Zusammenfassung
Etwa 40 % der Demenzpatienten entwickeln eine Schlafstörung. Klinisch beginnt die Symptomatik mit vermehrten Aufwachvorgängen, die zunehmend in eine Fragmentation des Nachtschlafes münden können. Der Zerfall der zirkadianen Rhythmik und die zunehmenden kognitiven Defizite im Rahmen der Demenz stehen in Beziehung zu funktionellen und neuroanatomischen Veränderungen, die die Therapie komplizieren. Benzodiazepine können teilweise hilfreich sein, aber auch paradoxe Reaktionen hervorrufen. Neuroleptika sind in vielen Fällen unverzichtbar, weisen aber ein erhöhtes Risiko für zerebrovaskuläre Ereignisse auf. In diesem Zusammenhang sind nicht pharmakologische Optionen wie der Einsatz von Lichttherapie und körperlicher Aktivität zur Stabilisation des Schlaf-/Wachrhythmus von Interesse. Auch Cholinesterasehemmer und Melatonin können zu einer Stabilisierung des Schlaf-/Wachrhythmus beitragen.
Zusammenfassung
Approximately 40 % of dementia patients develop a sleep disorder. Clinically the symptoms commence with wakening processes growing in frequency, which may finally result in a fragmentation of nocturnal sleep. The disintegration of the circadian rhythms and the increasing cognitive deficits within the scope of dementia are related to functional and neuroanatomical changes which complicate therapy. Benzodiazepine receptor agonists may be partly helpful, but may also provoke paradoxical reactions. Neuroleptics are indispensable in many cases, but exhibit a higher risk for cerebrovascular events. In this context non-pharmacological options such as the application of light therapy and physical activity are of particular interest in stabilizing the sleep-wake cycle. In addition to that, melatonin and cholinesterase inhibitors might also contribute to a stabilization of the sleep-wake cycle.
Keywords
sleep - sundowning - dementia - RBD - melatonine - light treatment
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Korrespondenzadresse:
Prof. Dr. med. Jürgen Staedt
Klinik für Psychiatrie und Psychotherapie - Memory Clinic
Vivantes Klinikum Spandau
Griesingerstr. 27-33
10623 Berlin
Email: juergen.staedt@vivantes.de
