Higher Frequency and Complexity of Sleep Disturbances in Dementia with Lewy Bodies as Compared to Alzheimer's Disease

Abstract

Background: Sleep disturbances (SDs) are common in patients with all forms of dementia. However, most studies focus on Alzheimer's disease (AD) and less is known about the prevalence and characteristics of SD in dementia with Lewy bodies (DLB). Objective: The aims of this cross-sectional study were: (1) to examine the frequency of SD in DLB versus AD; (2) to compare patients with and without SD with regard to relevant clinical variables, and (3) to investigate the associations between SD and medication use. Methods: Patients with a first-time diagnosis of probable or possible DLB or AD were selected from the Dementia Study of Western Norway and recruited from clinics for old age psychiatry from 2010 until the end of 2013. Results: In all, 123 (55.7%) subjects with dementia suffered from at least one SD. Insomnia was present in 77 (34.8%), and 34 (20.7%) patients had probable REM-sleep behaviour disorder (RBD). All SDs were also significantly more frequent in patients with DLB than in AD, and DLB patients also more often had several co-occurring SDs. The presence of any SD was associated with more neuropsychiatric symptoms, higher morbidity, more parkinsonian symptoms and excessive daytime sleepiness. Antiparkinsonian medication was used more often in RBD, restless leg syndrome (RLS) and periodic limb movements, and benzodiazepines were also common in RLS. Conclusions: Sleep problems are more common in DLB patients compared to AD, and are associated with more clinical impairment. DLB patients frequently have several sleep problems occurring simultaneously, which suggests a need for screening and accurate assessment of sleep in DLB.

REM Sleep Behavior Disorder Is Not Associated with a More Rapid Cognitive Decline in Mild Dementia

“…Our patients were referred to a memory clinic, not a sleep center, thus a selection bias leading to overrepresentation of pRBD is unlikely. The current study cohort was assessed regarding RBD inducing medication and no such association was found ( 42 ). Structural imaging (CT or MRI) was also performed in all participants, which made it possible to exclude subjects with major structural lesions that could secondarily lead to RBD.…”

Dementia prevention, intervention, and care

“…Sleep disturbances in older people with dementia are aetiologically heterogeneous and complex, occurring in 25-55% of those with neurodegenerative dementias (466)(467)(468). They may be caused by one or more of pain and physical health conditions; anxiety; lack of activity and neurodegenerative changes.…”

“…Rapid eye movement (REM) sleep behaviour disorder occurs commonly, in around 20% of DLB patients and in Parkinson's disease dementia (468). REM sleep disorder causes vivid, frequently frightening, dreams and loss of sleep paralysis during REM sleep, allowing motor activity or dream enactment, including aggression and fleeing, thus risking injury to the patient or bed-partner (479;480).…”

The prognosis of dementia with Lewy bodies

“…A small number of studies report higher levels of caregiver burden in DLB compared with AD, particularly due to the challenge of managing behavioural symptoms 74 (Table 1). Of note, psychiatric symptoms are also related to a variety of parasomnias which are particularly common in DLB, and thus likely also contribute to carer burden 54,77 . The literature includes a large cross-sectional survey of carers conducted by the Lewy Body Dementia Association, which highlighted the role of Activities of Daily Living as a potentially major factor in caregiver burden.…”