DOCSLIB.ORG

Sleep Disorders Associated to Vascular Dementia and Mild

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Sleep Disorders Associated to Vascular Dementia and Mild SLEEP DISORDERS IN VASCULAR DEMENTIA AND MILD COGNITIVE IMAPAIRMENT Copil Alexandra, Vladoi Adina, Munteanu Georgiana, Birdac Claudiu, Anghel Alexandra, Dan Flavius, Jianu Dragos Catalin OBJECTIVES GENERALITIES POLYSOMNOGRAPHY SLEEP DISORDERS - associated with dementia - associated with MCI CONCLUSION OBJECTIVES Determine whether disrupted daytime activity and altered sleep patterns predict development of mild cognitive impairment (MCI) or dementia [6] [8] Clarify whether patients with MCI demonstrate alterations in certain sleep parameters [5] Focus on identification of sleep disorders in the context of cognitive disturbances among professionals working with the elderly [7] Investigate and describe frequency and characteristics of sleep disorders in pacients with cognitive disorders [3] [4] [7] Review the predictive roles of overall sleep disturbances and other sleep problems [1] GENERALITIES There is a well-known relationship between neurodegenerative disease, disrupted sleep, and cognition. [6] Sleep disturbances and dementia are two common and significant health problems in older adults. [1] Compared with individuals without sleep disturbances, subjects who reported sleep disturbances had a higher risk of incident all-cause dementia, AD, and vascular dementia. [1][2] The mild cognitive impairment (MCI) is described as an intermediate state of cognitive impairment whereby individuals present with mild clinical symptoms but with nearly normal daily living activities. These subjects do not meet the clinical criteria for dementia, yet their cognitive functioning is below what we would expect for age and education in healthy people. [7] Sleep disturbance (especially sleep apnea syndrome- SAS) also occurs in patients with mild cognitive impairment (MCI) and is considered to be one of the predictive risk factors. Sleep disturbance appears to be involved in the cellular and molecular mechanisms of cognitive decline [5] [8] In the other hand, older adults are at risk for sleep disorders including obstructive sleep apnea syndrome, restless legs syndrome, REM sleep behavioral disorder and chronic insomnia, which could have an impact on cognitive functioning and are exclusion criteria for the MCI diagnosis. [7] POLYSOMNOGRAPHY: Definition Polysomnography is a comprehensive recording of the biophysiological changes that occur during sleep. The test result is called a polysomnogram, also abbreviated PSG. [10] It is usually performed at night, when most people sleep, though some labs can accommodate shift workers and people with circadian rhythm sleep disorders and do the test at other times of day. The PSG monitors many body functions, including brain activity (EEG), eye movements (EOG), muscle activity or skeletal muscle activation (EMG), and heart rhythm (ECG), during sleep. [10] Polysomnography is used to diagnose, or rule out, many types of sleep disorders, including idiopathic hypersomnia, periodic limb movement disorder (PLMD), REM behavior disorder, parasomnias, and sleep apnea. [10] Although it is not directly useful in diagnosing circadian rhythm sleep disorders, it may be used to rule out other sleep disorders. [10] POLYSOMNOGRAPHY: Mechanism A polysomnogram will typically record a minimum of 12 channels requiring a minimum of 22 wire attachments to the patient. [10] There is a minimum of three channels for the EEG, one or two measure airflow, one or two are for chin muscle tone, one or more for leg movements, two for eye movements (EOG), one or two for heart rate and rhythm (ECG), one for oxygen saturation, and one each for the belts, which measure chest wall movement and upper abdominal wall movement. [10] Wires for each channel of recorded data lead from the patient and converge into a central box, which in turn is connected to a computer system for recording, storing and displaying the data. [10] During sleep the computer monitor can display multiple channels continuously. In addition, most labs have a small video camera in the room so the technician can observe the patient visually from an adjacent room. [10] POLYSOMNOGRAPHY: Procedure For the standard test, the patient comes to a sleep lab and over the next 1–2 hours is introduced to the setting