Sleep in dementia.

In 2005, The American Journal of Geriatric Psychiatry (AJGP) devoted a special issue to sleep in the geriatric population. In the first issue, Ancoli-Israel and Alessi pointed out in their editorial that although sleep disturbances are very common in older adults, there is a growing understanding of the causes, consequences and treatments for these sleep problems. These sleep problems are not typically the result of aging. Rather, the majority of sleep disturbances that occur in older adults are likely the result of medical and psychiatric illnesses, disruptions of circadian rhythms, primary sleep disorders and environmental, psychosocial and behavioral disruptions that occur with increasing frequency in the older segments of the population. This increasing understanding is the result of the recent tremendous growth in research aimed at increasing the knowledge of the basis for sleep disturbances in older adults and elucidating effective treatments for them. With so much research focusing on sleep problems in the older adult, a second issue of the AJGP is now being devoted to this topic. Nowhere are the relationships between disturbed sleep and the diseases that are comorbid with aging more clearly demonstrated than in older adults suffering from dementing disorders, such as Alzheimer disease. Significant sleep disturbances occur early in the dementing process and typically worsen as the dementia progresses. Indeed, sleep-wake rhythm disruptions have been shown to predict accelerated decline in functional abilities and increased likelihood of institutionalization. This second issue therefore continues with this theme, first with a general review article by Ancoli-Israel and Ayalon on the progression from normal sleep to disturbed sleep in the older adult, followed by a series of articles on sleep in patients with dementia. Ancoli-Israel and Ayalon’s clinical review, “Diagnosis and Treatment of Sleep Disorders in Older Adults,” provides a comprehensive review of what is state-of-the-art clinical practice in this important area of geriatric care. 6 The authors review what is known about how sleep changes with advancing age and go on to describe our current state of understanding of the many causes of insomnia as well as a number of specific sleep disorders: Restless Legs Syndrome, REM Behavior Disorder, and Sleep Disordered Breathing. For each of these they carefully illustrate the nature of the disorder and briefly describe the most appropriate treatment approaches. Ancoli-Israel and Ayalon end with a discussion of sleep disturbance in dementing disorders and its treatment. While their review is comprehensive of our current knowledge in the area, the authors are also clear that there is much to be learned about effectively treating sleep problems, particularly in older patients suffering from dementing disorders. The remaining four articles in this special issue flow directly from the last section of Ancoli-Israel and Ayalon’s clinical review, as they all examine sleep-related issues in either community dwelling or institutionalized dementia patients. As mentioned in all the articles, problems of sleep in patients with dementia are of particular import as they often predict or lead to institutionalization. The take home message from each article should be that it is crucial to recognize the problem and treat it because, as suggested in 2002 by Ancoli-Israel et al., this may