Abstract
Sleep disorders are common in patients with Alzheimer dementia and affect the quality of life of patients and of their caregivers. Despite the rising number of studies in the area, almost all of them are about non-pharmacological treatment. Our objective was to review the literature concerning pharmacological and non-pharmacological approaches to treat sleep disorders of elderly patients with Alzheimer dementia in the ambulatory setting. The treatments revised consisted of sleep hygiene and/or use of intense light coupled or not with use of melatonin, cholinesterase inhibitors, antipsychotics, hypnotics or antidepressants. In addition to the non-pharmacological measures, there is evidence that the use of trazodone may aid the treatment of sleep disorders of older individuals with Alzheimer dementia. More studies are necessary to examine the non-pharmacological and pharmacological treatments revised herein.
Highlights
Sleep disorders (SD) in patients with Alzheimer’s disease (AD) are among the behavioral disorders that most interfere in the quality of life of the patient and of the caregiver
The factors that contribute towards SD in the elderly with dementia come from the neuropathological alterations observed in AD, such as neuronal loss and atrophy of the suprachiasmatic nucleus of the hypothalamus, which interfere in the organization of the sleep-wake cycle and in reduction of cholinergic activity, since acetylcholine participates in REM sleep.[4,5] less exposure to light, lower light capture and difficulty in comprehending temporal references throughout the day influence the sleep of elderly with AD.[6]
Five studies assessed non-drug treatment;(10-14) as to pharmacological treatment, three studies evaluated the effectiveness of melatonin,(15-17) two of antipsychotics,(18,19) five of acetyl cholinesterase inhibitors (IAch),(20-24) and three of antidepressant agents.[25,26,27]
Summary
Sleep disorders (SD) in patients with Alzheimer’s disease (AD) are among the behavioral disorders that most interfere in the quality of life of the patient and of the caregiver. Besides the increased risk of institutionalization, SD have negative repercussions on cognition, functionality, and behavior of these patients.[1,2] Up to 40% of the patients with AD present some SD along the clinical course of the disease.[3]. In AD, the most common symptoms related to SD are perambulation, confusion, and nocturnal awakening, besides sleepiness during the day and inversion of the sleep-wake cycle, with reports of night waking being the most stressful aspect for caregivers, and daytime somnolence the most frequent observation.[5,7,8]. The circumscribed routine and standardized care given in these environments are limitations that interfere in the conduction of a
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