and "wired up" so that multiple channels of data can be recorded when he/she falls asleep. [10] During the study, the technician observes sleep activity by looking at the video monitor and the computer screen that displays all the data second by second. [10] The patient would sleep with the screening device for one to several days, then return the device to the health care provider. [10] The provider would retrieve data from the device and could make assumptions based on the information given. For example, series of drastic blood oxygen desaturations during night periods may indicate some form of respiratory event (apnea). The equipment monitors, at a minimum, oxygen saturation. [10] After the test is completed a "scorer" analyzes the data by reviewing the study in 30-second "epochs". [10] POLYSOMNOGRAPHY: Interpretation The score consists of the following information: o Onset of sleep from time the lights were turned off: this is called “ sleep onset latency" and normally is less than 20 minutes. [10] o Sleep efficiency: the number of minutes of sleep divided by the number of minutes in bed. Normal is approximately 85 to 90% or higher. [10] o Sleep stages: these are based on 3 sources of data coming from 7 channels: EEG (4 channels), EOG (2), and chin EMG (1). [10] o Each 30-second epoch is scored as "awake" or one of 4 sleep stages: 1, 2, 3, and REM, or Rapid Eye Movement, sleep. o Stages 1–3 are together called non-REM sleep. Non-REM sleep is distinguished from REM sleep, which is altogether different. Within non-REM sleep, stage 3 is called "slow wave" sleep” because of the relatively wide brain waves compared to other stages OR "deep sleep". By contrast, stages 1 and 2 are "light sleep". [10] "Arousals" are sudden shifts in brain wave activity. They may be caused by numerous factors, including breathing abnormalities, leg movements, environmental noises, etc. An abnormal number of arousals indicates "interrupted sleep" and may explain a person's daytime symptoms of fatigue and/or sleepiness. [10] o Cardiac rhythm abnormalities. o Leg movements. o Body position during o Oxygen saturation duringsleep. sleep. Once scored, the test recording and the scoring data are sent to the sleep medicine physician for interpretation. Ideally, interpretation is done in conjunction with the medical history, a complete list of drugs the patient is taking, and any other relevant information that might impact the study such as napping done before the test. [10] Any breathing irregularities, mainly apneas and hypopneas. Apnea is a complete or near complete cessation of airflow for at least 10 seconds followed by an arousal and/or 4% oxygen desaturation; hypopnea is a 30% or greater decrease in airflow for at least 10 seconds followed by an arousal and/or 4% oxygen desaturation. [10] SLEEP DISORDERS: Types of disturbances Sleep and circadian disorders occur frequently in all types of dementia [2] Are common in dementia, with problems including difficulty falling asleep or staying asleep, sleep fragmentation, wandering and excessive daytime sleepiness. [9] Sleep is one of the cornerstones of human wellbeing, and reduced or poor-quality night-time sleep can significantly impact daytime functioning and quality of life [9] A careful clinical evaluation of sleep disorders should be performed routinely in the clinical setting of persons with cognitive decline. [3] In most cases, the sleep disturbances evaluated are: insomnia, excessive daytime sleepiness (EDS), REM behavior disorder (RBD), restless legs syndrome (RLS), and nightmares [3][9], sleep disordered breathing [SDB]), and other sleep problems (e.g. circadian rhythm sleep disorder, and nonspecific sleep problems) [1] SLEEP DISORDERS IN DEMENTIA Within dementia, the causes of sleep disorders can be – as in people without dementia – physical health conditions, pain or discomfort, medications or anxiety or depression. In addition, there are often disturbances of the circadian rhythm (including early sleep onset and offset or late sleep initiation and rise time) [9] The neurodegenerative changes in vascular dementia but not only, affect the structure and functioning of relevant brain networks. [9] Pathologic and imaging studies have shown that regions in the brain shown to regulate sleep and circadian rhythm are abnormal in VaD and AD. [6] Most of the studies enroll patients with different subtypes