Department of Human Neuroscience, "Sapienza" University, Rome, Italy.
Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
J Alzheimers Dis. 2023;94(2):601-610. doi: 10.3233/JAD-230094.
The term sundowning is used to describe the emergence or worsening of neuropsychiatric symptoms in late afternoon or early evening in people with dementia.
Our aim was to evaluate sundowning's prevalence and clinical manifestations among patients attending a tertiary memory clinic and to investigate its clinical and neuropsychological correlates.
Patients with dementia attending our memory clinic were enrolled in the study. Sundowning was identified through a specifically designed questionnaire. Sociodemographic and clinical features of sundowners and non-sundowners were compared, and a logistic regression was performed to identify the variables associated with the phenomenon. A subgroup of patients underwent a complete neuropsychological assessment.
Among 184 recruited patients, 39 (21.2%) exhibited sundowning, mostly expressed as agitation (56.4%), irritability (53.8%), and anxiety (46.2%). Sundowners were significantly older, had a later dementia onset, exhibited more severe cognitive and functional impairment, more frequent nocturnal awakenings, and hearing loss relative to non-sundowners. They were also more likely to use anticholinergic medications and antipsychotics, and less likely to use memantine. In a multi-adjusted model, the factors significantly associated with sundowning were the Clinical Dementia Rating score (OR 3.88; 95% CI 1.39-10.90) and the use of memantine (OR 0.20; 95% CI 0.05-0.74). Participants with and without sundowning obtained similar results in single domain neuropsychological tests.
Sundowning is commonly experienced by patients with dementia and appears as a multiply determined condition. Its presence should always be evaluated in clinical practice and a multidimensional approach should be adopted to identify its predictors.
“黄昏症候群”一词用于描述痴呆症患者在下午晚些时候或傍晚时分出现或恶化的神经精神症状。
我们旨在评估在三级记忆诊所就诊的患者中黄昏症候群的患病率和临床表现，并探讨其临床和神经心理学相关性。
我们招募了在记忆诊所就诊的痴呆症患者参与研究。通过专门设计的问卷确定黄昏症候群的存在。比较黄昏症候群患者和非黄昏症候群患者的社会人口学和临床特征，并进行逻辑回归以确定与该现象相关的变量。一组患者接受了全面的神经心理学评估。
在招募的 184 名患者中，有 39 名（21.2%）出现黄昏症候群，主要表现为激越（56.4%）、烦躁（53.8%）和焦虑（46.2%）。与非黄昏症候群患者相比，黄昏症候群患者年龄更大，痴呆症发病时间更晚，认知和功能障碍更严重，夜间觉醒更频繁，听力损失更常见。他们也更有可能使用抗胆碱能药物和抗精神病药物，而不太可能使用美金刚。在多调整模型中，与黄昏症候群显著相关的因素是临床痴呆评定量表评分（OR 3.88；95% CI 1.39-10.90）和使用美金刚（OR 0.20；95% CI 0.05-0.74）。有和没有黄昏症候群的参与者在单一领域神经心理学测试中获得了相似的结果。
黄昏症候群是痴呆症患者常见的症状，表现为多种因素决定的情况。在临床实践中应始终评估其存在，并应采用多维方法来确定其预测因素。
