Sundowning: severe dementia and bringing on the night

KP-PC k.p.collins at worldnet.att.net%remove%
Sat Mar 29 00:41:40 EST 2003


As gently as possible, I stand on what I've posted.

Cheers, Tony, ken

"Tony Aguado" <aguado at bigfoot.com> wrote in message
news:3e84f34a.7942031 at news.hunterlink.net.au...
| 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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