of dementia: Alzheimer's disease (AD), vascular dementia (VaD), mixed dementia, mild cognitive impairment (MCI), dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and frontotemporal lobar degeneration (FTLD) [3] Every type of sleep disorder was present in each type of dementia but with significant differences. Insomnia increased the risk of AD but not vascular or all-cause dementia. In contrast, SDB was associated with a higher incidence of vascular dementia and all-cause dementia (considered risk factor) [1] Frequency of RDB was associated more with VaD. RLS and nightmares were recognized mainly in FTD, LBD, and PDD patients scores [3] There are also the patients with VCIND that are compared with control subjects and simple stroke patients. [4] o Studies have been made and the PSG revealed that patients with VCIND or stroke were more likely to experience prolonged sleep latency (SL),
Load more

Recommended publications
  • Relationship Between the Postoperative Delirium And
    Theory iMedPub Journals Journal of Neurology and Neuroscience 2020 www.imedpub.com Vol.11 No.5:332 ISSN 2171-6625 DOI: 10.36648/2171-6625.11.1.332 Relationship Between the Postoperative Delirium and Dementia in Elderly Surgical Patients: Alzheimer’s Disease or Vascular Dementia Relevant Study Jong Yoon Lee1*, Hae Chan Ha2, Noh June Mo2, Hong Kyung Ho2 1Department of Neurology, Seoul Chuk Hospital, Seoul, Korea. 2Department of Orthopedic Surgery, Seoul Chuk Hospital, Seoul, Korea. *Corresponding author: Jong Yoon Lee, M.D. Department of Neurology, Seoul Chuk Hospital, 8, Dongsomun-ro 47-gil Seongbuk-gu Seoul, Republic of Korea, Tel: + 82-1599-0033; E-mail: [email protected] Received date: June 13, 2020; Accepted date: August 21, 2020; Published date: August 28, 2020 Citation: Lee JY, Ha HC, Mo NJ, Ho HK (2020) Relationship Between the Postoperative Delirium and Dementia in Elderly Surgical Patients: Alzheimer’s Disease or Vascular Dementia Relevant Study. J Neurol Neurosci Vol.11 No.5: 332. gender and CRP value {HTN, 42.90% vs. 43.60%: DM, 45.50% vs. 33.30%: female, 27.2% of 63.0 vs. male 13.8% Abstract of 32.0}. Background: Delirium is common in elderly surgical Conclusion: Dementia play a key role in the predisposing patients and the etiologies of delirium are multifactorial. factor of POD in elderly patients, but found no clinical Dementia is an important risk factor for delirium. This difference between two subgroups. It is estimated that study was conducted to investigate the clinical relevance AD and VaD would share the pathophysiology, two of surgery to the dementia in Alzheimer’s disease (AD) or subtype dementia consequently makes a similar Vascular dementia (VaD).
    [Show full text]
  • Vascular Dementia Vascular Dementia
    Vascular Dementia Vascular Dementia Other Dementias This information sheet provides an overview of a type of dementia known as vascular dementia. In this information sheet you will find: • An overview of vascular dementia • Types and symptoms of vascular dementia • Risk factors that can put someone at risk of developing vascular dementia • Information on how vascular dementia is diagnosed and treated • Information on how someone living with vascular dementia can maintain their quality of life • Other useful resources What is dementia? Dementia is an overall term for a set of symptoms that is caused by disorders affecting the brain. Someone with dementia may find it difficult to remember things, find the right words, and solve problems, all of which interfere with daily activities. A person with dementia may also experience changes in mood or behaviour. As the dementia progresses, the person will have difficulties completing even basic tasks such as getting dressed and eating. Alzheimer’s disease and vascular dementia are two common types of dementia. It is very common for vascular dementia and Alzheimer’s disease to occur together. This is called “mixed dementia.” What is vascular dementia?1 Vascular dementia is a type of dementia caused by damage to the brain from lack of blood flow or from bleeding in the brain. For our brain to function properly, it needs a constant supply of blood through a network of blood vessels called the brain vascular system. When the blood vessels are blocked, or when they bleed, oxygen and nutrients are prevented from reaching cells in the brain. As a result, the affected cells can die.
