The Management of Sleep and Circadian Disturbance in Patients with Dementia.
Summary of "The Management of Sleep and Circadian Disturbance in Patients with Dementia."
Sleep and circadian disturbances are common among patients with dementia. Symptomatic manifestations vary according to dementia subtype, with one commonly shared pattern-the irregular sleep-wake rhythm (ISWR), a circadian disorder characterized by an absence of the sleep-wake cycle's circadian synchronization. Hypothesized mechanisms of circadian rhythm disturbance include suprachiasmatic nucleus (SCN) circadian pacemaker damage, pineal gland and melatonin secretion alterations, and reduced zeitbeigers and decreased input to the SCN. Management options include prescribed sleep/wake scheduling, light therapy, melatonin, physical and social activity, and mixed modality. The mixed-modality approach is the most effective method in treating ISWR. Pharmacologic interventions are controversial, with no evidence supporting their effectiveness while associated with multiple side effects. They should be used with caution and only be considered as short-term therapy. All treatment strategies should be individualized to achieve the best outcomes.
Affiliation
School of Nursing, College of Health and Human Services, George Mason University, 4400 University Drive, MS: 3C4, Fairfax, VA, 22030-4400, USA, qzhou3@gmu.edu.
Journal Details
This article was published in the following journal.
Name: Current neurology and neuroscience reports
ISSN: 1534-6293
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22314860
- DOI: http://dx.doi.org/10.1007/s11910-012-0249-8
Medical and Biotech [MESH] Definitions
Smith-magenis Syndrome
Complex neurobehavioral disorder characterized by distinctive facial features (FACIES), developmental delay and mental retardation. Behavioral phenotypes include sleep disturbance, maladaptive, self-injurious and attention-seeking behaviors. The sleep disturbance is linked to an abnormal circadian secretion pattern of MELATONIN. The syndrome is associated with de novo deletion or mutation and HAPLOINSUFFICIENCY of the retinoic acid-induced 1 protein on chromosome 17p11.2.
Sleep Disorders, Circadian Rhythm
Dyssomnias associated with disruption of the normal 24 hour sleep wake cycle secondary to travel (e.g., JET LAG SYNDROME), shift work, or other causes.
Dyssomnias
A broad category of sleep disorders characterized by either hypersomnolence or insomnia. The three major subcategories include intrinsic (i.e., arising from within the body) (SLEEP DISORDERS, INTRINSIC), extrinsic (secondary to environmental conditions or various pathologic conditions), and disturbances of circadian rhythm. (From Thorpy, Sleep Disorders Medicine, 1994, p187)
Delta Sleep-inducing Peptide
A nonapeptide that is found in neurons, peripheral organs, and plasma. This neuropeptide induces mainly delta sleep in mammals. In addition to sleep, the peptide has been observed to affect electrophysiological activity, neurotransmitter levels in the brain, circadian and locomotor patterns, hormonal levels, psychological performance, and the activity of neuropharmacological drugs including their withdrawal.
Sleep Stages
Periods of sleep manifested by changes in EEG activity and certain behavioral correlates; includes Stage 1: sleep onset, drowsy sleep; Stage 2: light sleep; Stages 3 and 4: delta sleep, light sleep, deep sleep, telencephalic sleep.
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