Low-Dose Atypical Antipsychotic Risperidone Improves the 5-Year Outcome in Alzheimer's Disease Patients with Sleep Disturbances

Abstract

Sleep disturbances (SD) accelerate the progression of Alzheimer's disease (AD) and increase the stress of caregivers. However, the long-term outcome of disturbed nocturnal sleep/wake patterns in AD and on increased stress of spousal caregivers is unclear. This study assessed the 5-year effect of nocturnal SD on the long-term outcome in AD patients. A total of 156 donepezil-treated mild-moderate AD patients (93 AD + SD and 63 AD - SD as a control group) were recruited. The AD + SD patients were formed into 4 subgroups according to the preferences of spousal caregivers for treatment with atypical antipsychotics (0.5-1 mg risperidone, n = 22), non-benzodiazepine hypnotic (5-10 mg zolpidem tartrate, n = 33), melatonin (2.55 mg, n = 9), or no-drug treatment (n = 29). SD were evaluated by polysomnography, sleep scale, and cognitive scale examinations. Moreover, all spousal caregivers of AD patients were assessed using a series of scales, including sleep, anxiety, mood, and treatment attitude scales. Our data showed that nocturnal sleep/wake disturbances were significantly associated with lower 5-year outcomes for AD patients, earlier nursing home placement, and more negative emotions of spousal caregivers. Treatment with low-dose atypical antipsychotic risperidone improved the 5-year outcome in AD + SD patients. In conclusion, low-dose atypical antipsychotic risperidone improves the 5-year outcome in AD patients with SD. Moreover, improvement of nocturnal sleep problems in AD patients will also bring better emotional stability for AD caregivers.

Treatment of Sleep Disorders in Dementia

“…After 5 years, the risperidone group did not have deterioration in ESS and PSQI, compared to the other groups, who had worsening in both measures [100]. …”

Melatonin for Sleep Disorders in Patients with Neurodegenerative Diseases

“…Sleep disorders or nocturnal behavioral disturbances predispose to earlier nursing home placement [33,34], are associated with poorer functional status [35], and worsened cognitive function [36], and may predict earlier mortality [37].…”

Polysomnographic assessment of suvorexant in patients with probable Alzheimer's disease dementia and insomnia: a randomized trial

“…There is emerging evidence that poor sleep may contribute to the development of AD and impair memory function . Options for effective pharmacological treatment of insomnia in AD are limited, with inconsistent or poor‐quality evidence for efficacy of melatonin, second‐generation antipsychotics (which are primarily used to target other neuropsychiatric and behavioral symptoms associated with AD), and sedating antidepressants . Furthermore, potential for adverse events and worsening of cognitive impairment and functional decline is an important concern in treating sleep problems in patients with AD using antipsychotics and sedatives …”