Department of Internal Medicine, Geriatric section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2010 Dec;25(12):1201-8. doi: 10.1002/gps.2454.
Circadian rhythm disturbances, like sundowning, are seen in dementia. Because the circadian rhythm is regulated by the biological clock, melatonin might be effective in the treatment of these disturbances. We systematically studied the effect of melatonin treatment in patients with dementia. In addition, we elaborate on the possible effects one might expect of melatonin treatment in patients with delirium, since dementia and delirium are strongly related. Moreover, some evidence exists that sundowning in patients with dementia and the alterations in the sleep/wake cycle, seen in patients with delirium both originate from circadian rhythm disturbances.
A systematic search of the literature, published between 1985 and April 2009, was performed using PubMed and other databases. All papers on melatonin treatment in dementia were retrieved. Effects of melatonin on circadian rhythm disturbances were scored by means of scoring sundowning/agitated behaviour, sleep quality and daytime functioning.
Nine papers, including four randomised controlled trials (RCTs) (n = 243), and five case series (n = 87) were reviewed. Two of the RCTs found a significant improvement on sundowning/agitated behaviour. All five case series found an improvement. The results on sleep quality and daytime functioning were inconclusive.
Sundowning/agitated behaviour improves with melatonin treatment in patients with dementia. There are several arguments that sundowning in patients with dementia and the alterations in the sleep/wake cycle in patients with delirium have a common background, namely a disturbance of the circadian rhythm. This suggests that melatonin treatment could also have the same positive effects in patients with delirium.
昼夜节律紊乱，如日落综合征，可见于痴呆症患者中。由于昼夜节律受生物钟的调节，褪黑素可能对这些紊乱的治疗有效。我们系统地研究了褪黑素治疗痴呆患者的效果。此外，我们详细阐述了褪黑素治疗谵妄患者可能产生的效果，因为痴呆症和谵妄密切相关。此外，有一些证据表明，痴呆症患者的日落综合征以及谵妄患者睡眠/觉醒周期的改变均源自昼夜节律紊乱。
使用 PubMed 和其他数据库，对 1985 年至 2009 年 4 月期间发表的文献进行了系统搜索。检索了所有关于褪黑素治疗痴呆症的论文。通过评分日落综合征/激越行为、睡眠质量和日间功能来评估褪黑素对昼夜节律紊乱的影响。
共回顾了 9 篇论文，包括 4 项随机对照试验（RCT）（n=243）和 5 项病例系列研究（n=87）。两项 RCT 发现日落综合征/激越行为有显著改善。所有 5 项病例系列研究均发现有所改善。关于睡眠质量和日间功能的结果尚无定论。
褪黑素治疗可改善痴呆症患者的日落综合征/激越行为。有几个论点表明，痴呆症患者的日落综合征以及谵妄患者的睡眠/觉醒周期改变具有共同的背景，即昼夜节律紊乱。这表明褪黑素治疗也可能对谵妄患者产生同样的积极效果。
