations and hallucinations. Longer duration of cognitive changes usually aids in DLB diagnosis. However, presentation of DLB with an abrupt onset as a prolonged confusional state and hallucinations is also, even if rarely, described. We report the case of an elderly patient with probable dementia with Lewy body pathology, presenting with a prolonged acute confusional state, in order to draw attention to its diagnostic difficulty and the importance of careful target-oriented anamnesis in such cases. This type of dementia should be included in the differential diagnosis of elderly patients presenting with otherwise unexplained prolonged acute confusional states.
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Buskova J, Busek P, Nevsimalova S. Gabapentin in the treatment of dementia-associated nocturnal agitation. Med Sci Monit 2012; 17:CS149-51. [PMID: 22129906 PMCID: PMC3628129 DOI: 10.12659/msm.882114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Nocturnal sleep of patients suffering from various forms of dementia is often impaired by nocturnal agitation or nocturnal wandering. Anticonvulsives such as carbamazepine or valproate are reported to have some therapeutic efficacy, but there is little information about other drugs suitable for treatment of this condition. Case Report Our patient, a 77-year-old Czech woman with incipient vascular dementia, received gabapentin 400mg at bedtime for 6 months and showed convincing improvement. Conclusions Gabapentin was very effective in treating nocturnal agitation.
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Affiliation(s)
- Jitka Buskova
- Department of Neurology - Sleep Disorders Center, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
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14
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Auger RR, Boeve BF. Sleep disorders in neurodegenerative diseases other than Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2011; 99:1011-1050. [PMID: 21056241 DOI: 10.1016/b978-0-444-52007-4.00020-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- R Robert Auger
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Terzano MG, Parrino L. Neurological perspectives in insomnia and hyperarousal syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2010; 99:697-721. [PMID: 21056224 DOI: 10.1016/b978-0-444-52007-4.00003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Weldemichael DA, Grossberg GT. Circadian rhythm disturbances in patients with Alzheimer's disease: a review. Int J Alzheimers Dis 2010; 2010. [PMID: 20862344 PMCID: PMC2939436 DOI: 10.4061/2010/716453] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/27/2010] [Indexed: 11/20/2022] Open
Abstract
Circadian Rhythm Disturbances (CRDs) affect as many as a quarter of Alzheimer's disease (AD) patients during some stage of their illness. Alterations in the suprachiasmatic nucleus and melatonin secretion are the major factors linked with the cause of CRDs. As a result, the normal physiology of sleep, the biological clock, and core body temperature are affected. This paper systematically discusses some of the causative factors, typical symptoms, and treatment options for CRDs in patients with AD. This paper also emphasizes the implementation of behavioral and environmental therapies before embarking on medications to treat CRDs. Pharmacotherapeutic options are summarized to provide symptomatic benefits for the patient and relieve stress on their families and professional care providers. As of today, there are few studies relative to CRDs in AD. Large randomized trials are warranted to evaluate the effects of treatments such as bright light therapy and engaging activities in the reduction of CRDs in AD patients.
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Affiliation(s)
- Dawit A Weldemichael
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
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Richards K, Shue VM, Beck CK, Lambert CW, Bliwise DL. Restless legs syndrome risk factors, behaviors, and diagnoses in persons with early to moderate dementia and sleep disturbance. Behav Sleep Med 2010; 8:48-61. [PMID: 20043249 PMCID: PMC3745281 DOI: 10.1080/15402000903425769] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this study, restless legs syndrome (RLS) risk factors, RLS-associated behaviors, and the ability to understand and answer an RLS diagnostic interview were investigated. In 23 older adults with early to moderate dementia and nighttime sleep disturbance, the most common risk factors for RLS were a periodic leg movement sleep index > 15 (54.55%), based on polysomnography, and use of selective serotonin reuptake inhibitors (SSRIs) (34.78%). The most common RLS-associated behaviors were repetitious mannerisms (56.52%) and general restlessness (34.78%), according to direct observation from research assistants. Finally, older adults with early to moderate dementia were unable to understand and reliably answer the RLS diagnostic interview. Older persons with mild to moderate dementia and sleep disturbance may require objective diagnostics to identify RLS.