    [Show full text]
  • Behavioral and Psychological Symptoms of Dementia
    REVIEW ARTICLE published: 07 May 2012 doi: 10.3389/fneur.2012.00073 Behavioral and psychological symptoms of dementia J. Cerejeira1*, L. Lagarto1 and E. B. Mukaetova-Ladinska2 1 Serviço de Psiquiatria, Centro Hospitalar Psiquiátrico de Coimbra, Coimbra, Portugal 2 Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK Edited by: Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsy- João Massano, Centro Hospitalar de chiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and São João and Faculty of Medicine University of Porto, Portugal behaviors occurring in subjects with dementia. BPSD constitute a major component of Reviewed by: the dementia syndrome irrespective of its subtype. They are as clinically relevant as cog- Federica Agosta, Vita-Salute San nitive symptoms as they strongly correlate with the degree of functional and cognitive Raffaele University, Italy impairment. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, Luísa Alves, Centro Hospitalar de depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. Lisboa Ocidental, Portugal It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their *Correspondence: J. Cerejeira, Serviço de Psiquiatria, illness, and is independently associated with poor outcomes, including distress among Centro Hospitalar Psiquiátrico de patients and caregivers, long-term hospitalization, misuse of medication, and increased Coimbra, Coimbra 3000-377, Portugal. health care costs. Although these symptoms can be present individually it is more common e-mail: [email protected] that various psychopathological features co-occur simultaneously in the same patient.Thus, categorization of BPSD in clusters taking into account their natural course, prognosis, and treatment response may be useful in the clinical practice.
    [Show full text]
  • Coding for Dementia & Other Unspecified Conditions
    www.hospicefundamentals.com Hospice Fundamentals Subscriber Webinar September 2014 Coding For Dementia & Other Unspecified Conditions Judy Adams, RN, BSN, HCS-D, HCS-O AHIMA Approved ICD-10-CM Trainer September 2014 Transmittal 3022 • CMS released Transmittal 3022, Hospice Manual Update for Diagnosis Reporting and Filing Hospice Notice of Election and Termination or Revocation of Election on August 22, 2014 to replace Transmittal 8877. • Purpose: to provide a manual update and provider education for new editing for principal diagnoses that are not appropriate for reporting on hospice claims. • Our focus today is on the diagnosis portion of the transmittal. • Basis for the information • Per CMS: ICD-9-CM/ICD-10-CM Coding Guidelines state that codes listed under the classification of Symptoms, Signs, and Ill- defined Conditions are not to be used as principal diagnosis when a related definitive diagnosis has been established or confirmed by the provider. © Adams Home Care Consulting All Rights Reserved 2014 1 www.hospicefundamentals.com Hospice Fundamentals Subscriber Webinar September 2014 Policy • Effective with dates of service 10/1/14 and later. • The following principal diagnoses reported on the claim will cause claims to be returned to provider for a more definitive code: • “Debility” (799..3), malaise and fatigue (780.79) and “adult failure to thrive”(783.7)are not to be used as principal hospice diagnosis on the claim.. • Many dementia codes found in the Mental, Behavioral and neurodevelopment Chapter are typically manifestation codes and are listed as dementia in diseases classified elsewhere (294.10 and 294.11). Claims with these codes will be returned to provider with a notation “manifestation code as principal diagnosis”.
