Harper D G, Stopa E G, McKee A C, Satlin A, Harlan P C, Goldstein R, Volicer L
Admissions Building, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA.
Arch Gen Psychiatry. 2001 Apr;58(4):353-60. doi: 10.1001/archpsyc.58.4.353.
Caregiver exhaustion is a frequent consequence of sleep disturbance and rest-activity rhythm disruption that occurs in dementia. This exhaustion is the causal factor most frequently cited by caregivers in making the decision to institutionalize patients with dementia. Recent studies have implicated dysfunction of the circadian pacemaker in the etiology of these disturbances in dementia.
We studied the activity and core-body temperature rhythms in a cohort of 38 male patients with a clinical diagnosis of probable Alzheimer disease (AD) approximately 2 years before death. These patients were later given a confirmed diagnosis of AD (n = 23), frontotemporal degeneration (FTD) (n = 9), or diffuse Lewy body disease (DLB) with mixed AD or FTD pathologies (n = 6) after autopsy and neuropathological examination. Physiological rhythms of patients with AD and FTD were then compared with a group of normal, elderly men (n = 8) from the community.
Alzheimer patients showed increased nocturnal activity and a significant phase-delay in their rhythms of core-body temperature and activity compared with patients with FTD and controls. The activity rhythm of FTD patients was highly fragmented and phase-advanced in comparison with controls and apparently uncoupled from the rhythm of core-body temperature.
Patients with AD and patients with FTD show different disturbances in their rhythms of activity and temperature compared with each other and with normal elderly patients.
照顾者疲惫是痴呆症患者睡眠障碍和休息 - 活动节律紊乱的常见后果。这种疲惫是照顾者在决定将痴呆症患者送入养老院时最常提及的因果因素。最近的研究表明，昼夜节律起搏器功能障碍在痴呆症这些紊乱的病因中起作用。
我们研究了一组38名男性患者的活动和核心体温节律，这些患者在临床诊断为可能的阿尔茨海默病（AD）后约2年死亡。这些患者在尸检和神经病理学检查后，后来被确诊为AD（n = 23）、额颞叶变性（FTD）（n = 9）或伴有AD或FTD混合病理的弥漫性路易体病（DLB）（n = 6）。然后将AD和FTD患者的生理节律与一组来自社区的正常老年男性（n = 8）进行比较。
与FTD患者和对照组相比，阿尔茨海默病患者夜间活动增加，核心体温和活动节律出现明显的相位延迟。与对照组相比，FTD患者的活动节律高度碎片化且相位提前，并且明显与核心体温节律解耦。
与彼此以及正常老年患者相比，AD患者和FTD患者在活动和体温节律方面表现出不同的紊乱。
