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Aging Clinical and Experimental Research

, Volume 6, Issue 6, pp 451–458 | Cite as

Sleep in non-institutionalized Alzheimer’s disease patients

  • Sonia Ancoli-Israel
  • M. R. Klauber
  • J. C. Gillin
  • S. S. Campbell
  • C. R. Hofstetter
Original Article

Abstract

The sleep of Alzheimer’s disease (AD) patients is often disturbed by medications, depression, circadian rhythm changes and sleep disorders. Institutionalization is often precipitated by the effect of the patient’s sleep and wakefulness on the caregiuer. We examined reports of sleep disturbance in mild AD patients. The study cohort consisted of 246 AD patients and 94 controls. Self-reports of sleep disturbance in mild AD patients were examined as was the relationship of sleep and medication use. Results were compared to those of normal controls, and the patients’ responses to the reports of their caregiuers. Dementia was assessed with the Mini Mental Status Exam, the Blessed Dementia Scale, the Mattis Dementia Rating Scale, and the Pfeiffer Outpatient Disability Test. The more demented the patients, the more time they spent in bed, the more fragmented their sleep, and the more naps they took. Caregiuers reports of increased wandering at night and more aggressive behavior during the day were associated with increased use of sedative-hypnotics and with going to bed early. Lengthy sleep was associated with disruptive behavior. We conclude that increased sleep may be associated with dementia and with more disruptive behavior. (Aging Clin. Exp. Res. 6: 451-458, 1994)

