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Sundowning: severe dementia and bringing on the night

John H. johnh at faraway.xxx
Fri Mar 28 06:46:13 EST 2003

Just now a friend of mine advised that in nursing homes vitamin D deficiency
is a real problem(think this was on the Aus sci program Catalyst just last
week). Vitamin D maintains tranforming growth factor beta which helps
modulates the immune system. In dementia patients interleukin 1 is usually
if not always elevated in the brain, tgf b can play an important role in
modulating the release of il 1. il1 plays a key component in the stress
response vis a vis my previous comments re nore. Some concordance with your
remarks re sensory input and subsequent perceptual disorientation.

Your comments re a totally dark room are interesting, supporting your idea
that low light and subsequent sensory loss may initiate a confusion state,
leading to anxiety ... . Interesting point. Thanks.

Light therapy probably relates to tgf b more than circadian jazz, still
can't see how it could help in relation to this particular issue.

My friend in the nursing home advised that yes in the night these patients
really do go on a bender. Strange thing.

John H.

"Larry Brash" <lbrash at ozemail.com.au> wrote in message
news:3E841E89.AF3E7298 at ozemail.com.au...
> "John H." wrote:
> >
> > Recently a friend of mine starting working in a dementia ward for
> > demented individuals. She was advised by other staff that to be careful
> > after sundown because many of the patients become violent and extremely
> > difficult to control. I'm mystified by this, just wondering if anyone
> > has noticed this in severe dementia and\or if they have any ideas re the
> > same. I did note a few months ago a report stating that bright light
> > proved beneficial for some dementia patients but this doesn't account
> > the above observations.
> This phenomenon occurs in delirium, e.g. post-op delirium, DTs etc.
> There is always a clear worsening in the evening. Delirious people seem
> almost lucid in the daytime and off the planet at night. 15-20% of
> general hospital patients are delirious at any point in time.
> It seem to be due to the reduced sensory (mainly visual) input that
> occurs at sunset. The degree of reduction in light between full day
> light and a well light room at night is actually massive (at least
> hundred fold difference). A dimly light room is the worse. A totally
> dark room is actually better.
> Of course, the intact brain copes with this easily, but the impaired
> brain (i.e. delirium) does not cope and starts to experience sensory
> distortions (illusions) and hallucinations (mainly visual). Disturbed
> behaviour may then result in response to this.
> Dementia patients, who are in care, are usually well advanced and
> experience delirium very easily. Urinary tract infection, constipation
> being some of the more common mundane triggers for this.
> Delirium literally means "out of (de) the furrow (lirium)" [Latin].
> Dementia means "out of one's mind" and originally referred more to
> psychosis than organic impairment.
> I don't know if Light Therapy would work but it is an interesting thought.
> --
> Larry Brash

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