Is There a Characteristic Clinical Profile for Patients with Dementia and Sundown Syndrome?

BACKGROUND: Sundown syndrome (SS) is the onset or worsening of behavioral symptoms in the evening in patients with dementia. OBJECTIVE: To identify the differential clinical profile of patients with dementia who present SS. METHODS: A cross-sectional, case-control observational study was conducted by retrospectively reviewing the medical records of patients with dementia in a specialized Memory Unit. We compared the characteristics of patients with and without SS, including sociodemographic variables, etiology, and severity of the dementia, behavioral symptoms, sleep disorders (considering insomnia and hypersomnia), other diseases and treatments employed. We identified the factors related to SS and conducted a logistic regression analysis to establish a predictive nomogram. RESULTS: Of the 216 study patients with dementia, 41 (19%) had SS. There was a predominance of women (2.4:1), advanced age (p = 0.0001), dependence (p < 0.0001), institutionalization (p < 0.0001), caregiver burden (p < 0.0001), anxiety (p < 0.0001), delirium (p < 0.0001), hallucinations (p < 0.0001), wandering (p < 0.0001), Lewy body dementia (p = 0.05), higher Global Deterioration Scale score (GDS; p < 0.0001), and sleep disorders (p < 0.0001). The multivariate analysis revealed that age (p = 0.048), GDS score (p = 0.01), and the presence of insomnia or hypersomnia (p < 0.0001) independently defined the presence of SS. We established a predictive nomogram for developing SS in patients with dementia, with a predictive capacity of 80.1%. CONCLUSION: In our study, age, a higher score on the GDS, and the presence of insomnia or hypersomnia are differential clinical characteristics of patients with SS. We defined a nomogram that helps predicting the occurrence of SS in patients with dementia.

Consumption of Drugs and Nonpharmacological Therapies in Caregivers of Patients with Alzheimer's Disease: A Case-Control Study in Madrid.

BACKGROUND: Dementia is a neurodegenerative disease whose prevalence is rising, and the need for assistance to patients becomes indispensable. The different types of dementia and their treatments have been widely studied; however, the health status of caregivers also requires our attention. OBJECTIVE: The aim of our research was to evaluate whether caregivers of patients with dementia consume more medications than the general population, indicating underlying pathologies. METHODS: A total of 91 caregivers of dementia patients were interviewed and their answers were compared with those from a control group of 48 people, taking into account demographic data, characteristics of patients and caregivers, pharmacological and nonpharmacological treatments and burden. RESULTS: Caregivers showed a significantly higher consumption of anxiolytics, antidepressants and antiplatelets (22.3, 13.2 and 11%, respectively) than the control group (14.6, 0 and 0%, respectively). Moreover, 45.1% of the caregivers used nonpharmacological therapies compared with 6.2% of the control group. There was a tendency to take more medications in those caregivers suffering from burden and those who had to take care of patients with behavioral changes. CONCLUSION: Caregivers of dementia patients need more pharmacological and nonpharmacological therapies. They are a risk group that needs better care from the health system.

¿Qué saben sobre la demencia los cuidadores de nuestros pacientes? / Caregivers of our patients, what know about dementia?

Objetivo: determinar si el hecho de ser cuidador principal de un paciente con demencia supone un mayor conocimiento de esta patología. Material y métodos: estudio transversal, llevado a cabo mediante una encuesta autoadministrada de 14 preguntas relacionadas con aspectos generales de la demencia (conceptos, clínica, diagnóstico, tratamiento), realizada a un grupo de cuidadores y a otro de población general, externa al ámbito asistencial. Se analiza la proporción de aciertos y fallos, considerando los factores incluidos en el estudio (grupo, edad, sexo, nivel de estudios). Resultados: el porcentaje de aciertos del grupo de cuidadores (n = 40) y el de la población general (n = 40) fue similar (70 % frente a 72 %; NS). Se ha detectado una mayor proporción de aciertos en los encuestados jóvenes y con estudios superiores (86 % y 76 %; p < 0,01). En el grupo de cuidadores, los bloques con más aciertos fueron el de clínica y tratamiento (77 % y 70 %; p < 0,01), con una tendencia positiva al mayor conocimiento en aquellos que pertenecían a una asociación, sin alcanzar la significación estadística (74 % frente a 71 %; NS). Conclusiones: un mayor conocimiento sobre la demencia parece independiente de ser cuidador de estos pacientes y está más relacionado con el nivel de estudios y la edad. Sería importante facilitar más información relacionada con la enfermedad para evitar la sobrecarga del cuidador y conseguir una mejor atención del paciente (AU)

Objective: To determine whether caregivers of patients with dementia are more familiar with the disease than the general population. Method: Cross-sectional study carried out via a 14-question survey related to general aspects of dementia (concepts, clinical presentation, diagnosis, treatment), filled out by two groups: caregivers and general population, unrelated to the clinical field. The proportion of correct and wrong answers is analysed considering the variables included in the study (group, age, sex, education level). Results: A similar proportion of right answers was found in both groups, caregivers (n = 40) and general population (n = 40) (70% vs. 72%; NSS). However, a higher proportion of correct answers was detected amongst younger individuals and those with a higher education level (86% and 76%; p < 0.01). Regarding the caregivers’ group, questions related to clinical presentation and treatment were answered more successfully (77% and 70% were right; p < 0.01). A positive tendency to greater knowledge was found amongst caregivers who belonged to an association without, however, reaching statistical significance for the results (74% vs. 71%; NSS). Conclusions: Caregivers have a similar level of knowledge about dementia compared to the general population. However, a better understanding of the disease seems directly related to age and level of education. Didactic and supportive interventions could help alleviate the caregiver’s burden and would result in better care for the patient (AU)