En]Keywords

Alzheimer’s disease caregivers hypnotics napping sleep 

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References

  1. 1.
    Ancoli-Israel S., Kripke D.F.: Now I lay me down to sleep: The problem of sleep fragmentation in elderly and demented residents of nursing homes. Bull. Clin. Neurosci. 54: 127–132, 1989.Google Scholar
  2. 2.
    Reynolds C.F.III, Kupfer D.J., Taska L.S., Hoch C.C. Spiker D.G., Sewitch D.E., Zimmer B., Marin R.S., Nelson J.P., Martin D., Morycz R.: EEG sleep in elderly depressed, demented, and healthy subjects. Biol. Psychiatry 20: 431–442, 1985.PubMedCrossRefGoogle Scholar
  3. 3.
    Feinberg I., Koresko R.L., Heller N.: EEG sleep patterns as a function of normal and pathological aging in man. J. Psychiatr. Res. 5: 107–144, 1967.PubMedCrossRefGoogle Scholar
  4. 4.
    Allen S.R., Seiler W.O., Stahelin H.B., Spiegel R.: Seventy-two hour polygraphic and behavioral recordings of wakefulness and sleep in a hospital geriatric unit: comparison between demented and nondemented patients. Sleep 10: 143–159, 1987.PubMedGoogle Scholar
  5. 5.
    Prinz P.N., Vitaliano P.P., Vitiello M.V., Bokan J.A., Raskind M., Peskind E., Gerber C.: Sleep, EEG and mental function changes in senile dementia of the Alzheimer’s type. Neurobiol. Aging 3: 361–370, 1982.PubMedCrossRefGoogle Scholar
  6. 6.
    Reynolds C.F.III, Kupfer D.J., Houck P.R., Hoch C.C., Stack J.A., Berman S.R., Zimmer B.: Reliable discrimination of elderly depressed and demented patients by electroencephalographic sleep data. Arch. Gen. Psychiatry 45: 258–264, 1988.PubMedCrossRefGoogle Scholar
  7. 7.
    Prinz P.N., Peskind E.R., Vitaliano P.P., Raskind M.A., Eisdorfer C., Zemcuznikov N., Gerber C.J.: Changes in the sleep and waking EEGs of nondemented and demented elderly subjects. J. Am. Geriatr. Soc. 30: 8692, 1982.Google Scholar
  8. 8.
    Bliwise D.L., Tinklenberg J., Yesavage J.A., Davies H., Pursley A.M., Petta D.E., Widrow L., Guilleminault C., Zarcone V.P., Dement W.C.: REM latency in Alzheimer’s disease. Biol. Psychiatry 25: 320–328, 1989.PubMedCrossRefGoogle Scholar
  9. 9.
    Vitiello M.V., Prinz P.N.: Alzheimer’s disease: sleep and sleep/wake patterns. In: Roth T., Roehrs T.A. (Eds.), Clinics in Geriatric Medicine. W.B. Saunders Company, Philadelphia, 1989, pp. 289–299.Google Scholar
  10. 10.
    Vitiello M.V., Bokan J.A., Kukull W.A., Muniz R.L., Smallwood R.G., Prinz P.N.: Rapid eye movement sleep measures of Alzheimer’s type dementia patients and optimally healthy aged individuals. Biol. Psychiatry 19: 721–734, 1984.PubMedGoogle Scholar
  11. 11.
    Vitiello M.V., Prinz P.N., Williams D.E., Frommlet M.S., Ries R.K.: Sleep disturbances in patients with mild-stage Alzheimer’s disease. J. Gerontol. 45: M131–M138, 1990.PubMedCrossRefGoogle Scholar
  12. 12.
    Reynolds C.F.III, Hoch C.C., Stack J., Campbell D.: The nature and management of sleep/wake disturbance in Alzheimer’s dementia. Overview: sleep disturbance in Alzheimer’s dementia. Psychopharmacol. Bull. 24: 43–48, 1988.Google Scholar
  13. 13.
    Berry D.T.R., Webb W.B., Block A.J., Bauer R.M., Switzer D.A.: Nocturnal hypoxia and neuropsychological variables. J. Clin. Exp. Neuropsychol. 8: 229–238, 1986.PubMedCrossRefGoogle Scholar
  14. 14.
    Erkinjuntti T., Partinen M., Sulkava R., Telakivi T., Salmi T., Tilvis R.: Sleep apnea in multiinfarct dementia and Alzheimer’s disease. Sleep 10: 419–425, 1987.PubMedGoogle Scholar
  15. 15.
    Cheshire K., Engleman H., Deary I., Shapiro C., Douglas N.J.: Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Arch. Intern. Med. 152: 538–541, 1992.PubMedCrossRefGoogle Scholar
  16. 16.
    Greenberg G.D., Watson R.K., Deptula D.: Neuropsychological dysfunction in sleep apnea. Sleep 10: 254–262, 1987.PubMedGoogle Scholar
  17. 17.
    Yesavage J.A., Bliwise D.L., Guilleminault C., Carskadon M.A., Dement W.C.: Preliminary communication: intellectual deficit and sleep-related respiratory disturbance in the elderly. Sleep 8: 30–33, 1985.PubMedGoogle Scholar
  18. 18.
    Ancoli-Israel S., Klauber M.R., Butters N., Parker L., Kripke D.F.: Dementia in institutionalized elderly: Relation to sleep apnea. J. Am. Geriatr. Soc. 39: 258–263, 1991.PubMedGoogle Scholar
  19. 19.
    Smallwood R.G., Vitiello M.V., Giblin E.C., Prinz P.: Sleep apnea: relationship to age, sex, and Alzheimer’s dementia. Sleep 6: 16–22, 1983.PubMedGoogle Scholar
  20. 20.
    Reynolds C.F.III, Kupfer D.J., Taska L.S., Hoch C.C., Sewitch D.E., Restifo K., Spiker D.G., Zimmer B., Marin R.S., Nelson J., Martin D., Morycz R.: Sleep apnea in Alzheimer’s dementia: correlation with mental deterioration. J. Clin. Psychiatry 46: 257–261, 1985.PubMedGoogle Scholar
  21. 21.
    Pond C.D., Mant A., Eyland E.A., Saunders N.A.: Dementia and abnormal breathing during sleep. Age Ageing 19: 247–252, 1990.PubMedCrossRefGoogle Scholar
  22. 22.
    Mant A., Saunders N.A., Eyland A.E., Pond C.D., Chancellor A.H., Webster I.W.: Sleep-related respiratory disturbance and dementia in elderly females. J. Gerontol. 43: 140–144, 1988.CrossRefGoogle Scholar
