Dementia and Sleep Disturbance

Sleep Disturbance in Dementia

• Up to 25% of people with mild to moderate dementia and 50% of people with severe dementia experience sleep disturbances.
• Lauren, a person with dementia, exhibits agitated behavior during the day and wanders around the house at night, but does not show signs of hallucinations or Parkinsonism.

NCSD (Non-Cognitive Symptoms of Dementia)

• NCSDs affect people with dementia and include agitation, aggression, disinhibition, delusions, hallucinations, anxiety, apathy, wandering, and repetitive actions.
• Most NCSDs will resolve themselves within a 4-week period, so "watchful waiting" is recommended.
• Pharmacological approaches have limited effectiveness and can have harmful side-effects, so non-pharmacological interventions should be prioritized.

Interventions for NCSD

• Indirect interventions target caregivers and the environment, including caregiver training, multidisciplinary team approaches, individualized treatment plans, and modifying environmental factors.
• Direct interventions target individuals with dementia, such as art, music, physical exercise, meaningful activities, life story discussion groups, and Cognitive Stimulation Therapy (CST).
• CST is a talking therapy that improves quality of life and maximizes available cognition in people with mild to moderate dementia.

Bio-Psycho-Social-Physical Perspective

• An integrated approach considers biological, psychological, social, physical, and environmental factors for effective management of NCSD.

Person-Centered Care

• Focus on the whole person, not just the disease.
• Get to know the person with dementia, recognize and accept their reality, and support ongoing opportunities for meaningful engagement.
• Build and nurture authentic, caring relationships and create a supportive community.

Caregiver Support

• Family carers play a central role in caring for people with dementia and need support to develop their skills and address their own emotional and practical needs.
• Recommendations include dementia-specific training, carer support, and address the risk of depression among carers.

Communication

• Good communication skills are essential in supporting people with dementia.
• Techniques include creating a calm environment, speaking clearly, and respecting the person's perspective.

Environmental Design

• A well-designed environment can reduce NCSD, improve orientation, and reduce behavioral disturbance.
• Key principles include reducing crowding and noise, using clear signage, and providing easy-to-use toilets.

Pharmacological Intervention

• Prior to considering psychotropic medication, a comprehensive assessment must be performed.
• Antipsychotics may be indicated for agitation, psychosis, and aggression, but risks and benefits must be fully explained to the patient and/or caregivers.

Lauren, a dementia patient, experiences sleep disturbance, agitation, and wandering at night. What could be the cause of her worsening symptoms?