Development of Diagnostic Criteria for Defining Sleep Disturbance in Alzheimer's Disease

Abstract

This article proposes new standards for identifying, defining, and naming sleep/wake cycle disturbances associated with Alzheimer's disease (AD) to aid in more effective research, including the development and testing of potential treatments. Many AD patients develop sleep/wake cycle disturbances associated with distress, depression, and sleep disturbances in the caregiver, as well as early nursing home placement for the patient. The Food and Drug Administration Psychopharmacological Drugs Advisory Committee has emphasized the need for a comprehensive diagnostic system. A key point made by the committee was that behavioral problems associated with dementia (including sleep and chronobiological disturbances) are scientifically and clinically valid targets of pharmacologic treatment. However, current diagnostic criteria preclude development of FDA-acceptable studies of pharmacological interventions because they do not include the required specific indications for treatment. This article attempts to develop better-defined provisional criteria with the goal of promoting epidemiological, physiological, and, especially, pharmacological research on sleep/wake disturbances.

Effect of timed bright light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease

“…bright light) contribute to the etiology of the rest-activity disruption (Bliwise et al, 1995;Yesavage et al, 2003). Pharmacologic treatment for sleep disruption has proven only minimally effective and is often associated with unacceptable side effects (McCurry and Ancoli-Israel, 2003;Yesavage et al, 2003).…”

Psychiatric Complications of Dementia

“…Likewise diagnostic criteria have been proposed for depression in AD 5 and sleep disturbance in AD. 6 In contrast to this approach, Lyketsos et al 4 argue, specifically regarding the Jeste and Finkel criteria, 3 that the degree of co-occurrence of psychotic with other NPSs is poorly addressed, especially as cooccurrence is the rule rather than the exception. Various scales, most commonly the NPI, 29 have been used to characterize psychiatric symptoms in dementia for statistically identifiable components.…”

“…89 In the initial stages of AD, sleep disturbances appear to be an exaggeration of the changes in sleep architecture seen in older adults, as well as reduced REM sleep. 6 Certain neurodegenerative disorders such as DLB, Parkinson disease with dementia, multisystem atrophy, and progressive supranuclear palsy are associated with RBD. RBD is a parasomnia characterized by dreamenacting behaviours, such as shouting, punching, and falling out of bed.…”

“…This is part of a syndromic approach to several psychiatric syndromes, 2 which is advancing to include diagnostic criteria in AD. [3][4][5][6] While syndromic approaches can improve diagnostic agreement, especially when used with a structured interview, they are especially valued for allowing etiological identification. 2 Even so, the history of psychiatric research shows that validating psychiatric syndromes is difficult.…”

Timing of Activities and their Effects on Circadian Rhythm in the Elderly with Dementia: A Literature Review

“…CRD symptoms include late afternoon/evening agitation (e.g., "sundowning") and irregular sleep-wake rhythms such as daytime hypersomnia, frequent night wakenings, and poor sleep efficiency [12][13][14]. CRDs pose the greatest burden to family caregivers of persons with dementia, and are the principal causes of distress, poor quality of life (QoL), and institutionalization in this growing population [8,15].…”