Sundowning: severe dementia and bringing on the night

Tony Aguado aguado at bigfoot.com
Fri Mar 28 20:24:18 EST 2003


The cause is probably multifactorial, and would involve circadian
rhythms, changes in stimuli (as Larry pointed out -visual, sensory,
auditory), including changes in nursing shift. Another possiblity may
be the kinetics of  earlier medication. Aletring medication schedules
often minimse :sundowning" though the cause ihas not been isolated in
a scientifec sense. Generally in delirium, protective behaviours often
predominate, with aggression not uncommon, perhaps in compromised
brains, an ancient response to the coming of evening was to percieve
danger if one was not in a home environment.
Tony Aguado


 On, Fri, 28 Mar 2003 20:40:16 GMT, "KP-PC"
<k.p.collins at worldnet.att.net%remove%> wrote:

>If what you say were 'all there is', then the only 'therapy'
>necessary would be to assure that  patients' nutritional intakes were
>rigorously-balanced - vitamin pills would 'cure' all 'dementia'.
>
>Of course there can be inbred metabolic deficits, and at least some
>of these could be 'show-stoppers' [until retroactive gene therapy
>might address such].
>
>But the biggest 'problem' remains the absence of understanding with
>respect to the way nervous systems actually work, on the parts of the
>'helpers'.
>
>As a result of the 'ignorance' they carry into the 'therapeutic'
>setting, the 'helpers' fail with respect to, "First, do no harm."
>
>They 'intervene' in ways that only impose more dis-order within
>nervous systems whose main 'problem' is that they have descended into
>the dis-order that is what relatively-high TD E/I is.
>
>What's necessary is to develop treatement strategies that focus upon
>re-establishing internal order - that, in effect, temporarily
>externalize TD E/I-miniization.
>
>It's why I'm not actually 'sorry' that during the course of my
>working to bring NDT's stuff forward, 'ignorant' folks reacted to my
>efforts by throwing me into a 'psychiatric' institution, and twice
>imprisoning me. As a result, I was able to study the dynamics that
>occur within such places first hand.
>
>In all three instances, all there was was 'ignorance' posing as
>'authority', doing more harm than good.
>
>If anyone wants to actually address the 'problem', =this= is where
>they must actually begin.
>
>It's 'humanity' as a whole that's certifiably 'insane', but which,
>through 'blindly'-automated TD E/I-minimization that derives in
>noting more than repetition of merely-'familiar' consensual 'rules',
>declares itself to be 'sane', and woe to anyone who tells it plain,
>that the "emperor has no clothes".
>
>And it's 'hilarious' - NDT has been out-there for decades already,
>and all folks've done with respect to it, in ways that're inversely
>correlated to individuals' adherence to 'coersed-consensus' stuff, in
>'move away from'.
>
>It's all 'inside-out, upside-down, and backward' with respect to
>Truth, but who cares? "We've got all of our so-and-so's saying
>such-and-such, and we're safe in our understanding, as long as we
>look to such."
>
>And 'the beast', "Abstract Ignorance" [ the absence of understanding
>of how nervous systems process information via 'blindly'-automated TD
>E/I-minimization within nervous systems that, nevertheless, do
>process information via 'blindly-automated TD E/I-minimization] is
>'rolling on the floor laughing.
>
>It's got so many 'helpers' - so many folks who work with-it to
>sustain the dis-order that is Ignorance, why shouldn't it 'laugh'?
>
>I 'cry', though. I 'cry'. There exists no greater Tragedy - that
>Humans Love ['move toward'] Ignorance, and Hate ['move away from']
>Understanding - even imposing such upon the Children, in ways that,
>literally, constitute sacrificing them to 'the beast'.
>
>I 'cry'.
>
>"Still it moves."
>
>K. P. Collins
>
>"John H." <johnh at faraway.xxx> wrote in message
>news:mwWga.236$Sa5.8255 at nnrp1.ozemail.com.au...
>| 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
>| severely
>| > > 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
>| else
>| > > 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
>| therapy
>| > > proved beneficial for some dementia patients but this doesn't
>account
>| for
>| > > 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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