  23. 23.
    Bliwise D.L.: Sleep apnea, dementia, and Alzheimer’s disease: a mini review. Bull. Clin. Neurosci. 54: 123–126, 1989.Google Scholar
  24. 24.
    Bliwise D.L., Yesavage J.A., Tinklenberg J.R., Dement W.C.: Sleep apnea in Alzheimer’s disease. Neurobiol. Aging 10: 343–346, 1989.PubMedCrossRefGoogle Scholar
  25. 25.
    Bliwise D.L.: Neuropsychological function and sleep. In: Roth T., Roehrs T.A. (Eds.), Clinics in Geriatric Medicine. W.B. Saunders Company, Philadelphia, 1989, pp. 381–393.Google Scholar
  26. 26.
    Bliwise D.L.: Cognitive Function and Sleep Disordered Breathing in Aging Adults. In: Kuna S.T., Remmers J.E., Suratt P.M. (Eds.), Sleep and Respiration in Aging Adults. Elsevier, New York, 1991, pp. 237–244.Google Scholar
  27. 27.
    Fischer L., Visintainer P.F., Schulz R.: Reliable assessment of cognitive impairment in dementia patients by family caregivers. Gerontologist 29: 333–335, 1989.PubMedCrossRefGoogle Scholar
  28. 28.
    McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E.M.: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34: 939–944, 1984.PubMedCrossRefGoogle Scholar
  29. 29.
    Hansen L., Salmon D.P., Galasko D., Masliah E., Katzman R.: The Lewy body variant of Alzheimer’s disease: A clinical and pathological entity. Neurology 40: 1–8, 1990.PubMedCrossRefGoogle Scholar
  30. 30.
    Folstein M.F., Folstein S.E., McHugh P.R.: Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.Google Scholar
  31. 31.
    Blessed G., Tomlinson E., Roth M.: The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br. J. Psychiatry 114: 797–811, 1968.PubMedCrossRefGoogle Scholar
  32. 32.
    Mattis S.: Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L., Katasu T.B. (Eds.), Geriatric Psychiatry: A Handbook For Psychiatrists and Primary Care Physicians. Grune & Stratton, New York, 1976, pp. 77–121.Google Scholar
  33. 33.
    Pfeiffer R.I., Kurosaki T.T., Harrah C.H. Jr., Chance J.M., Filos S.: Measurement of functional activities in older adults in the community. J. Gerontol. 37: 323–329, 1982.CrossRefGoogle Scholar
  34. 34.
    Ancoli-Israel S., Kripke D.F., Klauber M.R., Mason W.J., Fell R., Kaplan O.: Sleep disordered breathing in community-dwelling elderly. Sleep 14: 486–495, 1991.PubMedGoogle Scholar
  35. 35.
    Mantel N.: Chi-Square tests with one degree of freedom; extensions of the Mantel-Haenszel procedure. J. Am. Stat. Assoc. 58: 690–700, 1963.Google Scholar
  36. 36.
    Tune G.S.: Sleep and wakefulness in normal human adults. Br. Med. J. 2: 269–271, 1968.PubMedCrossRefGoogle Scholar
  37. 37.
    Carskadon M.A., Brown E.D., Dement W.C.: Sleep fragmentation in the elderly: relationship to daytime sleep tendency. Neurobiol. Aging 3: 321–327, 1982.PubMedCrossRefGoogle Scholar
  38. 38.
    Winget C.M., Vernikos-Danellis J., Cronin S.E., Leach C.S., Rambaut P.C., Mack P.B.: Orcadian rhythm asynchrony in man during hypokinesis. J. Appl. Physiol. 33: 640–643, 1972.PubMedGoogle Scholar
  39. 39.
    Ancoli-Israel S., Kripke D.F.: Prevalent sleep problems in the aged. Biofeedback Self-Regul. 16: 349–359, 1991.PubMedCrossRefGoogle Scholar
  40. 40.
    Evans L.K.: Sundown syndrome in institutionalized elderly. J. Am. Geriatr. Soc. 35: 101–108, 1987.PubMedGoogle Scholar
  41. 41.
    Cohen-Mansfield J.: Agitated behaviors in the elderly. II. Preliminary results in the cognitively deteriorated. J. Am. Geriatr. Soc. 34: 722–727, 1986.Google Scholar
  42. 42.
    Cohen-Mansfield J., Watson V., Meade W., Gordon M., Leatherman J., Emor C.: Does sundowning occur in residents of an Alzheimer’s unit? Int. J. Ger. Psych. 4: 293–298, 1989.CrossRefGoogle Scholar
  43. 43.
    Pollak C.P., Perlick D., Linsner J.P., Wenston J., Hsieh F.: Sleep problems in the community elderly as predictors of death and nursing home placement. J. Commun. Health 15: 123–135, 1990.CrossRefGoogle Scholar
  44. 44.
    Sanford J.R.A.: Tolerance of debility in elderly dependents by supporters at home: its significance for hospital practice. Br. Med. J. 3: 471–473, 1975.PubMedCrossRefGoogle Scholar
  45. 45.
    Rebok G.W., Rovner B.W., Folstein M.F.: Sleep disturbance and Alzheimer’s disease: Relationship to behavioral problems. Aging Clin. Exp. Res. 3: 193–196, 1991.Google Scholar

Copyright information

© Springer Internal Publishing Switzerland 1994

Authors and Affiliations

  • Sonia Ancoli-Israel
    • 1
    • 2
  • M. R. Klauber
    • 2
    • 3
    • 4
  • J. C. Gillin
    • 1
  • S. S. Campbell
    • 5
  • C. R. Hofstetter
    • 4
    • 6
  1. 1.Department of PsychiatryUniversity of California San Diego and Veterans Affairs Medical CenterSan DiegoUSA
  2. 2.Sam and Rose Stein Institute for Research on AgingUSA
  3. 3.Department of Family and Preventive MedicineUniversity of California San DiegoUSA
  4. 4.Alzheimer’s Disease Research CenterUniversity of California San DiegoUSA
  5. 5.Department of PsychiatryCornell University Medical CollegeUSA
  6. 6.Department of Political ScienceSan Diego State UniversitySan DiegoUSA

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