Nocturnal Wandering Research Articles

Pharmacotherapies for sleep disturbances in dementia.

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Nocturnal Wandering Diversion: Preliminary Results from 8 Homes

Nocturnal Wandering Diversion: Preliminary Results from 8 Homes

Context awareness architecture for ambient-assisted living applications: Case study of nighttime wandering.

ObjectivesThis work presents an ambient-assisted living application that encourages seniors during nocturnal wandering episodes to return to bed in calm and comfort reassurance.MethodsStructuring knowledge by designing a software architecture capable of delivering high-level analysis and processing. A senior’s home has been upgraded into a smart home enabling the gathering of habits for two weeks and set up for personalized assistance over four weeks. Home automation devices associated with Actigraph monitors and self-reported sleep were used for more accuracy.ResultsThe architectural model can be used in ambient-assisted living applications for which data collection is permanent and continuous. Its layered organization facilitates the management of specific and general activities of daily life. The results of the home experience show that the system gave a notification whenever the need arose. On the other hand, it allowed the caregiver to get more information about the lifestyle of the senior.ConclusionsFuture work should focus on providing more services to contextualize assistance. Ontology is used to structure all the ambient knowledge of the smart home. We also plan to do more home experiments.

Impact of Alzheimer disease patients' sleep disturbances on their caregivers

Sleep disturbance symptoms are common in persons living with Alzheimer disease (AD). However little is known about the impact of sleep disturbance symptoms in patients living with AD on caregiver burden and quality of life (QOL). The aims of this study were to determine the prevalence of symptoms of disturbed sleep in patients with AD, identify the care-recipient sleep disturbance symptoms that predict caregiver burden and QoL, and determine how care-recipient sleep disturbance symptoms compare to other caregiver and patient characteristics when predicting caregiver QoL. Caregiver burden was assessed using the Screen for Caregiver Burden. Sixty percent of the care-recipients had at least one sleep symptom. In 130 caregiver/patient dyads, nocturnal awakenings, nocturnal wandering, and snoring predicted caregiver burden. Multivariate modeling demonstrated that caregiver burden, caregiver physical and mental health, and caregiver depression were predictors of overall caregiver QoL. Treating disturbed sleep in care-recipients and caregiver mental health symptoms could have important public health impact by improving the lives of the caregiving dyad.

Pharmacotherapies for sleep disturbances in dementia.

Pharmacotherapies for sleep disturbances in dementia.

A nocturnal cursorial predator attracts flying prey with a visual lure

Body coloration has been known to play an important role in animal visual communication. Attraction of prey by visual signals, such as bright body coloration, has been mainly observed in diurnal predators. For nocturnal cursorial predators, however, this foraging tactic has been largely ignored, because one would not expect it to occur under low ambient illumination at night and because of the technical constraints of conducting research in dim light conditions. Metabolic constraints prevent most cursorial spiders moving continuously for a long time to improve prey encounter rate. Any adaptation that induces prey to orient towards these cursorial predators would greatly enhance their foraging success. Bright body coloration of certain nocturnal invertebrates may play such a role. In this study, we investigated colour-mediated prey attraction in a nocturnal cursorial predator, the brown huntsman spider, Heteropoda venatoria , which has a conspicuous moustache-like white stripe on the forehead. We conducted field experiments using dummy and real spiders and monitored with infrared video cameras the responses of nocturnal prey to treatment groups with the white stripe intact or removed. The results showed that in both dummy and real spiders the presence of the white stripe can significantly increase prey attraction rate. Nocturnal flying insects such as moths comprised the majority of attracted prey. We conclude that cursorial invertebrate predators can visually lure prey, especially flying insects such as moths, by their conspicuous body coloration at night. • Animals use their bright body coloration to lure prey. • This strategy has never been found in nocturnal cursorial predators. • We examined the prey lure function in a nocturnal wandering spider. • Heteropoda venatoria can lure prey with its conspicuous white stripe on the forehead. • Nocturnal flying insects are the major prey.

Are confusional arousals pathological?

