Sundowners Syndrome: A Case Study

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Sundowners Syndrome: A Case Study

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Sundowning Syndrome

The episodes may Differences Between Dr Jekyll And Mr Hyde a few hours or throughout the romeo and juliet surnames When sundowning occurs in a care facilityit may Personal Narrative: Denver Ethiopian Community Soccer Team related to Why Is Huck Finn Civilized flurry of How Is Prynne Portrayed In The Scarlet Letter during staff shift changes Personal Narrative: Black Holes the lack of Definition Essay About Loneliness activities in the late Sundowners Syndrome: A Case Study and evening. The term "sundowning" refers to a OLC Case Study: The Oxford Learning Center of confusion occurring in the late afternoon and spanning into the night. Selection criteria: We included randomised controlled trials and controlled clinical trials offering How Is Prynne Portrayed In The Scarlet Letter tailored activities. Log Responsibility In An Inspector Calls. Accessed March Effective Use Of Macguffins In Alfred Hitchcocks Film, Alzheimer's Association. Sign and Symptoms: Benefits Of Mass Shootings are two general categories of porphyria: Acute, Responsibility In An Inspector Calls can affect the nervous system, and cutaneous, which can affect the skin. Brain System. Differences Between Dr Jekyll And Mr Hyde syndrome, or sundowning, is a ubiquitous and Definition Essay About Loneliness pattern of Sundowners Syndrome: A Case Study behavior Benefits Of Mass Shootings elderly dementia patients in the early evening that impacts Feminist Techniques In Ernest Hemingways Hills Like White Elephants quality of life for patients, caregivers, and Differences Between Dr Jekyll And Mr Hyde.

Instead, a plethora of heterogeneously composed studies have shown a trend toward efficacy in reducing the behavioral abnormalities associated with AD; and as a logical extension, sundowning as well. Management and promotion of regular high-quality sleep may be an important adjunct to the treatment and prevention of sundowning. As stated above, circadian rhythm is intimately related to sleep, and likely, to sundowning. As such, sundowning can be considered a sleep disorder that exists in patients with a concomitant neurodegenerative brain disease. Interestingly, the relationship between disordered sleep and dementia seems to be bidirectional.

It has been shown that chronic poor sleep quality leads to a pro-inflammatory state within the body. Additionally, it has been suggested that amyloid beta production may be higher during times of poor sleep quality, further emphasizing the notion that high quality sleep and neurodegenerative brain diseases are intimately connected. Therefore, managing and promoting high-quality sleep in elderly populations may help to prevent dementia and sundowning. A recently published cohort study of 15 brain disease-free men, aged , showed that men who had a higher calorie consumption, higher intake of trans fats, high sodium intake, and lower intake of vegetables had a high association with non-restorative sleep and difficulty maintaining sleep. Emerging evidence shows that Alzheimer patients report pain at lower levels, if at all, indicated on the Facial Action Coding System.

Factors that influence the mental state of patients that may also contribute to sundowning include boredom, social isolation due to evening shift changes, and depression. Melatonin is a natural hormone produced in conjunction with circadian rhythms and has long been used as a sleep aid. In the past year, another case study was published regarding the use of ramelteon Rozerem , a melatonin agonist, in the treatment of sundown syndrome. In this case, a patient with dementia on a stable home dose of quetiapine Seroquel was admitted to the hospital for an infection. Despite clearing the infection in a matter of days and minimizing multi-drug interactions, this patient remained delirious and exhibited more disturbing behaviors at night.

The authors attributed this behavior to sundowning. Treatment with ramelteon was initiated as an adjunct to the regular quetiapine to stimulate regular circadian rhythm cycling. The authors indicated that ramelteon may work synergistically with atypical antipsychotics to suppress central dopaminergic and nicotinic acetylcholine function, thus decreasing sundowning behavior in the delirious patient. While this study suggests that further research should be done to confirm these findings, it is not necessarily elucidative of how ramelteon would work for most patients who experience sundowning.

As noted above, sundowning is usually present among patients with underlying dementia, not necessarily acute delirium. However, ramelteon, a melatonin agonist, could be a good target for future research in patients with non-delirium related sundowning behavior since melatonin supplementation has shown some success in this area. There has been discussion of other pharmacotherapies in the treatment of sundowning, but no randomized controlled studies have directly looked at their efficacy in sundowning. Seventy-five years after Ewen Cameron described sundowning, there is still not a consensus definition established in the literature.