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Affiliation(s)
- Kathy Richards
- Polisher Research Institute, Madlyn and Leonard Abramson Center for Jewish Life, 1425 Horsham Rd., North Wales, PA 19454-1320, USA.
| | - Valorie M. Shue
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock
| | - Cornelia K. Beck
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock
| | - Corinne W. Lambert
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock
| | - Donald L. Bliwise
- Department of Neurology, Emory University Medical School, Atlanta, GA
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Molloy S, Minett T, O'Brien JT, McKeith IG, Burn DJ. Levodopa use and sleep in patients with dementia with Lewy bodies. Mov Disord 2009; 24:609-12. [PMID: 19191343 DOI: 10.1002/mds.22411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Sleep disturbance and excessive daytime somnolence (EDS) are features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB) that may be influenced by dopamine replacement therapy. The effect of levodopa on sleep and EDS in DLB is unknown and unclear in PD. The aim of this study is to determine if levodopa treatment alters sleep symptoms and EDS in DLB. Dopamine naïve patients with DLB (n = 15; mean mini mental state examination (MMSE) score 17.7(4.6)) and PD (n = 9; mean MMSE 25.5(2.2)) were assessed using the Epworth sleep scale, Parkinson's disease sleep scale, and the neuropsychiatric inventory prior to initiating treatment with levodopa. All measures were repeated after 3 and 6 months of levodopa therapy. The median final daily levodopa dose was 300 mg in both groups. Baseline sleep measures were comparable between groups. Levodopa treatment did not affect sleep or lead to increased EDS in DLB patients. The use of levodopa does not appear to adversely affect subjective sleep measures or increase EDS in DLB patients.
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Affiliation(s)
- Sophie Molloy
- Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom.
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19
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Affiliation(s)
- Bradley F. Boeve
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905
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20
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Liu HC, Hu CJ, Tang YC, Chang JG. A pilot study for circadian gene disturbance in dementia patients. Neurosci Lett 2008; 435:229-33. [DOI: 10.1016/j.neulet.2008.02.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 02/10/2008] [Accepted: 02/20/2008] [Indexed: 10/22/2022]
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Abstract
The advent of new immunostains have improved the ability to detect limbic and cortical Lewy bodies, and it is evident that dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia, after Alzheimer's disease (AD). Distinguishing DLB from AD has important implications for treatment, in terms of substances that may worsen symptoms and those that may improve them. Neurocognitive patterns, psychiatric features, extrapyramidal signs, and sleep disturbance are helpful in differentiating DLB from AD early in the disease course. Differences in the severity of cholinergic depletion and type/distribution of neuropathology contribute to these clinical differences.
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Boeve BF. Clinical, diagnostic, genetic and management issues in dementia with Lewy bodies. Clin Sci (Lond) 2005; 109:343-54. [PMID: 16171458 DOI: 10.1042/cs20050098] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
DLB (dementia with Lewy bodies) is a syndrome associated with underlying LBD (Lewy body disease), with manifestations in the cognitive, neuropsychiatric, motor, sleep and autonomic domains. The variable symptomatology and complex array of neuronal involvement and neurotransmitter deficiencies make the diagnosis and management of patients with DLB challenging. The genetic underpinnings of DLB have only recently begun to unfold. In this review, the clinical features, diagnostic criteria, genetics and treatment issues relating to DLB will be discussed, in which a comprehensive approach to the diagnosis and management is emphasized.
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Affiliation(s)
- Bradley F Boeve
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic, Rochester, MN 559505, U.S.A.
