Studies in senile nocturnal delirium

Cameron, D. Ewen

doi:10.1007/bf01613953

Cited by 90 publications

(39 citation statements)

References 2 publications

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“…These results may have useful applications to the study of age-and dementia-related circadian behavioral disturbances, namely sundowning syndrome, as well as provide insights into therapeutic interventions. Sundowning syndrome has been described in the geriatric clinical literature for over 70 y as a diurnal pattern of behavioral disturbances that worsen in the late afternoon or early evening (18). No efficacious treatment for sundowning exists, largely because of the paucity of information regarding its neurobiological mechanisms and the lack of an animal model to study the disorder.…”

Section: Discussionmentioning

confidence: 99%

Altered temporal patterns of anxiety in aged and amyloid precursor protein (APP) transgenic mice

Bedrosian

Herring

Weil

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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Both normal aging and dementia are associated with dysregulation of the biological clock, which contributes to disrupted circadian organization of physiology and behavior. Diminished circadian organization in conjunction with the loss of cholinergic input to the cortex likely contributes to impaired cognition and behavior. One especially notable and relatively common circadian disturbance among the aged is "sundowning syndrome," which is characterized by exacerbated anxiety, agitation, locomotor activity, and delirium during the hours before bedtime. Sundowning has been reported in both dementia patients and cognitively intact elderly individuals living in institutions; however, little is known about temporal patterns in anxiety and agitation, and the neurobiological basis of these rhythms remains unspecified. In the present study, we explored the diurnal pattern of anxiety-like behavior in aged and amyloid precursor protein (APP) transgenic mice. We then attempted to treat the observed behavioral disturbances in the aged mice using chronic nightly melatonin treatment. Finally, we tested the hypothesis that time-of-day differences in acetylcholinesterase and choline acetyltransferase expression and general neuronal activation (i.e., c-Fos expression) coincide with the behavioral symptoms. Our results show a temporal pattern of anxiety-like behavior that emerges in elderly mice. This behavioral pattern coincides with elevated locomotor activity relative to adult mice near the end of the dark phase, and with time-dependent changes in basal forebrain acetylcholinesterase expression. Transgenic APP mice show a similar behavioral phenomenon that is not observed among agematched wild-type mice. These results may have useful applications to the study and treatment of age-and dementia-related circadian behavioral disturbances, namely, sundowning syndrome.Alzheimer's disease | cholinesterase | nucleus basalis of Meynert | behavioral and psychological signs and symptoms of dementia B oth normal aging and dementia are associated with disturbances in the biological clock that contribute to dramatic circadian disorganization, including the sleep-wake cycle, body temperature rhythm, and daily patterns of hormone release (1). Generally, aging is associated with reduced amplitudes among these daily rhythms; the most severe changes are associated with Alzheimer's disease (AD) (2). Circadian disorders affect more than 80% of individuals over age 65 (3) because of several converging factors; loss of neurons in the suprachiasmatic nucleus, decreased melatonin and melatonin receptor sensitivity, and minimal zeitgebers because of lifestyle all contribute to circadian dysfunction (1, 4).Normal aging and dementia are also associated with impairments in cognition and behavior, in part caused by loss of cholinergic input to the cortex (5). In particular, parts of the basal forebrain, most notably the nucleus basalis of Meynert (NBM), undergo degenerative changes, such as down-regulation of choline acetyltransferase (ChAT) activity (the r...

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Section: Discussionmentioning

confidence: 99%

Altered temporal patterns of anxiety in aged and amyloid precursor protein (APP) transgenic mice

Bedrosian

Herring

Weil

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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“…Symptoms subsided within 1 h after patients were returned to a lighted environment. Cameron [7] concluded that darkness is a causative factor in nocturnal delirium. Unfortunately, the paucity of details of the patients' baseline mental status, and their mental status during and after light deprivation precludes more than a speculative comparison with what we now recognize as delirium.…”

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confidence: 99%

“…Whereas sundowning is typically used to describe the phenomenon of agitation associated with light deprivation, it should not be considered synonymous with delirium as currently defined [6]. Perhaps the oldest article on sundowning, published in 1941, de- Johnson scribed 16 'senile' patients of undescribed age and gender in whom 'delirium' appeared after they were placed in a dark room for an hour during midday [7]. Symptoms subsided within 1 h after patients were returned to a lighted environment.…”

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confidence: 99%

Identifying and Recognizing Delirium

Johnson¹

1999

Dement Geriatr Cogn Disord

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Clinicians fequently under-recognize delirium. Physicians and nurses can be taught to recognize delirium by focusing on each of the components of the criteria for delirium. Teachers of physicians and nurses should emphasize the ability to recognize acuteness of onset, fluctuation of course, and attention deficits. Attention deficits in the clinical setting can be recognized by digit span testing, spelling words backwards, or assessing accessibility during the clinical interview. Attention can be scored by assigning a score from 0–10, or ranking as mild, moderate or severe, the patients ability to engage in the medical interview.

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“…Possibly related to this, it could precipitate senile nocturnal delirium to place an elderly demented patient in a darkened room during the daytime (Cameron, 1941). As shown in Fig.…”

Section: Discussionmentioning

confidence: 99%

Influence of Bright Light during Daytime on Sleep Parameters in Hospitalized Elderly Patients.

Wakamura

Tokura

2001

J. Physiol. Anthropol.

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Nurses frequently care for sleepless elderly patients on bed rest in a hospital environment. Our previous study with young adults showed that bright light exposure during the daytime affected the induction of nocturnal deep sleep. The purpose of this study is aimed at finding whether similar research could be observed with hospitalized elderly patients. Seven patients (mean age 67; range 57-77 yrs, males 3: females 4) served as participants and their informed written consent was obtained. A fluorescent lamp fixed in the bed frame near

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Studies in senile nocturnal delirium

Cited by 90 publications

References 2 publications

Altered temporal patterns of anxiety in aged and amyloid precursor protein (APP) transgenic mice

Altered temporal patterns of anxiety in aged and amyloid precursor protein (APP) transgenic mice

Identifying and Recognizing Delirium

Influence of Bright Light during Daytime on Sleep Parameters in Hospitalized Elderly Patients.

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