    [Show full text]
  • A Personal Guide to Organic Brain Disorders
    CORE SERVICES RESOURCES HEADQUARTERS A Personal Guide to Organic Brain Disorders • 11 Specialized Adult Day • Annual Educational Conference 800 Northpoint Parkway, Suite 101-B A Personal Guide to Organic Brain Disorders Service Centers in Palm Beach, • Caregiver Support Groups West Palm Beach, FL 33407 Martin, and St. Lucie Counties • Information and Referral Tel: 561-683-2700 Fax: 561-683-7600 WHO GETS DEMENTIA? • 24-Hour Crisis Line (1-800-394-1771) www.alzcare.org • Quarterly Publication What is Dementia? Dementia is considered a late-life disease because it tends to develop mostly in elderly people. About 5% to 8% of all • Family Nurse Consultant Services • Volunteer Program people age 65 and above have some form of dementia. This number doubles every five years above that age. It is estimated Dementia is the decline of cognitive functions of sufficient severity to interfere with two or more • Education and Training • Case Management that as many as half of people in their 80s have dementia. Early-onset Alzheimer’s is an uncommon form of dementia that of a person’s daily living activities. It is not a disease in itself, but rather a group of symptoms strikes people younger than age 65. Of all the people with Alzheimer’s disease, 5 to 10 percent develop symptoms before STRATEGIC PRINCIPLE ALZHEIMER’S 24-HOUR CRISIS LINE which may accompany certain diseases or physical conditions. age 65. Early-onset Alzheimer’s has been known to develop between the ages 30 and 40, but it is more common to see We place a safety net around patients and caregivers every day.™ 1-800-394-1771 someone in his or her 50s who has the disease.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines
    ICD-10 ThelCD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines | World Health Organization I Geneva I 1992 Reprinted 1993, 1994, 1995, 1998, 2000, 2002, 2004 WHO Library Cataloguing in Publication Data The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. 1.Mental disorders — classification 2.Mental disorders — diagnosis ISBN 92 4 154422 8 (NLM Classification: WM 15) © World Health Organization 1992 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications — whether for sale or for noncommercial distribution — should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
    [Show full text]
  • Chapter 36: Recognizing Delirium, Dementia, and Depression
    Chapter 36: Recognizing Delirium, Dementia, and Depression Manjula Kurella Tamura Division of Nephrology, Stanford University School of Medicine, Palo Alto, California Neuropsychiatric disorders such as delirium, demen- high risk. Several ESKD-specific syndromes of delir- tia, and depression are common yet poorly recognized ium deserve special mention: causes of morbidity and mortality among elderly per- sons with chronic kidney disease (CKD) including Uremic Encephalopathy. end-stage kidney disease (ESKD). Patients with neu- Uremic encephalopathy is a syndrome of delirium ropsychiatric disorders are at higher risk for death, seen in untreated ESKD. It is characterized by lethargy hospitalization, and dialysis withdrawal. These disor- and confusion in early stages and may progress to sei- ders are also likely to reduce quality of life and hinder zures and/or coma. It may be accompanied by other adherence with the complex dietary and medication neurologic signs, such as tremor, myoclonus, or as- regimens prescribed to patients with CKD. This chap- terixis. Although rarely used for diagnostic purposes, ter will review the evaluation and management of de- the EEG shows a characteristic pattern in patients with lirium, dementia, and depression among persons with uremic encephalopathy.2 The syndrome is rapidly re- CKD and ESKD. versed with dialysis or kidney transplantation. Dialysis Dysequilibrium. DELIRIUM This syndrome of delirium is seen during or after the first several dialysis treatments. It is most likely Delirium is an acute confusional state characterized to occur in elderly patients with severe azotemia by a recent onset of fluctuating awareness, impair- undergoing high efficiency hemodialysis; however, ment of memory and attention, and disorganized it has also been reported in patients undergoing thinking that can be attributable to a medical con- peritoneal dialysis and long-term hemodialysis.3 dition, intoxication, or medication side effects.
