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,

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

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

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.) 

---

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

Sundowner's Syndrome: A Caregiver Guide

By SundownerFacts (Paperback - Oct 29, 2012)

$12.99

Rated 4.5 out of 5 by 39 reviewers on Amazon.com

Buy Now

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.

Causes of sundowning

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]


The Ohio State University, 

In "SUNDOWNING SYNDROME," people with dementia show high levels of anxiety, agitation, overactivity and delirium. It typically occurs in late afternoon and evening, before their normal time to go to bed. Learn how brain biology explains “sundowning.” 

---

COLUMBUS, Ohio – Valuable research provides the best evidence to date that the late-day anxiety and agitation sometimes seen in older institutionalized adults, especially those with dementia, has a biological basis in the brain.

The findings could help explain “sundowning,” a syndrome in which older adults show high levels of anxiety, agitation, general activity and delirium in late afternoon and evening, before they would normally go to bed.

“It’s a big problem for caregivers.  Patients can get aggressive and very disruptive,” said Tracy Bedrosian, lead author of the study and a doctoral student in neuroscience at Ohio State University.

“There have been a few clinical studies documenting sundowning, but until now there hasn’t been research in animals to see what’s going on in the brain to explain this.”

Article continues below ad...

More Activity

The important study found that aged mice showed significantly more activity and more anxiety-like behaviors in the hours before they would normally sleep when compared to middle-aged mice – just like sundowning in humans.

In these aged mice, the researchers found changes in parts of their brain associated with attention, emotions, and arousal, all of which could be associated with the behavior seen in sundowning.

In addition, mice that were genetically engineered to have an Alzheimer’s-like disease also showed more anxiety before sleep than did other mice.

“Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn’t communicate their needs over the course of the day, or by other factors,” said Randy Nelson, co-author of the study and professor of neuroscience and psychology at Ohio State.

“But our findings suggest there is a real phenomenon going on here that has a biological basis.”

The study appears in the online Proceedings of the National Academy of Sciences.

In the first experiment, researchers compared middle-aged adult mice (7 months old) with aged mice (29 months old) that would resemble humans in their 80s.

Results showed that the aged mice were significantly more active than middle-aged mice in the two to three hours before they would normally go to sleep.

“The middle-aged mice had a distinct pattern of activity, with three peaks of activity during their waking hours,” Bedrosian said.

“But the aged mice had a flattened rhythm in which they showed the same level of activity throughout their active period.”

Evenings

That means that in the evening, when the middle aged mice would slow down compared to their peak activity levels, the aged mice kept going.

The mice were also tested for anxiety-like behaviors at two different times during their waking hours.  The mice were placed in a maze where they were allowed to explore open areas – which are more anxiety-producing – or hide in enclosed areas.

The middle-aged mice showed consistent levels of anxiety at both times of the day.  However, the aged mice showed more anxiety when tested soon before they would have gone to sleep, which is consistent with sundowning, Bedrosian said.

There were also differences in the brains of the aged mice when compared to the middle aged mice.  The researchers looked specifically at the cholinergic system, because loss of function in that system is associated with dementia and many of the circadian changes associated with ageing.

Findings in aged mice showed greater expression of a certain enzyme – acetylcholinesterase – before sleep than earlier in the day.  High levels of this enzyme are associated with anxiety and agitation.

However, in the middle-aged mice, there were no time-of-day differences in the expression of this enzyme.

Nelson noted that drugs used to control levels of acetylcholinesterase are sometimes used on dementia patients, although there has been no research evidence that it actually had an effect on sundowning.

These drugs include:

Brand Name	Generic Name
Aricept	donepezil
Exelon or Ebixa	rivastigmine
Reminyl or Razadyne	galantamine or galanthamine

“These drugs were prescribed for other purposes, but it also seemed to calm patients down.  Now we have some evidence on why it works,” Nelson said.

Anxiety, Agitation & Proteins

The researchers also found differences in expression of two other proteins in the brains of the aged mice that are also associated with behavioral disturbances.

“All of these results converge to suggest there are changes in the cholinergic systems of aged mice that may be contributing to the anxiety and agitation symptoms that we documented,” Bedrosian said.

In another experiment, the researchers used mice that were genetically engineered to develop Alzheimer’s-like disease in their brain.  They were compared, at nine months of age, to similar wild-type mice of the same age.

The Alzheimer’s-like mice showed more anxiety-type behaviors when tested before they would normally sleep than they did when tested earlier in their waking period.  That is consistent with sundowning in humans, the researchers said.

However, the wild-type mice showed no differences in anxiety levels based on the time of day they were tested.

Nelson said one of the theories about sundowning is that it is tied to disruptions that often occur in the biological clocks of older people, where their sleep-wake cycles are fragmented.

To test this theory, the researchers also treated the aged mice with melatonin for four weeks in order to help consolidate their circadian rhythms.  However, this treatment did not work to reduce anxiety issues in the mice.

Nelson said melatonin alone may not work because it doesn’t deal with the disruptions in the cholinergic system that was identified in this study.

“We need to study whether treating cholinergic dysfunction alone or in combination with melatonin treatment will help deal with sundowning symptoms,” he said.

---

SOURCE:
The Ohio State University

Is sundowning curable

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]

University of Cambridge

arly-evening restlessness and agitation, known as 'sundowning', is common in Alzheimer's. So is fragmented sleep. A major discovery indicates these symptoms are curable. 

---

People with Alzheimer's often have poor biological rhythms, something that is a burden for both patients and their carers. Periods of sleep become shorter and more fragmented, resulting in periods of wakefulness at night and snoozing during the day. They can also become restless and agitated in the late afternoon and early evening, something known as 'sundowning'.

