If the subject’s health conditions permit it, physical exercise may be useful. The use of drugs is an option, but several are contraindicated in these patients
Who suffers from severe cognitive impairmentsuch as those present in Alzheimer’s disease, sooner or later also manifests itself sleep disorders, which in turn can worsen the general clinical outcome. Sleep disturbances in Alzheimer’s disease sufferers are associated with greater cognitive declineworse functional status and reduced quality of life — write Ruth Benca of the Psychiatry & Human Behavior Unit of the Wake Forest School of Medicine in Irvine, and her collaborators, in an article published in the Journal of Alzheimer’s Disease —. Additionally people with Alzheimer’s disease who also have sleep disorders often exhibit behavioral symptoms, depression, apathy, psychotic symptoms, with a typical worsening in the evening. There are also disturbing nocturnal behaviors, with an increase in the care burden for caregivers. Sleep disturbances are one of the main causes of institutionalization (hospitalization, ndr) of people with Alzheimer’s disease, precisely for the stressful action on caregivers.
sleep hygiene strategies
On the other hand, the treatment of sleep disturbances in these people is particularly complicated, since it is difficult to implement therapeutic strategies usually used in insomnia. The first ones that are implemented are part of the so-called sleep hygiene and are behavioral, such as exposure to light during the day or exerciseas far as your health conditions allow. The implementation of these non-pharmacological treatments can reduce the probability that we will have to resort to institutionalization and its economic burden – adds Ruth Benca -. But along with these strategies in many cases it is necessary to resort to pharmacotherapy to ensure that people can stay at home as long as possible. Unfortunately, drugs that could improve the duration and quality of sleep can be used with many limitations in elderly people suffering from severe cognitive disorders, since carry a risk of worsening mental conditionsbut also of falls, fractures, daytime sleepiness, which in turn precipitate the general clinical conditions.
Pharmacological therapies
This applies to both benzodiazepineboth for the hypnotic non-benzodiazepines such as zolpidem, which the American Geriatric Society does not recommend for use in these patients. There are also many problems with the use of antipsychotics which, as reported by the US FDA, can increase the risk of death in elderly people with dementia. Recently, the scientific community has shown some interest in hypnotics that have a different mechanism of action from those available so far: they are orexin receptor antagonists, which appear to be effective and safe enough for the treatment of insomnia in older adults with severe cognitive impairment. However, there remains a general condition of uncertainty regarding the balance between risks and benefits of the treatment of sleep disorders of people with Alzheimer’s dementia concludes Ruth Benca.
March 8, 2023 (change March 8, 2023 | 07:11)
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