Continuous measurement of the circadian rest-activity cycle for 598 days in a demented patient with probable Alzheimer's disease revealed slow progressive changes in temporal organization until death. Circadian and sleep analysis of the actigraphic data provided objective documentation of the gradual insertion of wakefulness into rest and rest into wake periods. Pacing, a nonphotic zeitgeber strengthening, led to improved synchronization of the rest-activity cycle. (J Geriatr Psychiatry Neurol 2002; 15:55-59).
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References
1.
Witting K, Kwa IH, Eikelenboom P, et al. Alterations in the circadian rest-activity rhythm in aging and Alzheimer's disease. Biol Psychiatry1990; 27:563-572.
2.
Van Someren EJW, Mirmiran M, Swaab DF.Non-pharmacological treatment of sleep and wake disturbances in aging and Alzheimer's disease: chronobiological perspectives. Behav Brain Res1993; 57:235-253.
3.
Myers BL, Badia P.Changes in circadian rhythms and sleep quality with aging: mechanisms and interventions. Neurosci Biobehav Rev1995; 19:553-571.
4.
Bliwise DL.Sleep and circadian rhythm disorder in aging and dementia. In: Turek FW, Zee PC, eds. Regulation of sleep and circadian rhythms. New York: Marcel Dekker, 1999:487-525.
5.
Satinoff E, Li H, Tcheng TK, et al. Do the suprachiasmatic nuclei oscillate in old rats as they do in young ones?Am J Physiol1993 ; 265:R1216-R1222.
6.
Weinert H, Weinert D.Circadian activity rhythms of laboratory mice during the last weeks of their life. Biol Rhythm Res1998; 29:159-178.
7.
Swaab DF, Fliers E, Partiman TS.The suprachiasmatic nucleus of the human brain in relation to sex, age and senile dementia. Brain Res1985; 342:37-44.
8.
Aharon-Peretz J, Masiah A, Pillar T, et al. Sleep-wake cycles in multi-infarct dementia and dementia of the Alzheimer type. Neurology1991; 41:1616-1619.
9.
Satlin A, Teicher MH, Liebermann HR, et al. Circadian loco-motor activity rhythms in Alzheimer's disease. Neuropsychopharmacology1991; 5:115-126.
10.
Mishima K, Okawa M, Satoh K, et al. Different manifestation of circadian rhythms in senile dementia of Alzheimer's type and multi-infarct dementia. Neurobiol Aging1997; 18:105-109.
11.
Pollak CP, Stokes PE.Circadian rest-activity rhythms in demented and nondemented older community residents and their caregivers. JAm Geriatr Soc1997; 45:446-452.
12.
Ancoli-Israel S, Clopton P, Klauber MR, et al. Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep1997; 20:24-27.
13.
Yesavage JA, Friedman L, Kraemer HC, et al. A follow-up study of actigraphic measures in home-residing Alzheimer's disease patients. J Geriatr Psychiatry Neurol1998 ; 11:7-10.
14.
Van Someren EJW, Swaab DF, Colenda CC, et al. Bright light therapy: improved sensitivity to its effects on rest-activity rhythms in Alzheimer patients by application of nonparametric methods. Chronobiol Int1999; 16:505-518.
15.
Colenda CC, Cohen W, McCall WV, Rosenquist PB.Phototherapy for patients with Alzheimer's disease with disturbed sleep patterns: results of a community-based pilot study. Alzheimer Dis Assoc Disord1997 ; 11:175-178.
16.
Cohen-Mansfield J, Werner P, Marx S, Freedman L.Two studies of pacing in the nursing home. J Gerontol Med Sci1991; 46:M77-M83.
17.
Klein DA, Steinberg M, Galik E, et al. Wandering behaviour in community-residing persons with dementia. Int J Geriatr Psychiatry1999; 14:272-279.
18.
Redlin U, Mrosovsky N.Exercise and human circadian rhythms: what we know and what we need to know. Chronobiol Int1997; 14:221-229.
19.
Van Someren EJW, Lijzenga C, Mirmiran M, Swaab DF.Long-term fitness training improves the circadian rest-activity rhythm in healthy elderly males. J Biol Rhythms1997; 12:146-156.
20.
Swaab DF.Brain aging and Alzheimer's disease, "wear and tear" versus "use it or lose it."Neurobiol Aging1991; 12:317-324.
21.
Van Someren EJW, Scherder JA, Swaab DF.Stimulation of the circadian timing system in healthy and demented elderly. In: Iqbal K, Swaab DF, Winblad B, Wisniewski HM , eds. Alzheimer's disease and related disorders. Chichester, UK: John Wiley & Sons , 1999:771-779.
22.
Mishima K, Okawa M, Hishikawa Y, et al. Morning bright light therapy for sleep and behavior disorders in elderly patients with dementia. Acta Psychiatr Scand1994; 89:1-7.
23.
Wirz-Justice A, Werth E, Savaskan E, et al. Halopendol disrupts, clozapine reinstates the circadian rest-activity cycle in a patient with early-onset Alzheimer's disease. Alzheimer Dis Assoc Disord2001; 14:212-215.