Dementia-How to stop sundowning

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

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The Dementia Caregiver's Little Book of Hope [Kindle Edition]

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SOURCE:
The Alzheimer's Disease Education and Referral (ADEAR) Center is a service of the National Institute on Aging, part of the National Institutes of Health. The Center offers information and publications for families, caregivers, and professionals about Alzheimer's disease and age-related cognitive changes.

AGITATION & ANXIETY IN ALZHEIMER'S: 

Get these tips for coping with "sundowning". (Sundowning is restlessness or agitation in the late afternoon or early evening in Alzheimer's.) 

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Late afternoon and early evening can be difficult for some people with Alzheimer's disease. They may experience sundowning (restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade) often just when tired caregivers need a break. 

Sundowning can continue into the night, making it hard for people with Alzheimer's to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day. 

Possible Causes

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The causes of sundowning are not well understood. One possibility is that Alzheimer's-related brain changes can affect a person's "biological clock," leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors. 

Other possible causes of sundowning include: 

• being overly tired
• unmet needs such as hunger or thirst
• depression
• pain
• boredom

Coping with Sundowning

Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person's behavior. 

If the person with Alzheimer's becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events. 

You can also try these tips: 

• Reduce noise, clutter, or the number of people in the room.
• Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).
• Make early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.
• Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.

Preventing Sundowning

Being too tired can increase late- afternoon and early-evening restlessness. Try to avoid this situation by helping the person: 

• go outside or at least sit by the window—exposure to bright light can help "reset the person's body clock"
• get physical activity or exercise each day
• get daytime rest if needed, but keep naps short and not too late in the day
• get enough rest at night

Avoid things that seem to make sundowning worse: 

• Do not serve coffee, cola, or other drinks with caffeine late in the day.
• Do not serve alcoholic drinks. They may add to confusion and anxiety.
• Do not plan too many activities during the day. A full schedule can be tiring.

If Problems Persist

If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect. 

If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.

SOURCE:
The Alzheimer's Disease Education and Referral (ADEAR) Center is a service of the National Institute on Aging, part of the National Institutes of Health. The Center offers information and publications for families, caregivers, and professionals about Alzheimer's disease and age-related cognitive changes.

Alzheimer;s agitation reduced by this

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter
The Dementia Caregiver's Little Book of Hope [Kindle Edition]

¹The JAMA Network Journals, Sep 22/29,2015
Aggression and agitation are hard challenges in dementia. An important study may offer some simple answers. 

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In a preliminary 10-week randomized trial, patients with probable Alzheimer disease who received the combination medication dextromethorphan-quinidine demonstrated less occurrences and severity of agitation, compared to patients who received placebo, according to a study in JAMA (The Journal of the American Medical Association)¹. 

Dr. Jeffrey Cummings, director of the Cleveland Clinic Lou Ruvo Center for Brain Health, said, "Agitation in Alzheimer's disease is one of the most disabling aspects of the disease. It interferes with the patient's life. It interferes with the ability of the caregiver to take care of the patient. It degrades the quality of life of both the patient and the caregiver." 

Agitation & Aggression

Agitation and aggression are highly prevalent in patients with dementia and are associated with distress for patients and caregivers, greater risk of institutionalization, and accelerated progression to severe dementia and death. Nonpharmacological interventions are recommended as first-line therapy, but many patients fail to respond. Although many classes of psychotropic drugs are prescribed for agitation, safety concerns and modest or unproven efficacy limit their use, according to background information in the article. 

Drug Combo

Dextromethorphan is commonly used in cough medicine. Quinidine is normally used to regulate an abnormal heart beat. Cummings said the combination pill had a substantial effect, greatly reducing agitation compared to the patients who got the placebo. Furthermore, he said, the caregivers also benefited. "There was a reduction in the stress experienced for caregivers of the patients who were treated with the dextromethorphan-quinidine combination. 

The combination of the drugs is also approved for the treatment of pseudobulbar affect (a neurologic disorder characterized by episodes of emotional displays such as crying), and there is evidence suggesting the potential benefit of these drugs for agitation. The researchers randomly assigned 220 patients to receive dextromethorphan-quinidine or placebo in stage 1. In stage 2, patients receiving dextromethorphan-quinidine continued; those receiving placebo were stratified by response and re-randomized to dextromethorphan-quinidine or placebo. The 10 week trial was conducted at 42 study sites. 

Trial Results

A total of 194 patients (88 percent) completed the study. Analysis combining stages 1 (all patients) and 2 (re-randomized placebo nonresponders) showed significantly reduced measures of agitation (occurrence and severity of symptoms). Patients treated with only dextromethorphan-quinidine had an average 51 percent reduction in the measure of agitation from baseline to week 10, compared with 26 percent for those treated with only placebo.

Adverse events included falls (8.6 percent for dextromethorphan-quinidine vs 3.9 percent for placebo), diarrhea (5.9 percent vs 3.1 percent, respectively), and urinary tract infection (5.3 percent vs 3.9 percent, respectively). Serious adverse events occurred in 7.9 percent with dextromethorphan-quinidine vs 4.7 percent with placebo. Dextromethorphan-quinidine was not associated with cognitive impairment or sedation.

Conclusions

"These preliminary findings require confirmation in additional clinical trials with longer treatment duration," the authors write.

Pending further evidence, there is a reasonably strong case to prioritize dextromethorphan-quinidine as an off-label treatment for agitation, possibly as a safer alternative to atypical antipsychotics, writes Anne Corbett, Ph.D., of King's College London, and colleagues in an accompanying editorial.

"However, while further studies are conducted to verify the efficacy and safety of this approach, it will be important to achieve a robust international expert consensus regarding the prioritization of potential treatments for agitation in patients with dementia to improve the consistency of clinical practice. This approach also must understand and incorporate patient and caregiver views regarding the evaluation of risk and benefits in relation to these treatments."

Source:

• ¹The JAMA Network Journals, Sep 22/29,2015

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References:

1. Clive Ballard, Samantha Sharp, Anne Corbett. Dextromethorphan and Quinidine for Treating Agitation in Patients With Alzheimer Disease Dementia. JAMA, 2015; 314 (12): 1233 DOI: 10.1001/jama.2015.10215
2. Jeffrey L. Cummings, Constantine G. Lyketsos, Elaine R. Peskind, Anton P. Porsteinsson, Jacobo E. Mintzer, Douglas W. Scharre, Jose E. De La Gandara, Marc Agronin, Charles S. Davis, Uyen Nguyen, Paul Shin, Pierre N. Tariot, João Siffert. Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia. JAMA, 2015; 314 (12): 1242 DOI: 10.1001/jama.2015.10214