The objective of this study was to determine the extent that confusional arousals (CAs) are associated with mental disorders and psychotropic medications. Cross-sectional study conducted with a representative sample of 19,136 noninstitutionalized individuals of the US general population aged 18 years or older. The study was performed using the Sleep-EVAL expert system and investigated sleeping habits; health; and sleep, mental, and medical conditions (DSM-IV-TR, ICSD-II, ICD-10). A total of 15.2% (95% confidence interval 14.6%-15.8%) (n=2,421) of the sample reported episodes of CAs in the previous year; 8.6% had complete or partial amnesia of the episodes and 14.8% had CAs and nocturnal wandering episodes. Eighty-four percent of CAs were associated with sleep/mental disorders or psychotropic drugs. Sleep disorders were present for 70.8% of CAs. Individuals with a circadian rhythm sleep disorder or a long sleep duration (≥9 hours) were at higher risk of CAs. Mental disorders were observed in 37.4% of CAs. The highest odds were observed in individuals with bipolar disorders or panic disorder. Use of psychotropic medication was reported by 31.3% of CAs: mainly antidepressant medications. After eliminating possible causes and associated conditions, only 0.9% of the sample had CA disorder. CAs are highly prevalent in the general population. They are often reported allegedly as a consequence of the treatment of sleep disorders. For the majority of subjects experiencing CAs, no medications were used, but among those who were using medications, antidepressants were most common. Sleep and/or mental disorders were important factors for CAs independent of the use of any medication.

Multiple Transitions, Because No Advance Directive

Multiple Transitions, Because No Advance Directive

Prevalence and Comorbidity of Nocturnal Wandering in the Us Adult General Population

As noted by Ohayon et al., nocturnal wandering (NW) is not synonymous with sleepwalking. NW may also refer to wandering during the night due to epilepsy. Alcohol intoxication can also result in drunken behavior while awake, but this type of cognitive impairment may be undistinguishable from other forms of NW. Dementia and CNS drug effects can also result in NW.

Randomized trial of deep brain stimulation for Parkinson disease: Thirty-six-month outcomes; Turning tables: Should GPi become the preferred DBS target for parkinson disease?

Weaver et al. and Tagliati mistakenly infer clinical equivalence between globus pallidus interna vs subthalamic nucleus deep brain stimulation based on failure to demonstrate statistically significant differences. A clinically meaningful-not statistically significant-difference in outcome should be decided a priori, after which the sample size necessary to have a reasonable probability of detecting the difference could be determined. (4) Fortunately, the study by Weaver et al. had sufficient sample size to demonstrate a 1-point difference in motor outcomes. However, such comparisons presume optimal management so as not to produce a "ceiling effect" that would obscure differences.

Noninvasive Positive Pressure Ventilation Improved Refractory Behavioral and Psychological Symptoms of Dementia in an Elderly Adult with Type 2 Respiratory Failure

Noninvasive Positive Pressure Ventilation Improved Refractory Behavioral and Psychological Symptoms of Dementia in an Elderly Adult with Type 2 Respiratory Failure

Prevalence and comorbidity of nocturnal wandering in the US adult general population

To assess the prevalence and comorbid conditions of nocturnal wandering with abnormal state of consciousness (NW) in the American general population. Cross-sectional study conducted with a representative sample of 19,136 noninstitutionalized individuals of the U.S. general population ≥18 years old. The Sleep-EVAL expert system administered questions on life and sleeping habits; health; and sleep, mental, and organic disorders (DSM-IV-TR; International Classification of Sleep Disorders, version 2; International Classification of Diseases-10). Lifetime prevalence of NW was 29.2% (95% confidence interval [CI] 28.5%-29.9%). In the previous year, NW was reported by 3.6% (3.3%-3.9%) of the sample: 1% had 2 or more episodes per month and 2.6% had between 1 and 12 episodes in the previous year. Family history of NW was reported by 30.5% of NW participants. Individuals with obstructive sleep apnea syndrome (odds ratio [OR] 3.9), circadian rhythm sleep disorder (OR 3.4), insomnia disorder (OR 2.1), alcohol abuse/dependence (OR 3.5), major depressive disorder (MDD) (OR 3.5), obsessive-compulsive disorder (OCD) (OR 3.9), or using over-the-counter sleeping pills (OR 2.5) or selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 3.0) were at higher risk of frequent NW episodes (≥2 times/month). With a rate of 29.2%, lifetime prevalence of NW is high. SSRIs were associated with an increased risk of NW. However, these medications appear to precipitate events in individuals with a prior history of NW. Furthermore, MDD and OCD were associated with significantly greater risk of NW, and this was not due to the use of psychotropic medication. These psychiatric associations imply an increased risk due to sleep disturbance.

