Canevelli Marco, Valletta Martina, Trebbastoni Alessandro, Sarli Giuseppe, D'Antonio Fabrizia, Tariciotti Leonardo, de Lena Carlo, Bruno Giuseppe
Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy.
Front Med (Lausanne). 2016 Dec 27;3:73. doi: 10.3389/fmed.2016.00073. eCollection 2016.
Sundowning means the emergence or worsening of neuropsychiatric symptoms (NPS) in the late afternoon or early evening. This syndrome has been recognized since a long time in the field of dementing illnesses and is well known among most of health-care providers involved in the assistance of people with dementia. Indeed, it represents a common manifestation among persons with dementia and is associated with several adverse outcomes (such as institutionalization, faster cognitive worsening, and greater caregiver burden). Its occurrence and phenotypic characteristics may be influenced by diverse neurobiological, psychosocial, and environmental determinants. Moreover, it may pose diagnostic challenges in relation to other common causes of behavioral disruptions. Beside these considerations, this phenomenon has so far drawn limited clinical and scientific interest compared to other specific NPS occurring in dementias, as indicated by the lack of commonly agreed definitions, specific screening/assessment tools, and robust estimates on its prevalence. Accordingly, no randomized controlled trial specifically investigating the effectiveness of pharmacological and non-pharmacological strategies in managing this condition among demented patients has been yet conducted. In the present narrative review, we present and discuss available evidence concerning sundowning occurring in people with dementia. A special focus is given to its definitions, pathophysiological determinants, and clinical relevance, as well as to the clinical and therapeutic approaches required for its management in the daily practice.
日落综合征是指在傍晚或夜间出现或加重的神经精神症状（NPS）。在痴呆症领域，这种综合征早已被认识，并且在大多数参与痴呆症患者护理的医疗保健人员中广为人知。事实上，它是痴呆症患者的常见表现，与多种不良后果相关（如入住养老院、认知功能更快恶化以及护理人员负担加重）。其发生和表型特征可能受到多种神经生物学、心理社会和环境因素的影响。此外，与行为紊乱的其他常见原因相比，它可能带来诊断挑战。除了这些考虑因素外，与痴呆症中出现的其他特定神经精神症状相比，到目前为止，这种现象在临床和科学方面受到的关注有限，这体现在缺乏普遍认可的定义、特定的筛查/评估工具以及对其患病率的可靠估计。因此，尚未进行专门研究药物和非药物策略在痴呆患者中管理这种情况有效性的随机对照试验。在本叙述性综述中，我们展示并讨论了有关痴呆症患者日落综合征的现有证据。特别关注其定义、病理生理决定因素和临床相关性，以及日常实践中管理它所需的临床和治疗方法。
