Affiliations: Department of Neurology, Alzheimer’s Disease and Other Cognitive Disorders Unit, La Princesa Health Research Institute, La Princesa University Hospital, Madrid, Spain
Correspondence:
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Correspondence to: Dra. Ana Beatriz Gago Veiga, Department of Neurology, Alzheimer’s Disease and Other Cognitive Disorders Unit, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Calle Diego de León 62, Madrid CP 28006, Spain. Tel.: +34 915202416; E-mail: [email protected].
Abstract: 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.
