Caregiver reports of sleep problems in non-Hispanic white, Hispanic, and African American patients with Alzheimer dementia

Department of Psychiatry and Public Health, Nova Southeastern University, Fort Lauderdale, FL, USA.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine (Impact Factor: 3.05). 06/2010; 6(3):281-9.
Source: PubMed


Sleep problems are common in persons with dementing illnesses and among the most stressful patient behaviors for caregivers. Although studies have shown differences in sleep across ethnic groups, little information is available on ethnic differences among persons with dementia. The purpose of this study was to investigate possible ethnic differences in sleep problems among patients with Alzheimer dementia.
Caregiver reports of 5 sleep- or circadian rhythm-related behavioral problems (behavior disturbance worse in the evening, difficulties falling asleep, frequent awakenings, early awakenings, and excessive daytime sleep) were evaluated in 395 patients who had received a diagnosis of Alzheimer disease after diagnostic evaluation. The average cognitive score of the groups suggested that they could be characterized as having moderately severe impairment. The frequency of sleep problems was then evaluated across subgroups defined by self-reported ethnicity (African American, Hispanic, and non-Hispanic white). As patient and caregiver characteristics may affect caregivers' reports of patients' behaviors, mixed effects regression models were used to adjust for patient and caregiver variables that might affect caregiver reports.
Analyses revealed ethnic differences in sleep or circadian rhythm disturbances. African American and Hispanic patients were reported to have more severe sleep disturbances than non-Hispanic whites. After correction for patient and caregiver variables that might have affected caregiver reports, differences between African Americans and others remained.
Sleep problems in patients with dementing illnesses are reported by caregivers with differing frequencies across groups of African Americans, Hispanics, and non-Hispanic whites. Clinicians should be aware of these differences in assessing sleep disturbance in patients with dementia as well as the potential effects of patient and caregiver variables on reports of these problems.

Download full-text


Available from: Raymond Ownby,
  • Source
    • "ise , 2004 ) , are not necessarily effective for all cases . Nevertheless , clinicians are at times pressured to prescribe such medications despite lack of evidence for efficacy and increased risks , especially since insom - nia in demented patients is frequently accompanied by disruptive behaviour , rising from bed and increased risk of falling ( Ownby et al . , 2010 ; Rowe et al . , 2009 ) , which endanger the patient or are intolerable for the support system ( Gallagher - Thompson et al . , 1992 ; Pollak et al . , 1990 ) . A variety of medications are being prescribed for sleep disturbances in demented individuals , including benzodiazepines ( Rikala et al . , 2011b ; Tsunoda et al . , 2010 ) , an"
    [Show abstract] [Hide abstract]
    ABSTRACT: Physicians treating demented individuals are confronted with complex clinical presentations. This complexity results from the multi-factorial nature of clinical phenomena, the aetiologies of these phenomena, which differ from similar symptoms in younger populations, limited physiological reserves and the multiple co-morbidities and medications. This intricacy is well exemplified within the clinical presentation and management of psychological and behavioural symptoms of dementia. The latter are associated with a poor quality of life, increased burden for both patient and caregivers. A further challenge and source for frustration is the fact that many of the medications used to treat cognitive and behavioural symptoms of dementia are only marginally effective or not effective at all, on the one hand, and associated with increased risk for morbidity and mortality on the other hand. In the present review, we discuss these factors in the context of polypharmacy and suggest further clinical and research strategies that may enable more accurate and less harmful therapeutic strategies.
    The International Journal of Neuropsychopharmacology 07/2013; 17(07):1-11. DOI:10.1017/S1461145713000412 · 4.01 Impact Factor
  • Source
    • "Interestingly, dysregulation of the clock also appears to contribute to disturbances of the sleep-wake cycles in individuals with Alzheimer's disease. These spontaneous night-time awakenings in patients with Alzheimer's disease are one of the most challenging issues for caregivers [42]. Likewise, individuals suffering from Huntington's disease exhibit clock-regulated disruption of neuroendocrine output, and of the sleep-wake cycles [43-45]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The biochemical activity of a stunning diversity of cell types and organ systems is shaped by a 24-hour (circadian) clock. This rhythmic drive to a good deal of the transcriptome (up to 15% of all coding genes) imparts circadian modulation over a wide range of physiological and behavioral processes (from cell division to cognition). Further, dysregulation of the clock has been implicated in the pathogenesis of a large and diverse array of disorders, such as hypertension, cancer and depression. Indeed, the possibility of utilizing therapeutic approaches that target clock physiology (that is, chronotherapy) has gained broad interest. However, a deeper understanding of the underlying molecular mechanisms that modulate the clock, and give rise to organ-specific clock transcriptomes, will be required to fully realize the power of chronotherapies. Recently, microRNAs have emerged as significant players in circadian clock timing, thus raising the possibility that clock-controlled microRNAs could contribute to disorders of the human circadian timing system. Here, we highlight recent work revealing a key role for microRNAs in clock physiology, and discuss potential approaches to unlocking their utility as effectors of circadian physiology and pathophysiology.
    Genome Medicine 02/2011; 3(2):10. DOI:10.1186/gm224 · 5.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Circadian rhythmicity was repeatedly determined in a patient with Alzheimer's disease by measuring his core temperature with a rectal thermistor and motor activity by an ambulatory activity monitor. The first recording, performed 9 years after he was diagnosed with Alzheimer's disease, showed well organized 24 hr circadian rhythm of core body temperature. The second recording, made four months later, showed very poor fit of core body temperature to 24 hour rhythm, but excellent fit with 36 hour rhythm. The third recording, made two months later, showed again good fit of core body temperature with 24 hour cycle. The last recording, which was performed 5 months later, showed almost complete disappearance of circadian rhythm of body temperature. These changes probably reflect gradual lengthening of the circadian cycle that at one point became extremely lengthened before returning to the 24 hr cycle.
    The Journal of Nutrition Health and Aging 12/2012; 16(10):888-90. DOI:10.1007/s12603-012-0085-1 · 3.00 Impact Factor
Show more