The fly brain is half a millimeter across and contains approximately 100,000 nerve cells (green). The A-beta peptide forms plaques (red) that are linked to nerve cell death and behavioral abnormalities in the flies. Credit: Dr. Stanislav Ott, Department of Genetics, University of Cambridge

Now, scientists from Cambridge have discovered that in fruit flies with Alzheimer's the biological clock is still ticking but has become uncoupled from the sleep-wake cycle it usually regulates. The findings -- published in Disease Models & Mechanisms -- could help develop more effective ways to improve sleep patterns in people with the disease.

Biological clocks go hand in hand with life, and are found in everything from single celled organisms to fruit flies and humans. They are vital because they allow organisms to synchronise their biology to the day-night changes in their environments.

Until now, however, it has been unclear how Alzheimer's disrupts the biological clock. According to Dr Damian Crowther of Cambridge's Department of Genetics, one of the study's authors: "We wanted to know whether people with Alzheimer's disease have a poor behavioural rhythm because they have a clock that's stopped ticking or they have stopped responding to the clock."

The team worked with fruit flies -- a key species for studying Alzheimer's. Evidence suggests that the A-beta peptide, a protein, is behind at least the initial stages of the disease in humans. This has been replicated in fruit flies by introducing the human gene that produces this peptide.

Taking a group of healthy flies and a group with this feature of Alzheimer's, the researchers studied sleep-wake patterns in the flies, and how well their biological clocks were working.

They measured sleep-wake patterns by fitting a small infrared beam, similar to movement sensors in burglar alarms, to the glass tubes housing the flies. When the flies were awake and moving, they broke the beam and these breaks in the beam were counted and recorded.

To study the flies' biological clocks, the researchers attached the protein luciferase -- an enzyme that emits light -- to one of the proteins that forms part of the biological clock. Levels of the protein rise and fall during the night and day, and the glowing protein provided a way of tracing the flies' internal clock.

"This lets us see the brain glowing brighter at night and less during the day, and that's the biological clock shown as a glowing brain. It's beautiful to be able to study first hand in the same organism the molecular working of the clock and the corresponding behaviours," Dr Crowther said.

They found that healthy flies were active during the day and slept at night, whereas those with Alzheimer's sleep and wake randomly. Crucially, however, the diurnal patterns of the luciferase-tagged protein were the same in both healthy and diseased flies, showing that the biological clock still ticks in flies with Alzheimer's.

"Until now, the prevailing view was that Alzheimer's destroyed the biological clock," said Crowther.

"What we have shown in flies with Alzheimer's is that the clock is still ticking but is being ignored by other parts of the brain and body that govern behaviour. If we can understand this, it could help us develop new therapies to tackle sleep disturbances in people with Alzheimer's."

Dr Simon Ridley, Head of Research at Alzheimer's Research UK, who helped to fund the study, said: "Understanding the biology behind distressing symptoms like sleep problems is important to guide the development of new approaches to manage or treat them. This study sheds more light on the how features of Alzheimer's can affect the molecular mechanisms controlling sleep-wake cycles in flies.

"We hope these results can guide further studies in people to ensure that progress is made for the half a million people in the UK with the disease."

Source:

• University of Cambridge

Journal Reference:

1. K.-F. Chen, B. Possidente, D. A. Lomas, D. C. Crowther. The central molecular clock is robust in the face of behavioural arrhythmia in a Drosophila model of Alzheimer's disease. Disease Models & Mechanisms, 2014; DOI:10.1242/dmm.014134

Study Helps Explain "Sundowning" in Elderly Dementia Patients

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

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

Sleep Review

A new study finds that late-day anxiety and agitation sometimes seen in older institutionalized adults, especially those with dementia, has a biological basis in the brain. The findings could help explain "sundowning,” a syndrome in which older adults show high levels of anxiety, agitation, general activity, and delirium in late afternoon and evening before they would normally go to bed. The findings appear in the Proceedings of the National Academy of Sciences.

Using lab mice, the researchers found that, similar to sundowning in humans, the aged mice showed significantly more activity and more anxiety-like behaviors in the hours before they would normally sleep when compared to middle-aged mice. Mice that were genetically engineered to have an Alzheimer's-like disease also showed more anxiety before sleep than did other mice.

"Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn't communicate their needs over the course of the day, or by other factors," said Randy Nelson, co-author of the study and professor of neuroscience and psychology at Ohio State University. "But our findings suggest there is a real phenomenon going on here that has a biological basis."

Results showed that the aged mice were significantly more active than middle-aged mice in the 2 to 3 hours before they would normally go to sleep.

“The middle-aged mice had a distinct pattern of activity, with 3 peaks of activity during their waking hours,” said Tracy Bedrosian, lead author of the study and doctoral student in neuroscience at Ohio State University. “But the aged mice had a flattened rhythm in which they showed the same level of activity throughout their active period.”

The mice were also tested for anxiety-like behaviors at two different times during their waking hours. The mice were placed in a maze where they were allowed to explore open areas—which are more anxiety-producing—or hide in enclosed areas. The middle-aged mice showed consistent levels of anxiety at both times of the day. However, the aged mice showed more anxiety when tested soon before they would have gone to sleep, which is consistent with sundowning, according to Bedrosian.

Differences were also found in the brains of the aged mice when compared to the middle-aged mice. Looking specifically at the cholinergic system, because loss of function in that system is associated with dementia and many circadian changes associated with ageing, the researchers found the aged mice showed greater expression of the enzyme acetylcholinesterase before sleep than earlier in the day. High levels of this enzyme are associated with anxiety and agitation. The middle-aged mice, however, demonstrated no time-of-day differences in the expression of this enzyme.

The researchers noted that drugs used to control levels of acetylcholinesterase are sometimes used with dementia patients, although there has been no research evidence that it actually has an effect on sundowning.