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.

Brain correlates of cognitive inhibition in fibromyalgia: emotional intrusion of symptom-related words.

Evidence coming from neuropsychological studies has showed the presence of cognitive alterations in fibromyalgia. Such dysfunctions are especially remarkable when the set in motion of executive control processes, such as inhibition, is required to perform successfully; however, neural data related to these mechanisms are very scarce. Present study tried to characterize cognitive inhibition mechanisms, as part of the attentional control functions, in patients with fibromyalgia. Participants (two groups: fibromyalgia patients and healthy control participants) were asked to perform in an emotional Stroop task while event-related potentials (ERP) were recorded. Four different emotional interference conditions were created: fibromyalgia symptom-related words, arousing-negative, arousing-positive and neutral words. Brain activity and behavioral data were analyzed. Principal component analyses were employed to reliably define ERP components along with a source-estimation technique. Symptom-related words elicited greater frontal P450 amplitudes and enhanced activation within right inferior frontal gyrus as compared to the rest of stimuli. This effect was only true for the fibromyalgia group. Behavioral contrasts, however, did not produce significant differences. Scalp and source estimation findings suggest the presence of a specific difficulty in cognitive inhibition in fibromyalgia patients (under conditions intimately linked with the core concerns of their disease). Data point to the involvement of right inferior frontal cortices in this inefficient mechanism, which might cause an enhanced and dysfunctional effort of processing to achieve only a comparable performance to healthy people. Implications of these results are discussed. Nevertheless, further investigations are needed to better understand dysfunctional cognition in fibromyalgia.

Generalized hypervigilance in fibromyalgia patients: an experimental analysis with the emotional Stroop paradigm.

OBJECTIVE: In recent years, a good deal of serious research has been carried out on the hypothesized presence of generalized hypervigilance to sensory stimulation in fibromyalgia (FM). However, there are no studies which, following an operationalization of generalized hypervigilance as a propensity to attend to any task-irrelevant stimuli presented, make use of interference paradigms as the most appropriate experimental models for its analysis. The purpose of this study was to test the hypothesis of generalized hypervigilance in FM using the emotional modification of the Stroop task and to explore the possible mediating role of anxiety. METHODS: To this end, 25 women diagnosed with fibromyalgia and 25 matched controls were shown 32 stimulus words equally distributed in four categories: fibromyalgia symptoms, arousing-negative (A-), arousing-positive (A+), and neutral (N). These words had been selected on the basis of the results of an independent study. In addition to the emotional Stroop task, measures of trait and state anxiety were included. RESULTS: The results showed the possible presence of a generalized hypervigilance response in fibromyalgia patients based on significant slowness in the color-naming. This effect was mediated by the degree of perceived unpleasantness of the A-stimuli. However, the expected mediation effect of anxiety was not found. CONCLUSIONS: These results suggest the presence of a generalized hypervigilance response in FM patients that is not mediated by anxiety. Implications for the correct functioning of controlled self-regulatory processes in fibromyalgia and similar pathologies are discussed.