Sundowning: severe dementia and bringing on the night

John H. johnh at faraway.xxx
Sat Mar 29 02:15:00 EST 2003


Can you be more specific re the altering of medication schedules. Timing,
type of medicaton?


Thanks,


John H.
"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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