Is There a Characteristic Clinical Profile for Patients with Dementia and Sundown Syndrome?

Sevilla, David Angulo; Rodríguez, María Teresa Carreras; Rodríguez, Patricia Heredia; Sánchez, Marisa Fernández; Mora, José Aurelio Vivancos; Gago-Veiga, Ana Beatriz

doi:10.3233/jad-170488

Cited by 10 publications

(17 citation statements)

References 36 publications

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“…Interestingly, a higher rate of sundowning is reported during the winter months when sunlight exposure is often limited [306]. Melatonin treatment for individuals with sundowning appears to reduce agitated behaviors [307]. The most studied and clinically used therapy is light therapy for sundowning patients, although, in some cases, the SCN may be too degenerated for light therapy to be effective [308].…”

Section: Sundowning Syndromementioning

confidence: 99%

Circadian Rhythms of the Hypothalamus: From Function to Physiology

Drunen

Eckel‐Mahan

2021

Clocks & Sleep

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The nearly ubiquitous expression of endogenous 24 h oscillations known as circadian rhythms regulate the timing of physiological functions in the body. These intrinsic rhythms are sensitive to external cues, known as zeitgebers, which entrain the internal biological processes to the daily environmental changes in light, temperature, and food availability. Light directly entrains the master clock, the suprachiasmatic nucleus (SCN) which lies in the hypothalamus of the brain and is responsible for synchronizing internal rhythms. However, recent evidence underscores the importance of other hypothalamic nuclei in regulating several essential rhythmic biological functions. These extra-SCN hypothalamic nuclei also express circadian rhythms, suggesting distinct regions that oscillate either semi-autonomously or independent of SCN innervation. Concurrently, the extra-SCN hypothalamic nuclei are also sensitized to fluctuations in nutrient and hormonal signals. Thus, food intake acts as another powerful entrainer for the hypothalamic oscillators’ mediation of energy homeostasis. Ablation studies and genetic mouse models with perturbed extra-SCN hypothalamic nuclei function reveal their critical downstream involvement in an array of functions including metabolism, thermogenesis, food consumption, thirst, mood and sleep. Large epidemiological studies of individuals whose internal circadian cycle is chronically disrupted reveal that disruption of our internal clock is associated with an increased risk of obesity and several neurological diseases and disorders. In this review, we discuss the profound role of the extra-SCN hypothalamic nuclei in rhythmically regulating and coordinating body wide functions.

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Section: Sundowning Syndromementioning

confidence: 99%

Circadian Rhythms of the Hypothalamus: From Function to Physiology

Drunen

Eckel‐Mahan

2021

Clocks & Sleep

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“…Silva et al (2017) also associated sundowning with increased depressive and cognitive symptoms, suggesting that multiple emotional systems are disrupted in this syndrome and that these become even more compromised as AD progresses with more associated cognitive decline. Angulo Sevilla et al (2018) also noted an association of such sundowning symptoms with an increased severity of dementia, but also in association with insomnia and hypersomnia. Interestingly, Pyun et al (2019) found a strong association between these sundowning symptons and the presence of the apolipoprotein E (APOE) ε4 allele, an important genetic risk factor in the development of late-onset AD that promotes amyloid pathology (Corder et al, 1993).…”

Section: Introductionmentioning

confidence: 89%

“…These challenges probably contribute to the wide range of prevalence reported for sundowning across studies, with some studies reporting as high as 60%, while others reporting as low as 2.5% for dementia patients depending on the setting (Khachiyants et al, 2011;Canevelli et al, 2016). However, more recent work suggests a more narrow prevalence between 20 and 27.8% (Angulo Sevilla et al, 2018;Pyun et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, during this same time, numerous more groups reported disturbances in AD and dementia patients that temporally and qualitatively match the traditional description of sundowning-related agitation and aggression ( Martino-Saltzman et al, 1991 ; Cohen-Mansfield et al, 1992 ; O’Leary et al, 1993 ; Burgio et al, 1994 ; Sloane et al, 1998 ). Even more recently, several observational studies defining sundowning as an increase in neuropsychiatric behaviors (including agitation and aggression) in the late afternoon and early evening have observed this phenomenon in AD patients in association with important circadian or AD-related factors ( Silva et al, 2017 ; Angulo Sevilla et al, 2018 ; Menegardo et al, 2019 ; Pyun et al, 2019 ; Shih et al, 2019 ). For instance, Menegardo et al (2019) associated the aggressiveness and irritability of sundowning with increased nocturnal behavior such as wandering.…”

Section: Introductionmentioning

confidence: 99%

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Potential Pathways for Circadian Dysfunction and Sundowning-Related Behavioral Aggression in Alzheimer’s Disease and Related Dementias

Todd

2020

Front. Neurosci.

