Vitiello M V, Borson S
Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington 98195-6560, USA.
CNS Drugs. 2001;15(10):777-96. doi: 10.2165/00023210-200115100-00004.
Older adults represent an ever-growing proportion of the population of the industrialised nations, with a corresponding increase in the numbers of patients with dementing disorders. A common complaint in both normal aging and the dementias is that of significant sleep disturbance. The major causes of sleep disruption in aging and dementia include: (i) physiological changes that arise as part of normal, 'nonpathological' aging; (ii) sleep problems due to one of many physical or mental health conditions and their treatments; (iii) primary sleep disorders; (iv) poor 'sleep hygiene', that is, sleep-related practices and habits; and (v) some combination of these factors. Disrupted sleep in patients with dementia is a significant cause of stress for caregivers and frequently leads to institutionalisation of patients. It should be a target of clinical management when the goal is sustained home care, and when it is associated with disturbances of mood or behaviour. While the neuropathology of dementia can directly disrupt sleep, sleep disturbances in patients with dementia often have multiple causes that require systematic evaluation. Thorough assessment of associated psychopathology, day-time behaviour, medical disorders, medications, pain and environmental conditions is needed for optimal management. Differential diagnosis of a sleep problem in dementia is the basis of rational pharmacotherapy. However, patients with dementia are likely to be more sensitive than elderly persons without dementia to adverse cognitive and motor effects of drugs prescribed for sleep. Clinicians need to: (i) evaluate sleep outcomes when treating medical, psychiatric and behavioural disorders in older adults; (ii) be alert to emerging behavioural and environmental approaches to treatment; (iii) combine nonpharmacological strategies with drug therapies, when required, for added value; and (iv) avoid use of multiple psychotropic medications unless they prove essential to the adequate management of sleep disturbances.
在工业化国家，老年人在人口中所占比例日益增长，患有痴呆症的患者数量也相应增加。正常衰老和痴呆症的一个常见症状是严重的睡眠障碍。衰老和痴呆症中睡眠中断的主要原因包括：(i) 作为正常“非病理性”衰老一部分而出现的生理变化；(ii) 由于多种身心健康状况及其治疗方法之一导致的睡眠问题；(iii) 原发性睡眠障碍；(iv) 不良的“睡眠卫生”，即与睡眠相关的行为和习惯；以及(v) 这些因素的某种组合。痴呆症患者的睡眠中断是护理人员压力的一个重要原因，并且经常导致患者被送入养老院。当目标是持续的家庭护理，以及当睡眠中断与情绪或行为障碍相关时，它应该成为临床管理的目标。虽然痴呆症的神经病理学可直接扰乱睡眠，但痴呆症患者的睡眠障碍往往有多种原因，需要进行系统评估。为了实现最佳管理，需要对相关的精神病理学、日间行为、医学疾病、药物、疼痛和环境状况进行全面评估。痴呆症睡眠问题的鉴别诊断是合理药物治疗的基础。然而，与没有痴呆症的老年人相比，痴呆症患者可能对用于治疗睡眠的药物的不良认知和运动影响更敏感。临床医生需要：(i) 在治疗老年人的医学、精神和行为障碍时评估睡眠结果；(ii) 留意新出现的行为和环境治疗方法；(iii) 在需要时将非药物策略与药物治疗相结合，以增加疗效；以及(iv) 避免使用多种精神药物，除非它们被证明对充分管理睡眠障碍至关重要。
