Recently, the use of activity monitoring has led to several interesting findings related to activity/rest issues in the care and management of Alzheimer patients. Evidence suggests that the “sleep” disturbances commonly reported in Alzheimer patients are actually a disturbance of the normal circadian cycle. This seems to be a normal progression of the disease and as such is not likely treatable with behavioral or pharmacological methods. These altered activity/rest patterns have direct implications for such areas as physical and pharmacological restraint use, supervision and injury risk, access and mobility issues, hospital ward design, and staffing policies.

Clinicians caring for Alzheimer patients have observed that some individuals show increased agitation, restlessness and confusion in the late afternoon, evening or at night. This has popularly been named 'sundowning' or 'the sundowning syndrome'. Despite its obvious clinical importance, little research has been conducted to investigate abnormal activity patterns in patients with Alzheimer's disease. In this study, rest-activity patterns were examined using an electronic monitor with a movement sensor. Eighteen patients diagnosed with Alzheimer's disease were monitored for 48 consecutive hours each. Analyses indicated that some subjects showed increased activity around the time of sunset, and that these individuals were most likely to be in the middle stages of the disease. Subjects in the early stages of the disease showed peak activity before sunset, while those in the late stage showed peak activity after sunset. This progressive phase shift with increasing years of illness is a previously unreported phenomenon which may offer an explanation for the 'sundowning syndrome'.

Clinicans caring for Alzheimer patients have observed that many have disruption in nocturnal sleep patterns. Despite their obvious clinical importance, little research has been conducted to investigate abnormal activity patterns in these patients. In this study, diurnal rest/activity patterns were examined using an electronic monitor with a movement sensor. Eighteen patients diagnosed with Alzheimer's disease were monitored for 48 consecutive hours each. Subject variables such as age, estiamted duration of illness and cognitive ratings were compared for degree of association with the movement data. Analyses indicated that an estimate of the duration of illness was superior to other variables in predicting the degree of change in activity rhythms. Specifically, the longer patients had suffered from Alzheimer's disease, the more disrupted their rest/activity patterns were. Patients who were in the late stages of Alzheimer's disease were less active and rested for longer than those in the earlier stages. In addition, circadian rhythmicity was reduced in the activity patterns of these patients. The present study confirms the findings of Hopkins and Rindlisbacher (1992) indicating that rest/activity patterns are dramatically altered as a result of Alzheimer's disease.

Activity cycles were studied in 12 subjects clinically diagnosed with Alzheimer's disease. Subjects wore a movement sensor attached to a solid-state ambulatory monitor for 96 consecutive hours each. Varying degrees of fragmentation of the normal diurnal activity pattern were observed. Subject variables such as age, estimated duration of illness, cognitive ratings, and months since first admission were compared for degree of association with the movement data. Simple regression analyses showed that an estimate of the duration of illness was superior to others in predicting the degree of fragmentation in activity rhythms. Pathology in the suprachiasmatic nucleus of the hypothalamus is discussed in the light of these findings.

Geriatric clinicians have observed that some demented individuals show increased agitation, restlessness and confusion in late afternoon, evening or night. This has popularly been named “sundowning,” or the “sundowning syndrome.” References to “sundowning' “in clinical writings disagree on virtually every aspect of the syndrome, and little research has been conducted to investigate this phenomenon. Despite this, light or light levels have been the most consistently noted cause.

Orientation assessments with regard to time, place and person tend to show a typical pattern of deterioration in progressive dementias. Some clinicians have established hierarchies of orientation based on these observed paterns. There are discrepancies in the order of these hierarchies, due perhaps to differences in the phrasing of questions asked of patients. It is possible to vary the difficulty of items by changing the question format and evidence is cited to show that format differences may be especially pertinent to demented populations. In two large samples of psychogeriatric subject frequencies of incorrect responses for individual orientation items were calculated along with probabilities of success based on chance responding. Results show that although the traditional contentbased hierarchy was observed, simple probabilities of success could also account for the observed frequencies of incorrect responding.

The increased agitation, and confusion in late afternoon, evening or night, shown by some victims of dementing disorders, has been called “sundowning,” or “the sundowning syndrome.” This paper reviews the available literature and examines the definition of this condition, the observed symptoms, reported time of occurrence, incidence, stability or regularity, relative importance, its relationship to other processes in dementia, etiology, treatment-as well as its diagnostic implications. Patterns in the literature are discussed. It is concluded that in spite of many references to it in clinical texts, sundowning remains a poorly understood phenomenon.

The expression of feelings about events occurring immediately before sleep was expected to increase the influence of remote memories on dream content and to decrease the influence of immediate presleep events on dream content. On each of two successive nights, twelve participants were asked to 1) view an emotionally involving film, 2) select the film segment that felt personally most important, and 3) rate the film segment using adjectives descriptive of affect. Participants in the feeling expression condition were then instructed to reflect on and characterize the feelings they experienced during the film, whereas participants in the no feeling expression condition were instructed to reflect on and analyze their impressions of the film's aesthetic quality. All participants were subsequently awakened from REM sleep and asked to 1) describe their sleep mentation and 2) rate the affect accompanying that mentation. As hypothesized, participants in the feeling expression condition were less likely than participants in the no feeling expression condition to have dreams with actions and scenes similar to those from the presleep films. They were also more likely than participants in the no feeling expression condition to have dreams with affect comparable to that experienced while viewing the presleep films.