    [Show full text]
  • A Healthcare Provider's Guide To
    A Healthcare Provider’s Guide To Parkinson’s Disease Dementia (PDD): Diagnosis, pharmacologic management, non-pharmacologic management, and other considerations This material is provided by UCSF Weill Institute for Neurosciences as an educational resource for health care providers. A Healthcare Provider’s Guide To Parkinson’s Disease Dementia (PDD) A Healthcare Provider’s Guide To Parkinson’s Disease Dementia (PDD): Diagnosis, pharmacologic management, non-pharmacologic management, and other considerations Diagnosis Definition dementia. Accompanying the cognitive decline, patients may also develop visual hallucinations. Visual hallucinations are sometimes Cognitive impairment may occur in Parkinson’s disease. Parkinson’s a result of escalating doses of levodopa or other dopaminergic Disease Dementia (PDD) is clinically defined as a progressive medications, but they can also be part of the progression of PDD. decline in cognitive function in a patient with an established The hallucinations of PDD are similar to those that DLB patients diagnosis of Parkinson’s disease. describe. They are usually well formed and colorful, often taking the form of small animals, people or children. Visual misperceptions are Etiology also common, for example seeing a tree and thinking it is a person. The cause of PDD is unknown. Pathology from autopsy reveals the Early in the disease, these hallucinations may not be distressful. As presence of Lewy bodies. the disease progresses, these may become more prominent. Course Cognitive impairment is important to monitor for and recognize in PD patients because dementia is one of the important risk factors The cumulative prevalence for PDD is at least 75% of PD patients for nursing home placement and also an independent predictor of who survive for more than 10 years.1 Most experts now believe that mortality in patients with PD.1 all patients with PD who survive long enough will also eventually develop dementia.
    [Show full text]
  • A Healthcare Provider's Guide To
    A Healthcare Provider’s Guide To Vascular Dementia (VaD): Diagnosis, pharmacologic management, non-pharmacologic management, and other considerations This material is provided by UCSF Weill Institute for Neurosciences as an educational resource for health care providers. A Healthcare Provider’s Guide To Vascular Dementia (VaD) A Healthcare Provider’s Guide To Vascular Dementia (VaD): Diagnosis, pharmacologic management, non-pharmacologic management, and other considerations Diagnosis Definition There are multiple risk factors that contribute to the development of Dementia is a clinical syndrome defined as a cognitive or vascular dementia that include:7 behavioral decline that leads to an inability to complete daily tasks independently. Dementia has many causes, some of which are • Hypertension reversible, such as metabolic disorders, while some are progressive • Atrial fibrillation and other cardiac conditions such as Alzheimer’s disease. Vascular dementia (VaD) is a common • High cholesterol cause of dementia and it is caused by damage to the brain that is • Diabetes the result of cerebrovascular disease.1,2 • Metabolic syndrome • Smoking Etiology • Sleep-disordered breathing VaD may result from a stroke or series of strokes or be the result of • Sedentary lifestyle conditions that reduce circulation to the brain such as small vessel • Hyperhomocysteinemia disease. The term VaD is used whether the cause of the vascular lesion is ischemic or hemorrhagic.3,4,5 Course The clinical manifestation of VaD depends on the vessels involved Risk Factors (large versus small vessel), location of vascular lesions, and the In general, seven risk factors have been identified that are extent of damage. The term Vascular Cognitive Impairment (VCI) associated with Alzheimer’s disease and other causes of dementia.
