Sundown syndrome in patients with Alzheimer’s disease dementia

ABSTRACT The sundown syndrome is a complex neurobehavioral disorder in patients with dementia associated with high financial cost and significant caregiver burden. It is a multifactorial phenomenon with unclear pathophysiology, characterized by the presence of neuropsychiatric symptoms in the evening period. Objective: To analyze the main neuropsychiatric symptoms, their correlation with one another, with comorbidities, and with time of day of greatest symptom intensity in patients with Alzheimer’s disease dementia. Methods: This is a cross-sectional, observational and explanatory study in which caregivers/relatives of elderly patients with dementia were interviewed using a structured tool called the Neuropsychiatric Inventory (NPI). Results: The sample studied was composed of 38 patients, 60.5% female and 39.5% male, with mean age of 81±6 (67-94) years. A high frequency of neuropsychiatric symptoms in the evening period was observed, predominantly irritability (55.3%), nocturnal behavior (47.4%), and aggressiveness (42.1%). Only 36.8% of the family caregivers used non-pharmacological strategies. Conclusion: The frequency of neuropsychiatric symptoms was exacerbated in the evening among patients with Alzheimer’s disease, especially for those behavioral symptoms that had a positive correlation with one another.

摘要 日落综合征（sundown syndrome）是一类复杂的痴呆相关神经行为障碍，会带来高昂的经济成本与沉重的照护负担。该现象由多因素介导，病理生理机制尚未明确，以傍晚时段出现神经精神症状为主要特征。
研究目的：分析阿尔茨海默病（Alzheimer’s disease）痴呆患者的主要神经精神症状、症状间的相关性、与共病的相关性，以及症状最强烈的时段与一日时间的关联。
研究方法：本研究为横断面、观察性及解释性研究，采用结构化工具神经精神问卷（Neuropsychiatric Inventory, NPI）对痴呆老年患者的照护者/家属进行访谈。
研究结果：本研究纳入38例患者，其中女性占比60.5%，男性占比39.5%，平均年龄为81±6岁，年龄范围67~94岁。研究观察到傍晚时段神经精神症状高发，主要表现为易激惹（55.3%）、夜间行为异常（47.4%）与攻击性（42.1%）。仅36.8%的家庭照护者采用了非药物干预策略。
研究结论：阿尔茨海默病患者的神经精神症状在傍晚时段会出现加重，尤其是彼此间呈正相关的行为症状。