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Dtsch Med Wochenschr 2020; 145(09): 634-638
DOI: 10.1055/a-1124-2374
Standpunkt

Dilemmasituation: Nächtlicher Unruhezustand beim älteren Patienten

Differenzialdiagnose und TherapieNighttime restlessness in elderly patients: differential diagnosis and treatmentDifferential diagnosis and therapy
Dirk Schwerthöffer
,
Bastian Fatke
,
Hans Förstl
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Abstract

Elderly individuals, particularly those with cognitive impairment, are oftentimes restless during the night, and this increases the distress of relatives, professional carers and themselves. A number of conditions other than dementia need to be considered from nyctophobia and insomnophobia, to pain, specific motor disorders during sleep, parasomnias as REM-sleep behaviour disorder, dipping, hypoglycemia, withdrawal or excessive tea, coffee and alcohol consumption. A clear-cut differential diagnosis between dementia and delirium is not always possible, as dementia is the major risk factor for confusional states decreasing the vulnerability by anticholinergic medication and any other disruptive factor, biological or psychological. Treatment of nocturnal agitation usually requires (1) reassurance and re-orientation; (2a) the discontinuation of anticholinergic substances; (2b) symptomatic psychotropic intervention; and (3) causal treatment of underlying problems. Benzodiazepines should only be used at the lowest necessary dosage for the shortest possible time, particularly in individuals who are already benzodiazepine-dependent. Quetiapine or mirtazapine at low dosages can be employed in patients with psychotic or depressive symptoms. Melatonin and its derivatives hold promise for chronic circadian rhythm disorders. There is no “one fits all” recipe for this notorious problem and each case needs to be examined individually.

Ältere Menschen, vor allem mit demenziellen Erkrankungen, sind nachts häufig unruhig, können sich dadurch selbst gefährden oder ihr Umfeld beeinträchtigen. Psychopharmaka sind oft nicht oder paradox wirksam und haben erhebliche Neben- und Wechselwirkungen. Was ist hier zu tun? – Der Beitrag bildet den Auftakt einer Reihe von Situationen, für die es keine oder gegensätzliche Therapieempfehlungen gibt und so die Behandler vor ein Dilemma stellen.

Schlüsselwörter

Agitation - Demenz - Insomnie - Verwirrtheitszustand - zirkadiane Rhythmusstörung

Key words

agitation - circadian rhythm disorder - confusional state - dementia - insomnia


Publication History

Article published online:
29 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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