    [Show full text]
  • Treatment of Sleep Disorders in Dementia Sharon Ooms, Msc1,2 Yo-El Ju, MD MSCI3,*
    Curr Treat Options Neurol (2016) 18:40 DOI 10.1007/s11940-016-0424-3 Dementia (E McDade, Section Editor) Treatment of Sleep Disorders in Dementia Sharon Ooms, MSc1,2 Yo-El Ju, MD MSCI3,* Address 1Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands 2Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands *3Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Box 8111, Saint Louis, MO, 63110, USA Email: [email protected] * Springer Science+Business Media New York 2016 This article is part of the Topical Collection on Dementia Keywords Sleep I Insomnia I Circadian I Dementia I Alzheimer’s disease I Dementia with Lewy bodies I Lewy body disease I Frontotemporal dementia I Parkinson’s disease with dementia I REM sleep behavior disorder Opinion statement Sleep and circadian disorders occur frequently in all types of dementia. Due to the multifactorial nature of sleep problems in dementia, we propose a structured approach to the evaluation and treatment of these patients. Primary sleep disorders such as obstructive sleep apnea should be treated first. Comorbid conditions and medications that impact sleep should be optimally managed to minimize negative effects on sleep. Patients and caregivers should maintain good sleep hygiene, and social and physical activity should be encouraged during the daytime. Given the generally benign nature of bright light therapy and melatonin, these treatments should be tried first. Pharmacolog- ical treatments should be added cautiously, due to the risk of cognitive side effects, sedation, and falls in the demented and older population. Regardless of treatment modality, it is essential to follow patients with dementia and sleep disorders closely, with serial monitoring of individual response to treatment.
    [Show full text]
  • Information on Dementia and Delirium in Hospital
    Royal Devon and Exeter The Team may suggest going directly home from the RD&E with support NHS Foundation Trust and follow up. This reduces further moves to Community Hospitals which can increase confusion. Often patients with dementia are better in their own home environment and this can reduce the risk of becoming de- skilled and dependent on nursing staff. Information on dementia and What Family, Carers and Friends can do to help: delirium in hospital 1. Fill out the Alzheimers Society ‘This Is Me’ leaflet. 2. Be available to sit with the patient if they are more confused than usual (having a familiar person near them is often extremely reassuring and reduces the need for sedation). 3. Be available to help at mealtimes and also help maintain fluid intake where appropriate. 4. Bring in familiar things and photos 5. When appropriate bring in clothing, shoes and mobility aids such as walking sticks, all marked with the patient’s name. Here to help We encourage you and your family or carers to raise any concerns or queries with the nurse in charge on the ward at the time. The Royal Devon and Exeter Hospital has a ‘Dementia Steering Group’ that provides guidance and monitors hospital care standards for those with dementia and their carers. The Royal Devon and Exeter Patient Advice and Liaison Service (PALS) can provide information and advice and liaise with hospital staff and relevant organisations, where appropriate, to help sort out an immediate problem and find a solution in a confidential and practical way. Call 01392 402093 during office hours.
    [Show full text]
  • Life Expectation in Organic Brain Disease David Jolley & David Baxter
    Advances in Psychiatric Treatment (1997), vol. 3, pp. 211-218 Life expectation in organic brain disease David Jolley & David Baxter The purpose of this review is to outline current with accuracy or certainty; for example, onset of knowledge on the life expectation of people illness or onset of symptoms. Similarly, death or suffering from organic brain disease, the tech discharge from hospital are hard, reliable outcome niques available for describing and comparing life events, whereas 'recovery from symptoms' is less expectation in populations, factors which are easy to determine. associated with longer and shorter lifeexpectation, Follow-up studies present a number of dif and the causes of death among patients with this ficulties in analysis. Some patients will have condition. reached the event of interest (death in studies of survival/mortality) while others have not. The period over which individuals have been followed usually varies and some patients will have been Survival analysis lost from the study, perhaps because they have moved away, withdrawn from the study, or become non-compliant with the treatment of Death is an event or outcome which occurs to an interest. Data relating to such individuals can be individual, and as such is similar to other outcomes included in analyses of survival/mortality but which include marriage, admission to hospital, needs to be 'censored' so that they contribute only discharge from hospital, or recovery from the time/experience during which they satisfy symptoms. These can be related in time to other inclusion criteria of the analysis. (previous) events - birth, onset of illness, referral Simple analyses of survival/mortality can be to a service, or onset of treatment.
    [Show full text]