Todd William D
Program in Neuroscience, Department of Zoology and Physiology, University of Wyoming, Laramie, WY, United States.
Front Neurosci. 2020 Sep 3;14:910. doi: 10.3389/fnins.2020.00910. eCollection 2020.
Patients with Alzheimer's disease (AD) and related dementias are commonly reported to exhibit aggressive behavior and other emotional behavioral disturbances, which create a tremendous caretaker burden. There has been an abundance of work highlighting the importance of circadian function on mood and emotional behavioral regulation, and recent evidence demonstrates that a specific hypothalamic pathway links the circadian system to neurons that modulate aggressive behavior, regulating the propensity for aggression across the day. Such shared circuitry may have important ramifications for clarifying the complex interactions underlying "sundowning syndrome," a poorly understood (and even controversial) clinical phenomenon in AD and dementia patients that is characterized by agitation, aggression, and delirium during the late afternoon and early evening hours. The goal of this review is to highlight the potential output and input pathways of the circadian system that may underlie circadian dysfunction and behavioral aggression associated with sundowning syndrome, and to discuss possible ways these pathways might inform specific interventions for treatment. Moreover, the apparent bidirectional relationship between chronic disruptions of circadian and sleep-wake regulation and the pathology and symptoms of AD suggest that understanding the role of these circuits in such neurobehavioral pathologies could lead to better diagnostic or even preventive measures.
据普遍报道，患有阿尔茨海默病（AD）及相关痴呆症的患者会表现出攻击性行为和其他情绪行为障碍，这给照料者带来了巨大负担。大量研究强调了昼夜节律功能对情绪和情绪行为调节的重要性，最近的证据表明，一条特定的下丘脑通路将昼夜节律系统与调节攻击性行为的神经元相连，从而调节全天的攻击倾向。这种共享的神经回路可能对阐明“日落综合征”背后的复杂相互作用具有重要意义，“日落综合征”是AD和痴呆症患者中一种理解不足（甚至存在争议）的临床现象，其特征是在傍晚和夜间早期出现躁动、攻击和谵妄。本综述的目的是强调昼夜节律系统可能是日落综合征相关的昼夜节律功能障碍和行为攻击的潜在输出和输入通路，并讨论这些通路可能为具体治疗干预提供信息的可能方式。此外，昼夜节律和睡眠 - 觉醒调节的慢性破坏与AD的病理和症状之间明显的双向关系表明，了解这些神经回路在这种神经行为病理学中的作用可能会带来更好的诊断甚至预防措施。