Distinctive polysomnographic traits in nocturnal frontal lobe epilepsy

To describe the polysomnographic features and distribution of epileptic motor events, in relation to conventional sleep measures and cyclic alternating pattern (CAP) parameters, in 40 untreated patients with nocturnal frontal lobe epilepsy (NFLE). We analyzed the basal polysomnographic recordings of 40 patients (20 male and 20 female; mean age: 31 ± 10 years) with a diagnosis of nocturnal frontal lobe epilepsy. Conventional sleep measures and CAP parameters were assessed. Polysomnographic recordings were subdivided in sleep cycles. The distribution of the epileptic motor events (including minor motor events, paroxysmal arousals, tonic-dystonic, or hyperkinetic seizures and epileptic nocturnal wandering) was analyzed throughout: total sleep time, non-rapid eye movement (NREM) and REM sleep, light sleep (S1 + S2), slow wave sleep (SWS), each sleep cycle, CAP or non-CAP sleep, phase A and phase B of CAP. Only clear epileptic motor events supported by video-polysomnographic evidence were taken into consideration. Polysomnographic findings of patients with NFLE were compared with those of 24 age- and gender-balanced healthy subjects without sleep complaints. Compared to controls, patients with NFLE showed a significant increase in wake after sleep onset, SWS duration, and REM latency, whereas REM sleep duration was significantly lower in NFLE patients. The patients with NFLE showed a significant increase of CAP time, CAP rate (72% vs. 32% in control group), CAP cycles, and mean duration of a CAP sequence. These findings were associated with a significant enhancement of all subtypes of the A phases of CAP (mainly subtype A1). A total of 139 epileptic motor events supported by video-polysomnographic evidence were counted: 98% of all seizures occurred in NREM sleep and 72% of NREM seizures emerged from SWS, the latter being particularly collected in the first sleep cycles and decreasing in frequency together with the progressive decline of deep sleep. Ninety percent of total NREM seizures occurred during a CAP sequence, and CAP-related seizures occurred in association with a phase A. Significant polysomnographic alterations seem to emerge in patients with NFLE (increased REM latency, epileptic fragmentation of SWS, and increase of CAP rate). The analysis of seizure distribution showed that most epileptic events occurred in SWS, with predominance in the first sleep cycle and decreasing in frequency together with the homeostatic decline of SWS across the night. Within the NREM sleep, CAP is a manifestation of unstable sleep and represents a powerful predisposing condition for the occurrence of nocturnal motor seizures, which arise in concomitance with a phase A.

Prevalence of and Risk Factors for Nocturnal Wandering

Parasomnias are conditions that disrupt sleep and include arousals with abnormal motor, behavioral, or sensory phenomena. Sonambulism (sleep walking) arises mainly out of slow-wave sleep and usually occurs in the first third of the night, when more slow-wave sleep is seen. Other sleep disorders such as nocturnal epilepsy, confusional …

Colour blindness of the movement-detecting system of the spider Cupiennius salei

The nocturnal wandering spider Cupiennius salei has one pair of principal eyes and three pairs of secondary eyes located on the prosoma, which differ in both morphology and function. Their spectral sensitivity, measured with intracellular recordings, is due to three different types of photoreceptors with absorbance maxima in the mid-range of the spectrum, at 480 nm and 520 nm and in the UV at 360 nm. Based on these physiological data colour vision might be possible. In the present study, the ability to discriminate coloured moving stimuli from grey backgrounds was tested. The perception of moving coloured stripes in front of backgrounds with 29 different grey levels was measured by using extracellular recordings from the anterior median eye muscles as a monitoring system. Each of these eyes has two muscles, which increase their activity when moving stimuli are presented in front of a secondary eye. This variation in eye muscle activity can be recorded extracellulary in a living spider using a single channel telemetry device. If colour perception exists, the animal should be able to detect a moving coloured stripe in front of any grey level. Blue, green and red stripes were used as moving stimuli, in front of all 29 grey backgrounds. The results indicate that C. salei is not able to discriminate the coloured stimuli from distinct shades of grey. It is therefore evident that the movement-detecting system in this spider appears to be colour blind.