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24
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Peter R, Peter T, Brigitta B, Zsuzsa V, Judit V, Waldemar S. From psychophysiological insomnia to organic sleep disturbances: a continuum in late onset insomnia - with special concerns relating to its treatment. Med Hypotheses 2005; 65:1165-71. [PMID: 16125334 DOI: 10.1016/j.mehy.2005.04.043] [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] [Received: 01/03/2005] [Revised: 04/06/2005] [Accepted: 04/12/2005] [Indexed: 01/10/2023]
Abstract
The population suffering from insomnia in old age onset (LOI) is quite large. LOI might include a larger scale of syndromes ranging from typical psychophysiological insomnia to night delirium. The correlation between the biological, biochemical changes and the quantitative as well as the qualitative alterations of the sleep process through aging has not been fully explored. One can suppose that any cerebral lesion leading to a dysfunction in mental performance can also act on the sleep. The majority of LOI brain metabolic disturbances might therefore have some etiological role. The authors suggest the application of this concept in the clinical evaluation of LOI. The authors constructed a heuristic model for the pathophysiology and treatment of LOI. It is a bipolar axis containing the most typical symptoms of LOI. On the opposite margins psychophysiological insomnia and organic/metabolic insomnia (up to delirious states) are settled. The position on the axis (i.e., its distance from the "edge syndromes") gives information on the probability of its organic nature. Based on their clinical experiences and considering the data of the very few studies, they suppose that with the help of a detailed analysis of the symptoms of LOI and using some additional (electrophysiological and neuroimaging) laboratory methods most patients with LOI can get a strict diagnostic position on the LOI axis. Using the LOI axis not only a detailed evaluation of the symptomatology but also more sophisticated therapeutic interventions become possible. Symptoms on the "metabolic side" can be cured by a single evening application of any drugs improving the function of the brain (like nootropics, neuroprotective agents or even slight stimulants, e.g., caffeine) might show a "paradoxical hypnotic" effect, or in combination with sleeping pills they can cause an additive effect in LOI patients. The efficacy of this treatment can also have a diagnostic value: i.e., it helps to differentiate between the primary (organic) and psychophysiological (exogenous or emotional/psychic) forms of LOI.
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Affiliation(s)
- Rajna Peter
- Semmelweis University, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Balassa u.6., H-1083 Budapest, Hungary.
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Petit D, Gagnon JF, Fantini ML, Ferini-Strambi L, Montplaisir J. Sleep and quantitative EEG in neurodegenerative disorders. J Psychosom Res 2004; 56:487-96. [PMID: 15172204 DOI: 10.1016/j.jpsychores.2004.02.001] [Citation(s) in RCA: 232] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews current knowledge on sleep problems, sleep architecture changes and quantitative EEG alteration brought on by various neurodegenerative diseases, such as Alzheimer's disease (AD), progressive supranuclear palsy (PSP), REM sleep behavior disorder (RBD), Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy MSA, Huntington's disease and Creutzfeldt-Jakob disease, in comparison to normal aging. The study of sleep variables and that of the spectral composition of the EEG can provide valuable information for understanding the pathophysiology and for assisting the diagnosis of neurodegenerative diseases.
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Affiliation(s)
- Dominique Petit
- Centre d'étude du sommeil et des rythmes diologiques, Hôpital du Sacré-Coeur, Montréal, Québec, Canada
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27
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McCurry SM, Ancoli-Israel S. Sleep Dysfunction in Alzheimer's Disease and Other Dementias. Curr Treat Options Neurol 2003; 5:261-272. [PMID: 12670415 DOI: 10.1007/s11940-003-0017-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Changes in sleep architecture and circadian rhythms, including increased sleep latency and nighttime awakenings, decreased slow-wave sleep, rapid eye movement sleep, and total sleep time, and increased daytime napping are widespread in people with dementia. In addition, cyclic agitation episodes ("sundowning"), nightmares or hallucinations, sleep attacks, and nocturnal behavioral outbursts are associated with specific dementia syndromes. Sleep hygiene recommendations, particularly those aimed at reducing daytime sleep and improving the sleep environment and routine, can offset the circadian disturbances of some dementia patients. However, they can be burdensome for caregivers to implement, and must be targeted to the specific patterns of sleep disturbances patients are experiencing. Pharmacologic treatments may be useful for symptomatic treatment of insomnia and nighttime behavioral disturbances in dementia patients, but there have been few controlled trials demonstrating their efficacy or long-term safety. Clonazepam is highly effective for treating the nighttime behaviors associated with rapid eye movement behavior disorder. For most dementia patients, however, the side effect risks of prolonged use of sedating medications must be weighed against the potential benefits. Dementia patients should be evaluated for common primary sleep disorders that may contribute to nighttime behavioral disturbances and impact treatment decisions. Continuous positive airway pressure, the gold standard for treating obstructive sleep apnea, can be tolerated by mild to moderately demented individuals with support from supervising caregivers. Increased daily light exposure and physical activity may help normalize circadian rest-activity rhythms in some dementia patients, although the frequency and dose needed to maintain treatment effects is currently not known.
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Affiliation(s)
- Susan M. McCurry
- Department of Psychiatry, University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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