Alzheimers patients’ sunset wanderings

Press, 27 July 1987, Page 13

Alzheimers patients’ sunset wanderings

From Dr George Honbury for the Royal New Zealand College of General Practitioners ‘

Family Doctor

When I was a child, my 80-year-old great-grand-mother used to come and stay with us on the form. She was a wise old thing and we loved her dearly, but just occasionally at night she would dress up in her best clothes and would be found (by torchlight) wandering over the house paddock towards the cowshed; she would tell us that she was going to have tea with Mrs Moss.

Now Mrs Moss, my mother told us, had died 20 years before, but she and my great-grand-mother had been firm friends until that time. It puzzled me briefly, but a child soon accepts what an adult might find strange and alarming.

This is called "sundowning” in the United States. Alzheimers disease — senility so-called — is a progressive disorder that shows a steady deterioration in the ability to function mentally. Over years a person with the disease shows memory loss, personality change, sleeplessness, confusion, incontinence, agitation. The memory loss is at first for recent events, and the old person seems to live in the past

Sometimes emotional disorders may mimic senility, and sometimes multiple small strokes may be the cause, though here the onset is usually more sudden.

Depression alone may seem like Alzheimers, and

here the doctor may suggest trying a small dose of antidepressant medication. "Sundowning” is the name given to confusion and agitation seen in many of these people at night, one of the main reasons that families feel they can no longer cope, and therefore one of the main reasons for institutionalising the old person. The patient may want to stay up all night, or wander away from home and be unable to find the way back, exhausting and frustrating those that care for them — whose pleadings that the old person go to bed and sleep are ignored. These abnormal sleep patterns usually begin after the other signs of confusion about relationships.

New discoveries suggest that the cause of sundowning may be a relative lack of that period of sleep called R.E.M., or rapid eye movement sleep, in its turn caused by degeneration of the brain centres that control sleep patterns. There is, in addition, a known shortage of a brain chemical called acetychollne in the brains of Alzheimers patients. This chemical is involved in the transfer of messages between nerve cells in the brain and, it may control R.E.M. sleep. A recent report is encouraging: a drug rejoicing under the name of tetrahydroamlnoacridine (THA) Increases brain levels of acetylcholine. In one study, when moderate to severe Alzheimers patients were given the drug, threequarters showed improvement

At present no specific test, and no preventive measure, can be brought to bear on this disorder, so support for the carers may be all that can be offered.