Gabapentin in the treatment of dementia-associated nocturnal agitation

SummaryBackgroundNocturnal 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 ReportOur patient, a 77-year-old Czech woman with incipient vascular dementia, received gabapentin 400mg at bedtime for 6 months and showed convincing improvement.ConclusionsGabapentin was very effective in treating nocturnal agitation.

POC10 The dark night: a family diagnosis

A 43-year-old woman presented with increasing daytime tiredness following a history of nocturnal events persisting from early childhood. She was told that she would wake and walk clumsily; she has...

The limits of agency in walking humans

An important principle of human ethics is that individuals are not responsible for actions performed when unconscious. Recent research found that the generation of an action and the building of a conscious experience of that action (agency) are distinct processes and crucial mechanisms for self-consciousness. Yet, previous agency studies have focussed on actions of a finger or hand. Here, we investigate how agents consciously monitor actions of the entire body in space during locomotion. This was motivated by previous work revealing that (1) a fundamental aspect of self-consciousness concerns a single and coherent representation of the entire spatially situated body and (2) clinical instances of human behaviour without consciousness occur in rare neurological conditions such as sleepwalking or epileptic nocturnal wandering. Merging techniques from virtual reality, full-body tracking, and cognitive science of conscious action monitoring, we report experimental data about consciousness during locomotion in healthy participants. We find that agents consciously monitor the location of their entire body and its locomotion only with low precision and report that while precision remains low it can be systematically modulated in several experimental conditions. This shows that conscious action monitoring in locomoting agents can be studied in a fine-grained manner. We argue that the study of the mechanisms of agency for a person's full body may help to refine our scientific criteria of selfhood and discuss sleepwalking and related conditions as alterations in neural systems encoding motor awareness in walking humans.

The rapid‐eye‐movement sleep behavior disorder in Chinese‐Taiwanese patients

While the features of rapid-eye-movement sleep behavior disorder (RBD) have been reported in Caucasian patients, the characteristics of Chinese-Taiwanese patients with RBD have never been examined. Subjects were retrospectively recruited between April 2005 and February 2008 from the neurological clinic and sleep laboratory in the Department of Neurology of Kaohsiung Medical University Hospital. A total of 70 consecutive subjects fulfilling the criteria for RBD were recruited. The records of standard overnight polysomnography in patients with RBD were analyzed retrospectively. Twenty-five (35.7%) of the patients were female; the mean age of diagnosis was 67 years and the mean age of symptom onset was 60 years. Among patients with idiopathic RBD, there were 28 men (61%) and 18 women (39%). Nocturnal wandering in the bedroom was reported in 11 cases and out of the bedroom in seven cases. Nineteen patients (27.1%) had accidental falling from bed and 27 patients (38.6%) had sleep-related injury that resulted in ecchymosis and laceration of the head, face or limbs. We found that some features in Chinese-Taiwanese patients with RBD were different from Caucasian patients, such as a greater female ratio, lower injury episodes during sleep and more sleep wandering.

Brain Germinoma in a Young Adult Man With Suspicion of Fatal Neglect

We report a forensic autopsy case of brain germinoma in a 26-year-old man who was severely wasted and initially suspected of fatal neglect. He had a history of nocturnal wandering and was confined by his parents. Neuropathological examination showed germinoma in the hypothalamus and neurohypophysis. The cause of death was certified as hypothalamo-hypophyseal insufficiency due to germinoma. Because hypothalamic lesions may dysregulate feeding behavior and sleeping rhythms, germinoma was considered the causative lesion of the anorexic wasting and nocturnal wandering. Confinement was a preventive measure of the patient's wandering. The findings in this case indicated that hypothalamic tumors should be recognized as a cause of wasting in autopsies suspected of fatal neglect.