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Patients with Alzheimer's disease (AD) and related dementias are commonly reported to exhibit aggressive behavior and other emotional behavioral disturbances, which create a tremendous caretaker burden. There has been an abundance of work highlighting the importance of circadian function on mood and emotional behavioral regulation, and recent evidence demonstrates that a specific hypothalamic pathway links the circadian system to neurons that modulate aggressive behavior, regulating the propensity for aggression across the day. Such shared circuitry may have important ramifications for clarifying the complex interactions underlying "sundowning syndrome," a poorly understood (and even controversial) clinical phenomenon in AD and dementia patients that is characterized by agitation, aggression, and delirium during the late afternoon and early evening hours. The goal of this review is to highlight the potential output and input pathways of the circadian system that may underlie circadian dysfunction and behavioral aggression associated with sundowning syndrome, and to discuss possible ways these pathways might inform specific interventions for treatment. Moreover, the apparent bidirectional relationship between chronic disruptions of circadian and sleepwake regulation and the pathology and symptoms of AD suggest that understanding the role of these circuits in such neurobehavioral pathologies could lead to better diagnostic or even preventive measures.

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“…The frequency of sleep problems in persons with ADRD varies by type of dementia, gender, severity of impairment, and physical function, and disrupts the sleep of their caregivers (Cipriani et al, 2015; Simpson & Carter, 2013). Furthermore, sleep disturbances in persons with ADRD are associated with more depressive symptoms and worse physical health for family caregivers (Angulo Sevilla et al, 2018; Peng & Chang, 2013). Thus, nighttime is another important period of time to examine BPSD and caregivers’ stress appraisal.…”

Section: Introductionmentioning

confidence: 99%

Temporal Patterns of Behavioral and Psychological Symptoms of Dementia and Caregiver Distress: Associated Daily and Individual Factors

Connelly,

Kim,

Liu

et al. 2023

J Appl Gerontol

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This study examined daily occurrences of behavioral and psychological symptoms of dementia (BPSD) and whether caregivers’ perceived distress towards BPSD varies throughout four phases of the day (i.e., morning, daytime, evening, and night). Family caregivers residing with relatives who were using adult day services (ADS) participated in an 8-day daily diary study (caregiver N = 173; caregiver-day N = 1,359). BPSD occurred most frequently in the evenings. ADS use, sleep disturbances, and dementia severity were significantly associated with BPSD occurrence for some phases of the day. Caregivers’ distress towards BPSD occurrences increased throughout the day (i.e., most stressful at night). However, caregivers showed lower reactivity to BPSD at night on days when their relatives used ADS. Evidence of temporal patterns of BPSD in community-dwelling older adults and caregiver distress demonstrated the importance of ADS use for BPSD reactivity and identified potential target windows and associated contextual factors for individualized interventions.

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Is There a Characteristic Clinical Profile for Patients with Dementia and Sundown Syndrome?

Abstract: In our study, age, a higher score on the GDS, and the presence of insomnia or hypersomnia are differential clinical characteristics of patients with SS. We defined a nomogram that helps predicting the occurrence of SS in patients with dementia.

Cited by 10 publications

References 36 publications

Circadian Rhythms of the Hypothalamus: From Function to Physiology

Circadian Rhythms of the Hypothalamus: From Function to Physiology

Potential Pathways for Circadian Dysfunction and Sundowning-Related Behavioral Aggression in Alzheimer’s Disease and Related Dementias

Temporal Patterns of Behavioral and Psychological Symptoms of Dementia and Caregiver Distress: Associated Daily and Individual Factors

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