Sleep Disturbance in Mild to Moderate Alzheimer's Disease
Andrew N. Wilner, MD, FAAN, FACP
From
Sleep Medicine
July 2005 (Volume 6, Number 4)
Sleep Disturbance in Mild to Moderate Alzheimer's Disease
Moran M, Lynch CA, Walsh C, Coen R, Coakley D, Lawlor BA
Sleep Med. 2005;6:347-352
This study assessed the frequency of sleep disturbances in patients with Alzheimer's disease with the Behavioral Pathology in Alzheimer's disease (BEHAVE-AD) rating scale. The investigators compared behavioral and psychological symptoms of patients with and without sleep disturbances.
Study Design
The study authors retrospectively reviewed the case records of 224 patients (70.1% women; mean age, 74.9) with probable Alzheimer's disease seen at The Mercer's Institute for Research on Ageing, a national referral Center in Ireland.
The BEHAVE-AD rating scale includes 3 questions regarding sleep. Patients who experienced any of these symptoms in the previous month were considered to have a sleep disturbance: (1) repetitive wakenings, (2) 50% to 75% of former sleep cycle, and (3) less than 50% of former sleep cycle.
The BEHAVE-AD also assesses abnormalities, such as activity disturbance, affective disturbance, aggressiveness, anxieties and phobias, hallucinations, paranoid and delusional ideation, and the global impact of behavioral symptoms on the patient and caregiver. A reliable informant provided the information necessary to complete the BEHAVE-AD.
The investigators also used the Blessed Dementia Scale and Instrumental Activities of Daily Living (IADL) to assess functional impairment, and the Mini-Mental State Examination (MMSE), the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), and the Clinical Dementia Rating Scale (CDR) to evaluate cognitive impairment.
Results
Fifty-five (24.5%) patients experienced sleep disturbances. Age, sex, the number of patients taking medications, and performance on the MMSE, CAMCOG, Blessed Dementia Scale, and IADL was similar between those who had sleep disturbances and those who did not. However, univariate analysis of the BEHAVE-AD revealed that aggressiveness (verbal outbursts, physical threats, and agitation; P = .0011) and global rating (P = .0041) scores were significantly worse for the patients with sleep disturbances.
Conclusion
In this study, sleep disturbances occurred in 24.5% of patients with Alzheimer's disease and were associated with aggressiveness and troubling behavior.
Commentary
Sleep disturbances in patients with Alzheimer's disease are common, and affect approximately 25% of patients.[1] Patients with Alzheimer's disease who do not sleep well during the night may have episodes of wandering and thus more opportunities for falls and injuries. These patients' inability to sleep at night may cause the primary caregivers, often the spouse, to have a sleepless night as well, adversely affecting his/her ability to provide care. This may explain why nocturnal wandering in patients with Alzheimer's disease is one of the most frequent causes of nursing home placement. Effective treatment of insomnia may improve the quality of life of both the patient and caregiver, delaying nursing home placement.
Although the BEHAVE-AD is not the ideal instrument for assessing the details of sleep initiation and maintenance, it is a reasonable tool in this case because no sleep questionnaire has been validated in patients with dementia.
The conclusions of this study are that aggressiveness and the impact of behavioral disturbances on both the caregiver and the patient (global rating) are associated with sleep disturbances. Clearly, sleepless patients add stress to the caregiver, resulting in a higher global rating. Aggressiveness and sleep disturbances may be part of a common pathophysiology of Alzheimer's disease, or one may worsen the other. The retrospective Nature of this study does not allow one to tease out cause and effect.
Clinicians who treat sleep disturbances in patients with Alzheimer's disease also may wish to evaluate behavioral disturbances. More studies are needed to assess the impact of improved sleep on abnormal behaviors, as well as the impact of treatment of abnormal behaviors on the quality of sleep.
Enviado por Dr. José Manuel Ferrer Guerra
From
Sleep Medicine
July 2005 (Volume 6, Number 4)
Sleep Disturbance in Mild to Moderate Alzheimer's Disease
Moran M, Lynch CA, Walsh C, Coen R, Coakley D, Lawlor BA
Sleep Med. 2005;6:347-352
This study assessed the frequency of sleep disturbances in patients with Alzheimer's disease with the Behavioral Pathology in Alzheimer's disease (BEHAVE-AD) rating scale. The investigators compared behavioral and psychological symptoms of patients with and without sleep disturbances.
Study Design
The study authors retrospectively reviewed the case records of 224 patients (70.1% women; mean age, 74.9) with probable Alzheimer's disease seen at The Mercer's Institute for Research on Ageing, a national referral Center in Ireland.
The BEHAVE-AD rating scale includes 3 questions regarding sleep. Patients who experienced any of these symptoms in the previous month were considered to have a sleep disturbance: (1) repetitive wakenings, (2) 50% to 75% of former sleep cycle, and (3) less than 50% of former sleep cycle.
The BEHAVE-AD also assesses abnormalities, such as activity disturbance, affective disturbance, aggressiveness, anxieties and phobias, hallucinations, paranoid and delusional ideation, and the global impact of behavioral symptoms on the patient and caregiver. A reliable informant provided the information necessary to complete the BEHAVE-AD.
The investigators also used the Blessed Dementia Scale and Instrumental Activities of Daily Living (IADL) to assess functional impairment, and the Mini-Mental State Examination (MMSE), the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), and the Clinical Dementia Rating Scale (CDR) to evaluate cognitive impairment.
Results
Fifty-five (24.5%) patients experienced sleep disturbances. Age, sex, the number of patients taking medications, and performance on the MMSE, CAMCOG, Blessed Dementia Scale, and IADL was similar between those who had sleep disturbances and those who did not. However, univariate analysis of the BEHAVE-AD revealed that aggressiveness (verbal outbursts, physical threats, and agitation; P = .0011) and global rating (P = .0041) scores were significantly worse for the patients with sleep disturbances.
Conclusion
In this study, sleep disturbances occurred in 24.5% of patients with Alzheimer's disease and were associated with aggressiveness and troubling behavior.
Commentary
Sleep disturbances in patients with Alzheimer's disease are common, and affect approximately 25% of patients.[1] Patients with Alzheimer's disease who do not sleep well during the night may have episodes of wandering and thus more opportunities for falls and injuries. These patients' inability to sleep at night may cause the primary caregivers, often the spouse, to have a sleepless night as well, adversely affecting his/her ability to provide care. This may explain why nocturnal wandering in patients with Alzheimer's disease is one of the most frequent causes of nursing home placement. Effective treatment of insomnia may improve the quality of life of both the patient and caregiver, delaying nursing home placement.
Although the BEHAVE-AD is not the ideal instrument for assessing the details of sleep initiation and maintenance, it is a reasonable tool in this case because no sleep questionnaire has been validated in patients with dementia.
The conclusions of this study are that aggressiveness and the impact of behavioral disturbances on both the caregiver and the patient (global rating) are associated with sleep disturbances. Clearly, sleepless patients add stress to the caregiver, resulting in a higher global rating. Aggressiveness and sleep disturbances may be part of a common pathophysiology of Alzheimer's disease, or one may worsen the other. The retrospective Nature of this study does not allow one to tease out cause and effect.
Clinicians who treat sleep disturbances in patients with Alzheimer's disease also may wish to evaluate behavioral disturbances. More studies are needed to assess the impact of improved sleep on abnormal behaviors, as well as the impact of treatment of abnormal behaviors on the quality of sleep.
Enviado por Dr. José Manuel Ferrer Guerra
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