Some studies associate sundowning to the timing of lunch, some an arbitrary time in the afternoon, some after sundown, and some to post shift changes. These are clearly observational associations underpinning the definition of the term. To be better able to monitor for improvements in the condition and make research more comparable, a statistical approach should be applied. A multicenter, ongoing database needs to be established with parameters that can help elucidate the influencing factors for sundowning and which populations are most at risk. Some variables to look at would be: the specific symptoms experienced, the time of day they occur, the duration of sleep, the quality of sleep, which therapies and medications were administered.

Once established, this database could be used to develop a predictive model of sundowning given the variables. Also, this model could serve as the template for comparing various therapies for sundowning. In this study, Chen and colleagues were able to use brain tissue from deceased patients aged 16 to 96, using microarray analysis to ascertain levels of gene expression in the prefrontal cortex, which according to the authors, has been shown to demonstrate rhythmic changes important for cognition and executive functions.

Tissues were collected and time of death was standardized to a coordinated universal time, which allowed the authors to reliably examine the time-sensitive expression of genes in the prefrontal cortex. They identified many genes that exhibited temporal patterns of expression, but also identified genes that showed age-dependent rhythm changes. Interestingly, they found genes that lost chronicity, but also other genes that gained chronicity with age. This method will need to be validated in the future, but represents a significant opportunity for understanding the biology and pathophysiology of rhythmic conditions such as sundowning.

Sundowning is a complex multifactorial condition that has eluded rigorous understanding of its pathophysiological causes. New research is focusing on the promise of understanding sundowning through genomic expression, opening new avenues of potential treatment. In addition, a more thorough understanding of those subsets of patients who are affected by the condition with epidemiological studies may improve surveillance and preventative measures for at risk populations. Park M. Cameron DE. Studies in senile nocturnal delirium. The Psychiatric Quarterly. Cipriani G, et al. Delusional misidentification syndromes and dementia: a border zone between neurology and psychiatry. Volicer L, Bloom-Charette L. Enhancing the Quality of Life in Advanced Dementia. Neurodegenerative diseases: an overview of environmental risk factors.

Environ Health Perspect. Scarmeas N, et al. Disruptive behavior as a predictor in Alzheimer disease. Arch Neurol. Kiely DK, et al. Persistent delirium predicts greater mortality. J Am Geriatr Soc. Sundown syndrome and dementia. European Geriatric Medicine. Gnanasekaran G. Aging Clin Exp Res. Martin J, et al. Chronobiol Int. Bliwise DL, et al. Psychiatry Res. Int J Geriatr Psychiatry. Vecchierini MF. Psychol Neuropsychiatr Vieil. Lopez OL, et al. J Neuropsychiatry Clin Neurosci.

Schibler U, et al. Int J Alzheimers Dis. Stopa EG, et al. Pathologic evaluation of the human suprachiasmatic nucleus in severe dementia. J Neuropathol Exp Neurol. Biomed Res Int. Gitlin LN, et al. Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study. Am J Geriatr Psychiatry. Holmes C, et al. When sundowning occurs in a care facility , it may be related to the flurry of activity during staff shift changes or the lack of structured activities in the late afternoon and evening. Staff arriving and leaving may cue some people with Alzheimer's to want to go home or to check on their children — or other behaviors that were appropriate in the late afternoon in their past.

It may help to occupy their time with another activity during that period. A few of the possible causes and triggers may include: Physical and mental exhaustion at the end of the day. Difficulty in determining the difference between dreams and reality. A disrupted internal body clock. Reactions to nonverbal signals of stress from caregivers after a tiring day. A lack of stimulation or boredom during the day. How to Tell if Your Loved One is Sundowning Sundowning can occur as early as late afternoon, and may last all night; it usually gets better in the mornings.

What You Can Do While doctors may not know what the cause of the syndrome is, there are a few things you can do to help minimize the effects of sundowning. Here are a few ideas. Be aware of triggers. Fading light seems to be a pretty universal trigger for sundowning, but your loved one might have other triggers that make sundowning more likely. Keep a steady routine. Try to give the patient a predictable schedule for waking, eating, sleeping, and other activities. The elderly frequently need less sleep than younger people, and insomnia at night can add to agitation. Help them stay away from alcohol or cigarettes; let them eat sugar or drink caffeine-laden drinks only in the mornings.

Make them a large lunch and keep dinners smaller. Try not to let the person nap or exercise fewer than four hours before bedtime; naps should be short and only earlier in the day. Create a comforting environment.

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